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Background Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with a global prevalence of 7.6 in 1,000 children. The Modified Checklist for Autism in Toddlers - Revised (M-CHAT-R) is one of many screening tools for ASD. It is fast, easy to use, and has been translated and validated in the Indonesian language. Objective To determine the prevalence of ASD in Indonesia and its risk factors. Methods A cross-sectional study was conducted from March to October 2020. In the first protocol (March to July 2020), 219 children aged 16-30 months from 20 hospital walk-in clinics in five districts of Jakarta were included. Subjects’ parents filled out the M-CHAT-R questionnaire during their visit. A series of questions were asked to provide information about probable risk factors associated with ASD: gender, family history of ASD, preterm birth, low birth weight (LBW), and history of seizures. The second protocol (August to October 2020) was completed by parents via an online form, where 746 children aged 16-30 months were enrolled. Therefore, a total of 965 subjects were eligible for statistical analysis. Results Of 965 subjects, 56.58% were males. Subjects’ mean of age was 22.59 (SD 4.15) months. M-CHAT-R screening showed that 34 (3.52%) subjects were at high risk of developing ASD. Only male gender was significantly associated with ASD. Conclusion We screened for ASD in healthy 16-30-month-old Indonesian children. The rate of high-risk M-CHAT-R score was 3.52%. Male gender was a significant risk factor for high-risk M-CHAT-R results.

Background. In young children, the most common liver disease leading to transplantation is biliary atresia. Liver transplantation has fundamentally improved the survival rate of children with biliary atresia. Studies on developmental outcomes in children are mostly limited to small samples; there are no such studies in the Russian Federation.Objective: to determine the cognitive outcomes in children undergoing one-stage or two-stage surgical treatment of biliary atresia.Materials and Methods. 83 children were divided into groups: 36 children underwent transplantation without previous surgical interventions (group 1), 47 children underwent the Kasai palliative portoenterostomy (group 2). Inclusion criteria: 24 months of age or younger at the moment of transplantation, no medical history of neurological pathology. All children were examined before transplantation and at 1, 3, 6 and 12 months after liver transplantation. Psychomotor development was assessed using the Griffiths Psychomotor Development Scale for children under 24 months (translated by E.S. Keshishian), the Griffiths Intellectual Development Scale for children aged 2 to 8 years, and the Modified Checklist for Autism in Toddlers, Revised, for children 16-30 months old.Results. All children had developmental delays at the time of transplantation. Up to 50% of the children had signs of cachexia, with a shoulder circumference of less than 3 percentile. Only two children showed obvious hepatic encephalopathy in the form of depressed consciousness. After liver transplantation, 94% of group 1 children recovered their preoperative psychomotor development levels, and only 68% in group 2 made these gains. At 3 and 6 months after transplantation, about 80% of group 1 children showed normal psychomotor development, whereas in group 2, only 61% did. By 12 months after liver transplantation, the difference between the groups was more evident: 83.3% of group 1 children and only 53.2% of group 2 children were developing according to age. The difference between the groups was statistically significant (p < 0.05).Conclusion. Children who received one-stage treatment of biliary atresia and underwent liver transplantation have better neuropsychological development within a year after surgery than children with two-stage surgical treatment.

Preterm birth has been reported to be associated with an increased risk of social communication and language problems. Recently, we found that preterm infants showed atypical patterns of social attention compared with term infants. However, it is still unknown how social attention develops and whether the individual differences are associated with developmental outcomes for social communication and language in preterm infants. The social attention of preterm and term infants at 6, 12, and 18 months was investigated using two types of social attention tasks (human-geometric preference task and gaze-following task). The Modified Checklist for Autism in Toddlers (M-CHAT) and the MacArthur Communicative Development Inventory adapted for Japanese were measured at 18 months. We found that compared with term infants, preterm infants spent less time looking toward dynamic human images and followed another's gaze directions less frequently through 6, 12, and 18 months. Moreover, hierarchical multiple regression analysis revealed that less preference for dynamic human images and gaze-following abilities was associated with high M-CHAT and low language scores in preterm and term infants, respectively. These findings suggest that birth status affects development of social attention through 18 months and individual differences in social attention reflect differences in social communication and language outcomes.

