title: Screening of Egyptian toddlers for autism spectrum disorder using an Arabic validated version of M-CHAT; report of a community-based study (Stage I).
abstract: BACKGROUND
  Although there is a recommendation that toddlers be screened for Autism spectrum disorder (ASD) during their 18- and 24-month well-care child visits, diagnosis often occurs well after the child turns 4 years old. Such delayed diagnosis hinders the implementation of early intervention thus worsens the long-term prognosis of ASD.
  
  
  OBJECTIVE
  The current community-based study in its stage I aimed at early screening of Egyptian toddlers for ASD using an Arabic validated version of Modified Checklist for Autism in Toddlers (M-CHAT).
  
  
  METHODS
  A cross-sectional community-based descriptive study was carried out enrolling 5546 Egyptian toddlers. They were randomly recruited from those attending Primary Health Care Units in six Egyptian governorates with a fair representation of the urban, semi-urban, and rural Egyptian populations. An Arabic validated version of M-CHAT was used as a screening tool for ASD.
  
  
  RESULTS
  The current study revealed failure of M-CHAT (suspected to have ASD and needs further evaluation) in 1320 out of the enrolled 5546 Egyptian toddlers (23.8%).
  
  
  CONCLUSIONS
  M-CHAT as a screening tool for ASD has flagged a considerable percent of the enrolled toddlers that necessitates referral for further evaluation (stage II) to settle the diagnosis of ASD in the true positive cases. Perfecting the delicate balance between sensitivity and specificity for ASD screening tools is crucial in order not to miss early detection of ASD cases and at the same time, to avoid over-diagnosis with subsequent abuse of the limited healthcare resources in developing countries.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: F E
authors.initials: FE
authors.lastname: Mohamed
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt. Electronic address: emanzaky@med.asu.edu.eg.
authors.forename: E A
authors.initials: EA
authors.lastname: Zaky
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Youssef
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: Elhossiny
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: S
authors.initials: S
authors.lastname: Zahra
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: Khalaf
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: W
authors.initials: W
authors.lastname: Youssef
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Wafiq
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: Abd-Elhakim
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Obada
authors.affiliation: Community Medicine, Faculty of Medicine, Ain Shams University, Egypt.
authors.forename: W S
authors.initials: WS
authors.lastname: Eldin
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000453:epidemiology; D057189:Checklist / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Arabic validated version of M-CHAT; Autism spectrum disorder (ASD); Childhood Autism Rating Scale (CARS); M-CHAT