title: Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F).
abstract: OBJECTIVE
  This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT.
  
  
  METHODS
  Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated.
  
  
  RESULTS
  The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis.
  
  
  CONCLUSIONS
  The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.
authors.affiliation: Department of Psychology, Georgia State University, PO Box 5010, Atlanta, GA 30302-5010. drobins@gsu.edu.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Robins
authors.forename: Karís
authors.initials: K
authors.lastname: Casagrande
authors.forename: Marianne
authors.initials: M
authors.lastname: Barton
authors.forename: Chi-Ming A
authors.initials: CM
authors.lastname: Chen
authors.forename: Thyde
authors.initials: T
authors.lastname: Dumont-Mathieu
authors.forename: Deborah
authors.initials: D
authors.lastname: Fein
mesh_terms: D000465:Algorithms; D057189:Checklist; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis*; D002675:Child, Preschool; D003661:Decision Support Techniques; D002658:Developmental Disabilities / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011581:Psychological Tests; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: autism; screening; toddlers