Objective Families, pediatric providers, and service systems would benefit from expanded knowledge regarding (1) who is most likely to receive a recommended diagnostic evaluation after a positive primary care-administered autism screen and (2) of those who screen positive, who is most likely to be diagnosed with autism? Method Participants included 309 predominantly low-income, racial/ethnic minority parents and their child, aged 15 to 27 months, who screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Generalized estimating equations were used to fit models of predictors for each binary outcome: receiving a diagnostic evaluation and receiving an autism diagnosis on evaluation. Results Significant predictors of diagnostic evaluation receipt included the parent being older or non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis on evaluation included male child, lower child communication functioning, screening directly in the parent's preferred language, White/non-Hispanic parent, and no parent history of mood disorder. Conclusion Children with younger parents, Hispanic ethnicity, relatively higher communication skills, public insurance, and no Early Intervention services were less likely to receive recommended diagnostic care. Reduced likelihood of autism diagnosis after a positive screen in non-White/non-Hispanic subgroups supports previous research indicating issues with M-CHAT-R/F positive predictive power for racial/ethnic minorities. The use of telephonic interpreters to administer screens, as opposed to directly screening in families' preferred languages, may lead to identification of fewer true autism cases. Thus, multilingual clinical staff capacity may improve positive predictive power of autism screening.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder (NDD). Toe walking has been reported in children with NDDs. However, the relationship between ASD and toe walking is still unclear. The aim of the paper is to describe toe walking in four children with ASD and comorbid attention deficit hyperactivity disorder (ADHD). Their age ranged between 28 months and 42 months and three of the cases had moderate to severe toe walking on both feet. All the cases scored in the high-risk category (8–20) of the Modified Checklist for Autism in Toddlers and above the cut-off scores (24 for girls and 32 for boys) of the ADHD RS-IV-P. In addition, they all met DSM-V diagnostic criteria for ASD and ADHD. Clinicians diagnosing ASD may be omitting an important element of the disorder in the form of toe walking, which could contribute to delayed or inaccurate diagnoses. Consideration of including motor function deficits such as toe walking in the diagnostic criteria for ASD might improve early detection and intervention.

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated. Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia. Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value. Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions. Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.

Objective Most autism spectrum disorder (ASD) screening measures have been developed for use with low-risk (LR) children; however, measures may perform differently in high-risk (HR) younger sibling populations. The current study sought to investigate the performance of an ASD screening measure, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), in a sample of HR younger siblings and directly compared its performance with that in an LR sample. Methods High-risk younger siblings (n = 187) and LR children (n = 15,848) were screened using the M-CHAT-R/F. Screen-positive children completed comprehensive evaluations. The M-CHAT-R/F psychometric properties and clinical characteristics were compared across the samples. Results The M-CHAT-R/F demonstrated a significantly higher screen-positive rate and ASD detection rate in the HR sample compared with the LR sample. Children with ASD in the HR sample had stronger verbal, nonverbal, and overall cognitive abilities compared with children with ASD in the LR sample despite comparable ASD severity and adaptive functioning. High positive predictive value of the M-CHAT-R at initial screen, with only incremental change after Follow-Up, suggests that Follow-Up is less critical in HR than LR samples. A significantly lower number of changed responses during Follow-Up further supports improved reporting accuracy of parents with ASD experience compared with parents less familiar with ASD. Conclusion The findings suggest that the M-CHAT-R/F can distinguish between ASD and non-ASD at 18 to 24 months in an HR sibling sample, with performance comparable with or better than its performance in the general population.

The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30 months old seen for 18 and 24 months’ well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care. Lay abstract This was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet’s automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them.

Studies have shown that Autism Spectrum Disorder (ASD) screening and diagnostic instruments may be affected by the presence of emotional and behavior problems (EBPs). This study assessed the impact of EBPs on the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). Participants included 290 children, 18–48 months of age, referred for ASD-related concerns. Those diagnosed with ASD had significantly lower externalizing EBPs compared to those who were not diagnosed with ASD. More externalizing symptoms and younger age were significantly predictive of an M-CHAT-R/F final score. Sensitivity and specificity was impacted by the age of the child. These results suggest that combining measures that assess EBPs and autism core symptoms may improve accuracy in this referred population.

STUDY QUESTION Are toddlers conceived by fertility treatment at higher risk of failing a screening tool for autism spectrum disorders (ASD) than toddlers not conceived by treatment? SUMMARY ANSWER Compared with children not conceived by infertility treatment, children conceived by any infertility treatment, ovulation induction with or without intrauterine insemination (OI/IUI), or assisted reproductive technologies (ART) appeared to have had higher odds of failing an ASD screening; however, results were inconclusive and need replication. WHAT IS KNOWN ALREADY Although most of the studies which have examined risk of ASD after ART show no association, the results are mixed. Thus, further studies are needed to clarify this association. STUDY DESIGN SIZE, DURATION The Upstate KIDS Study is a population-based, prospective cohort study of children born in New York State between 2008 and 2010. Children were screened for ASD using the Modified Checklist for Autism in Toddlers (M-CHAT) at ages 18 and 24 months. PARTICIPANTS/MATERIALS, SETTING, AND METHODS The New York State live-birth registry was used to identify newborns conceived with and without fertility treatment with a 1:3 ratio, frequency matched on region of birth. At 18 and 24 months, 3183 and 3063 mothers, respectively, completed the M-CHAT questionnaire. The current analysis included 2586 singletons and 1296 twins with M-CHAT information at 18 and/or 24 months. Multivariable logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (aOR) and 95% confidence intervals (CI) after adjustment for covariates such as maternal age, education and plurality. MAIN RESULTS AND THE ROLE OF CHANCE We found that 200 (5.2%) and 115 (3.0%) children failed the M-CHAT at 18 and 24 months, respectively. The associations between use of infertility treatment and failing the M-CHAT at 18 and/or 24 months were positive but inconclusive as they failed to exclude no association (18 months aOR 1.71, 95% CI: 0.81–3.61; 24 months aOR 1.78, 95% CI: 0.66–4.81; and both 18 and 24 months aOR 1.53, 95% CI: 0.78–2.99). The relationships between OI/IUI and ART with M-CHAT failure at 18 and/or 24 months were similar to those of using any fertility treatment. In vitro fertilization with intracytoplasmic sperm injection was not consistently positively or inversely associated with M-CHAT failure at each time point (18 months aOR 1.20, 95% CI: 0.51–2.83; 24 months aOR 0.93, 95% CI: 0.37–2.31; and both 18 and 24 months aOR 1.09, 95% CI: 0.50–2.60). LIMITATIONS REASONS FOR CAUTION The M-CHAT is a screening tool used for ASD risk assessment, and therefore, M-CHAT failure does not indicate ASD diagnosis. In addition, we did not have power to detect associations of small magnitude. Finally, non-response to follow-up may bias the results. WIDER IMPLICATIONS OF THE FINDINGS Despite lack of precision, the positive associations between ART and M-CHAT failure suggest that larger population-based studies with longer follow-up are needed. STUDY FUNDING/COMPETING INTEREST(S) Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts HHSN275201200005C, HHSN267200700019C). The sponsor played no role in the study design, data collection, data analysis or interpretation, writing of the manuscript or decision to submit the article for publication. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.

The Modified Checklist for Autism in Toddlers (M-CHAT) is a screening questionnaire for Autism Spectrum Disorder (ASD). Previous findings have confirmed the M-CHAT's sensitivity and specificity across several cultures, yet few studies have considered M-CHAT scores as a distributed trait in a sample of typical infants. The current study examined how the M-CHAT predicts concurrent word learning (experiment 1) as well as socio-emotional understanding (experiment 2) in 18-month-old infants. Results demonstrated that the number of items endorsed on the M-CHAT negatively correlated with the proportion of trials on which infants looked at a toy named by the experimenter as well as performance on the word learning task. In experiment 2, high scores on the M-CHAT correlated with less instrumental helping, less imitation, and a smaller productive vocabulary size.

1. Melissa Long, MD* 2. Kelly Register-Brown, MD, MSc† 1. *Division of General and Community Pediatrics 2. †Division of Psychiatry and Behavioral Health Sciences, Children’s National Hospital, Washington, DC * Abbreviations: AAP: : American Academy of Pediatrics ABA: : applied behavior analysis ADHD: : attention-deficit/hyperactivity disorder ASD: : autism spectrum disorder CBD: : cannabidiol CDC: : Centers for Disease Control and Prevention COVID-19: : coronavirus disease 2019 DSM-5 : : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition EEG: : electroencephalogram FDA: : Food and Drug Administration ID: : intellectual disability MCHAT-R/F: : Modified Checklist for Autism in Toddlers, Revised, with Follow-up With autism spectrum disorder (ASD) prevalence rising and a shortage of specialists available for diagnosis and management, pediatricians will need to be increasingly comfortable 1) giving a provisional diagnosis of ASD to create access to critical early behavioral interventions, 2) managing the comorbidities that significantly affect quality of life, and 3) supporting families to navigate the increasingly complex web of ASD-related services. After completing this article, readers should be able to: 1. Appreciate the evolution in prevalence data over time and recognize the disparities that exist in diagnosis based on race and sex. 2. Recognize the heterogeneity of autism spectrum disorder (ASD) clinical presentation depending on the child’s age, sex, and developmental abilities. 3. Understand the diagnostic criteria for ASD. 4. Distinguish findings associated with ASD from those of isolated speech and language delay, intellectual disability, and profound hearing loss. 5. Determine age-appropriate screening for ASD and be prepared to discuss results and next steps with families. 6. Plan for appropriate management of core symptoms of ASD and identify the common medical and psychiatric comorbidities with ASD. 7. Recognize the complexity of care coordination required to support families of children with ASD and the importance of advocating for a pediatric medical home. Autism spectrum disorder (ASD) is a neurodevelopmental disability characterized by differences in social and communication functioning and by restricted and repetitive behaviors and interests. The increasing prevalence of ASD has been the subject of intense attention in the medical literature and lay press. In the United States, the Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring Network, which measures confirmed diagnoses of ASD, has found an increased prevalence of ASD among 8-year-old US children from 1 in 150 in 2000 to 2002 to 1 in 54 during 2016. (1) Reasons for the observed increase in ASD prevalence likely include increased screening …

Background: There is a shortage of validated autism screening tests in the 11 official languages of South Africa. The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F TM ), a validated and well-known screening test, had already been adapted (in English) and translated into Northern Sotho for use in South Africa. Objectives: The aim was to collect pilot data to determine the preliminary reliability and feasibility of the two tests to confirm the equivalence of the adaptation and translation. Method: The study was conducted in a peri-urban community in South Africa. Twenty-one first-language Northern Sotho caregivers of children aged between 18 and 48 months were recruited by employing snowball sampling. The participants were asked to complete the Northern Sotho and the culturally adapted English M-CHAT-R/F, which were presented in random order. Results: The preliminary content validity and equivalence were evident, with no difference at the 5% interval of the Wilcoxon signed rank test. All 21 toddlers screened presented with a low risk for autism following the recommended execution of the Follow-Up section for the toddlers in the medium risk category. All participants completed the two screening tests, with none indicating unfamiliar words or constructs. A higher preference for the English adapted version was found but a need for the Northern Sotho screening test was also evident Conclusion: The Northern Sotho translation of the M-CHAT-R/F, as well as the adapted English version, appears feasible and is ready for comprehensive validation.

Objective: The present study examined the sensitivity and specificity of M-CHAT-Malay version [M-CHAT(MV)] to discriminate ASD from other developmental-behavioural disorders. Methods: This study was carried out in the Child Development Centre at a tertiary referral centre. Parents of 130 children aged 18–60 months, referred for developmental-behavioural disorders were asked to complete M-CHAT(MV). A child was considered to have ASD if they failed any 3 of the 23 total items or 2 or more of the 6 critical items. Results: Looking at the total items, M-CHAT(MV) has a good sensitivity (88.9%) to differentiate between ASD and other developmental-behavioural disorders, although specificity was only 47.8%. However, the critical items only has sensitivity of 71.4% and specificity of 77.6%. Sensitivity for children aged 49–60 months old was lower (80.0%) compared to those in the younger age group (100.0% and 90.3% for those aged 25-36 months and 37–48 months respectively). Based on the ROC curve, the optimal criteria to detect ASD was failing 1 out of 6 critical items or 3 out of 23 total items. Conclusion: M-CHAT(MV) is a good screening tool in differentiating ASD from other developmental-behavioural disorders although the critical items’ criteria may need to be lowered to improve its sensitivity in selected cohorts.

Objective Autism spectrum disorder (ASD) screening can improve prognosis via early diagnosis and intervention, but lack of time and training can deter pediatric screening. The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) is a widely used screener but requires follow-up questions and error-prone human scoring and interpretation. We consider an automated machine learning (ML) method for overcoming barriers to ASD screening, specifically using the feedforward neural network (fNN). Methods The fNN technique was applied using archival M-CHAT-R data of 14,995 toddlers (age 16-30 months, 46.51% male). The 20 M-CHAT-R items were inputs, and ASD diagnosis after follow-up and diagnostic evaluation (i.e., ASD or not ASD) was the output. The sample was divided into subgroups by race (i.e., white and black), sex (i.e., boys and girls), and maternal education (i.e., below and above 15 years of education completed) to examine subgroup differences. Each subgroup was evaluated for best-performing fNN models. Results For the total sample, best results yielded 99.72% correct classification using 18 items. Best results yielded 99.92% correct classification using 14 items for white toddlers and 99.79% correct classification using 18 items for black toddlers. In boys, best results yielded 99.64% correct classification using 18 items, whereas best results yielded 99.95% correct classification using 18 items in girls. For the case when maternal education is 15 years or less (i.e., associate degree and below), best results were 99.75% correct classification when using 16 items. Results were essentially the same when maternal education was 16 years or more (i.e., above associate degree); that is, 99.70% correct classification was obtained using 16 items. Conclusion The ML method was comparable to the M-CHAT-R with follow-up items in accuracy of ASD diagnosis while using fewer items. Therefore, ML may be a beneficial tool in implementing automatic, efficient scoring that negates the need for labor-intensive follow-up and circumvents human error, providing an advantage over previous screening methods.

Background The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M−CHAT-R/F) is a two-stage screening scale for determining the risk of autism spectrum disorder (ASD) in toddlers. However, the validity of the M−CHAT-R/F for Asian populations has not yet been established. Aims This study investigated the psychometric properties of the M−CHAT-R/F, Taiwan version (M−CHAT-R/F–T), among low- and high-risk Taiwanese toddlers aged 16–30 months. The associations among M−CHAT-R/F−T scores, developmental performance at 24 and 30 months, and ASD diagnosis prediction at 36 months were examined. Methods and Procedures A two-stage screening of the M−CHAT-R/F−T was applied to a study sample comprising 25 toddlers with ASD and 71 atypically developing (ATD) and 221 typically developing (TD) toddlers. Outcomes and Results The M−CHAT-R/F–T exhibited acceptable internal consistency and test–retest reliability. The M−CHAT-R/F–T scores were significantly correlated with several syndrome scores of the Child Behavior Checklist for Ages 1.5–5 and were significantly higher among toddlers with ASD than among ATD or TD toddlers. Furthermore, M−CHAT-R/F–T scores were negatively correlated with developmental scores in the Mullen Scales of Early Learning at 24 and 30 months. Moreover, the screening exhibited acceptable predictive validity (sensitivity = 0.86; specificity = 0.96) for ASD diagnosis at 36 months. Conclusions and Implications The findings indicate that the M−CHAT-R/F–T is a valid and reliable tool for the developmental screening of low- and high-risk Taiwanese toddlers in community and clinical settings.

Background The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. Objective The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. Study design Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. Result The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. Conclusion Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up was validated on a population sample in Reykjavik, Iceland. The participants (N = 1585) were screened in well-child care at age 30 months and followed up for at least 2 years to identify autism cases. The sensitivity, specificity, positive and negative predictive values were 0.62, 0.99, 0.72, and 0.99, respectively. True-positive children were diagnosed 10 months earlier than false-negative children. Autism symptom severity and the proportions of children with verbal and performance IQs/DQs

This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2–4 months and from 2–4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.

BACKGROUND: Persistent disparities exist in early identification of autism spectrum disorder (ASD) among children from low-income families who are racial and/or ethnic minorities and where English is not the primary language. Parental literacy and level of maternal education may contribute to disparities. The Developmental Check-In (DCI) is a visually based ASD screening tool created to reduce literacy demands and to be easily administered and scored across settings. In a previous study, the DCI showed acceptable discriminative ability between ASD versus non-ASD in a young, underserved sample at high-risk for ASD. In this study, we tested the DCI among an unselected, general sample of young underserved children. METHODS: Six hundred twenty-four children ages 24 to 60 months were recruited through Head Start and Early Head Start. Parents completed the DCI, Modified Checklist for Autism in Toddlers, Revised with Follow-Up, and Social Communication Questionnaire. Children scoring positive on any measure received evaluation for ASD. Those screening negative on both Modified Checklist for Autism in Toddlers, Revised with Follow-Up and Social Communication Questionnaire were considered non-ASD. RESULTS: Parents were primarily Hispanic, reported high school education or less, and had public or no insurance. The DCI demonstrated good discriminative power (area under the curve = 0.80), performing well across all age groups, genders, levels of maternal education, primary language, and included ethnic and racial groups. Item-level analyses indicated that 24 of 26 DCI items discriminated ASD from non-ASD. CONCLUSIONS: The DCI is a promising ASD screening tool for young, underserved children and may be of particular value in screening for ASD for those with low literacy levels or with limited English proficiency.

The objective of this study was to test a screening model that employs the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), in an underserved community to improve ASD detection. We collaborated with a large Early Intervention (EI) program and trained 4 providers reliably on the RITA-T. Toddlers received the Modified Checklist for Autism in Toddlers (MCHAT-R/F), the RITA-T, developmental and autism testing, and a best-estimate clinical diagnosis. Eighty-One toddlers were enrolled: 57 with ASD and 24 with Developmental Delay (DD) non-ASD. Wait-time for diagnosis was on average 6 weeks. The RITA-T correlated highly with autism measures and EI staff integrated this model easily. The RITA-T significantly improved the identification and wait time for ASD in this underserved community.

OBJECTIVES Parent-report screening tools for autism spectrum disorder (ASD) are widely used to promote early identification of children with or at risk for ASD. Most screening tools have been developed in English in the United States or United Kingdom; thus, translated versions are needed for use with culturally and linguistically diverse populations. Traditional translation methods include a forward translation, back translation, and review. However, when used in new cultural and linguistic contexts, this "forward-back" approach may have limitations, including differing psychometric properties compared with original instruments. This study presents a psychometric analysis of the forward-back translation methodology of an ASD screening tool. METHODS A retrospective chart review design was used to examine Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R; Robins et al.) records from 2974 toddlers. Data were compared between caregivers who completed the original English M-CHAT-R and caregivers who completed its forward-back "Spanish-Western Hemisphere" translation to compare select psychometric properties of the 2 instruments. RESULTS Significant differences were observed between the 2 versions, including a higher overall risk score, higher initial screen-positive rate, and increased likelihood of leaving items blank among Spanish-speaking respondents. CONCLUSION Traditional translation methods seemed to affect select psychometric properties between translations of the M-CHAT-R. A more rigorous cultural adaptation approach may be necessary to maintain equivalence with the original instrument. Until new rigorous translations are available, it is recommended that language-specific screening tools continue to be used, along with recommended follow-up interviews, to avoid exacerbating existing health disparities.

* Abbreviations: ASD — : autism spectrum disorder M-CHAT — : Modified Checklist for Autism in Toddlers PPV — : positive predictive value Despite efforts to reduce the age of diagnosis for autism spectrum disorder (ASD) and ameliorate disparities in the identification of children with ASD from diverse backgrounds, we have only recently begun to move the needle.1,2 We acknowledge the formidable task pediatricians face in recognizing ASD, a condition with relatively low prevalence and signs that may not be apparent during a brief clinical encounter.3 Despite its promise for aiding pediatricians and improving ASD identification, emerging research suggests that the Modified Checklist for Autism in Toddlers (M-CHAT) is less accurate in detecting ASD in clinical practice than previously thought. In this issue of Pediatrics , Carbone et al4 performed a retrospective study using electronic health record data to evaluate screening practices and ASD diagnostic outcomes for children aged 16 to 30 months seen between 2013 and 2016 in one large health system in Utah. This important work closely parallels a similar study published by our research group in Pediatrics in 2019.5 We applaud the editors for publishing 2 articles with such similar methods and findings, because replication is particularly critical … Address correspondence to Kate E. Wallis, MD, MPH, Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, 3550 Market St, 3rd Floor, Philadelphia, PA 19104. E-mail: wallisk{at}email.chop.edu

OBJECTIVES: To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis. METHODS: We examined data from children attending 18- and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age >4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral. RESULTS: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92–0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09–0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6–14.1) and were diagnosed younger (38.5 vs 48.5 months, P < .001). The M-CHAT’s sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns. CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.

Background: Delayed diagnosis of autism spectrum disorder (ASD) remains a persistent pediatric health problem, due to limited access to competent diagnosticians and tertiary health care. A telemedicine method using a store-and-forward approach presents an opportunity to facilitate early identification and referral for intervention. This study aimed to evaluate the validity of protocol-guided video recording compared with direct assessment (DA) for diagnosing ASD. Materials and Methods: Children aged 18-30 months with chief complaints of delayed speech or social indifference, and Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) score of more than two were included. Parents were instructed to video record certain scenarios, which were assessed by an experienced professional based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) checklist for ASD. DAs using DSM-5 criteria were considered to be the gold standard of diagnosis. Diagnostic agreement, sensitivity, specificity, predictive values, and likelihood ratios were calculated to measure diagnostic validity. Results: The diagnostic agreement between the two methods was 82.5%. The sensitivity of video recording for diagnosing ASD was 91.3% (95% confidence interval [CI] [79.7%-100%]), while the specificity was 70.6% (95% CI [48.9%-92.2%]). The positive predictive value was 80.7% (95% CI [65.6%-95.9%]), while the negative predictive value was 85.7% (95% CI [67.4%-100%]). The positive likelihood ratio was 3.1 (95% CI [1.47-6.5]), while the negative likelihood ratio was 0.16 (95% CI [0.03-0.47]). Conclusions: A telemedicine approach using protocol-guided video recording evaluation has substantial validity compared with DA for diagnosing ASD.

Purpose Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. Methods A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. Results A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. Conclusion The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) is the most widely used screener for ASD. Despite the comparable rate of ASD in Black and White children, the M-CHAT-R/F was validated on a primarily White, Non-Hispanic sample. Few studies have assessed whether the screener performs adequately with racial minorities. This study compared the M-CHAT-R/F Positive Predictive Value (PPV), for ASD, and for any developmental condition, in Black and White children. We also examined M-CHAT-R/F item-level PPV by race. The PPVs for ASD and other developmental disorders were similar in both racial groups for total score and individual items. Therefore, our findings support the use of the M-CHAT-R/F with Black and White children.

The prevalence of autism spectrum disorder (ASD) is continuously rising worldwide, with remarkable differences in ASD rates being reported across ethnic and socioeconomic groups. We conducted a prospective cohort study to identify the reasons for differences in ASD rates between the Bedouin and Jewish populations in southern Israel. Screening, referral, and diagnosis of toddlers aged 16-36 months were compared between Bedouin and Jewish populations. ASD screening was conducted at 35 randomly selected mother and child health centers (MCHCs) by trained nurses using the Modified Checklist for Autism in Toddlers with follow-up (M-CHAT/F) instrument. Toddlers screened positive at the MCHCs were monitored throughout the referral and diagnosis process at a single medical center until a diagnosis was determined by a physician specialist using DSM-5 criteria. The study cohort comprised 3,343 toddlers (996 Jewish and 2,347 Bedouin). Bedouin toddlers, compared to Jewish toddlers, were less likely to screen positive with M-CHAT/F (3.0% vs. 3.9%; P = 0.165), were significantly less likely to begin the hospital diagnosis process (HR = 0.38, 95% CI: 0.14-1.08; P = 0.068), and had a higher rates of loss-to-follow-up during the hospital diagnosis process (42.9% vs. 15.6%, respectively; P = 0.001). The results suggest that ethnic-specific barriers in the diagnosis process of ASD contribute to under-diagnosis of ASD in the Bedouin population. Facilitating the diagnosis process for Bedouin families will help to identify more children with ASD at earlier ages and consequently close the ethnic gap in ASD rates. LAY SUMMARY: We followed Bedouin and Jewish toddlers aged 16-36 months from southern Israel through their autism spectrum disorder (ASD) screening referral and diagnosis to identify the reasons for the differences in ASD prevalence between these ethnic groups. Jewish and Bedouin toddlers were equally identified in the ASD screening. However, Bedouin toddlers were less likely to complete the diagnosis process due to higher rates of loss-to-follow-up and slower diagnosis process. Facilitating ASD diagnosis for the Bedouin population will help identifying more toddlers with ASD.

Objective. Autism spectrum disorder is a neurodevelopmental disorder that affects communication, social skills, and behavior and can present in early childhood. The present study is aimed at investigating the effects of family-centered early intervention on the quality of social interaction and social interaction skills in infants with suspected autism spectrum disorder using a single-subject design. Method. As a single-subject design study, evaluations were conducted at baseline phase A, intervention phase B, baseline phase A′, and follow-up phase. The family-centered early intervention program was implemented during the intervention phase. Family-centered early intervention programs included home environmental modification, play video recording and training, task and feedback, related information training, and question and answer. The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up and Evaluation of Social Interaction was used for evaluation. Result. Three participants completed the study. After applying the family-centered early intervention program, the quality of social interaction and social interaction skills of all participants improved. In addition, the risk of autism spectrum disorder in all participants was reduced. Conclusion. Family-centered early intervention was confirmed to have a positive effect on the improvement of social interaction skills in infants with suspected autism spectrum disorder.

Objectives Although the American Academy of Pediatrics recommends screening for autism spectrum disorder (ASD) for all young children, disparities in ASD diagnosis and intervention in minority children persist. One potential contributor to disparities could be whether physicians take different actions after an initial positive screen based on patient demographics. This study estimated factors associated with physicians completing the follow-up interview for the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT-F), and referring children to diagnostic services, audiology, and Early Intervention (EI) immediately after a positive screen. Methods Children seen in a large primary care network that has implemented universal ASD screening were included if they screened positive on the M-CHAT parent questionnaire during a 16-30 month well child visit (N = 2882). Demographics, screening results, and referrals were extracted from the electronic health record. Results Children from lower-income families or on public insurance were more likely to have been administered the follow-up interview. Among children who screened positive, 26% were already in EI, 31% were newly referred to EI, 11% were referred each to audiology and for comprehensive ASD evaluation. 40.2% received at least one recommended referral; 3.7% received all recommended referrals. In adjusted multivariable models, male sex, white versus black race, living in an English-speaking household, and having public insurance were associated with new EI referral. Male sex, black versus white race, and lower household income were associated with referral to audiology. Being from an English-speaking family, white versus Asian race, and lower household income were associated with referral for ASD evaluation. A concurrent positive screen for general developmental concerns was associated with each referral. Conclusions We found low rates of follow-up interview completion and referral after positive ASD screen, with variations in referral by sex, language, socio-economic status, and race. Understanding pediatrician decision-making about ASD screening is critical to improving care and reducing disparities.

The Modified Checklist for Autism in Toddlers-revised/follow-up (M-CHAT-R/F) was developed to reduce the number of cases requiring telephone verification. The aim of this study was to validate a Spanish version of the M-CHAT-R/F in the Spanish public health system. The M-CHAT-R/F was translated, culturally adapted, and then administered to 6625 children. Of the 39 positive screening cases, 15 children were diagnosed with autism spectrum disorder (ASD) and 24 with non-ASD disorders or delays. The sensitivity was 0.79 and specificity of 0.99. Positive and negative predictive values were 0.39 and 0.99, respectively. These results are similar to the English equivalent, though observed prevalence was lower. This study supports Spanish National Health System policy makers to consider a universal ASD screening program.

AIM The Modified Checklist for Autism in Toddlers (M-CHAT) could be appropriate for universal screening for autism spectrum disorder (ASD) at 18 months and 24 months. Validation studies, however, reported differences in psychometric properties across sample populations. This meta-analysis summarized its accuracy measures and quantified their change in relation to patient and study characteristics. METHOD Four electronic databases (MEDLINE, PsycINFO, CINAHL, and Embase) were searched to identify articles published between January 2001 and May 2016. Bayesian regression models pooled study-specific measures. Meta-regressions covariates were age at screening, study design, and proportion of males. RESULTS On the basis of the 13 studies included, the pooled sensitivity was 0.83 (95% credible interval [CI] 0.75-0.90), specificity was 0.51 (95% CI 0.41-0.61), and positive predictive value was 0.53 (95% CI 0.43-0.63) in high-risk children and 0.06 (95% CI

There are many available tools with varying levels of accuracy designed to screen for Autism Spectrum Disorder (ASD) in young children, both in the general population and specifically among those referred for developmental concerns. With burgeoning waitlists for comprehensive diagnostic ASD assessments, finding accurate methods and tools for advancing diagnostic triage becomes increasingly important. The current study compares the efficacy of four oft used paper and pencil measures, the Modified Checklist for Autism in Toddlers Revised with Follow-up, the Social Responsiveness Scale, Second Edition, and the Social Communication Questionnaire, and the Child Behavior Checklist to a novel mobile-health screening tool developed by Cognoa, Inc. (Cognoa) in a group of children 18-72 months of age. The Cognoa tool may have potential benefits as it integrates a series of parent-report questions with remote clinical ratings of brief video segments uploaded via parent's smartphones to calculate level of ASD risk. Participants were referred to one of three tertiary care diagnostic centers for ASD-related concerns (n = 230) and received a best estimate ASD diagnosis. Analysis and comparison of psychometric properties indicated potential advantages for Cognoa within this clinical sample across age ranges not often covered by another single measure/tool. Autism Res 2018, 11: 1038-1049. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay summary With the wait times getting longer for comprehensive Autism Spectrum Disorder (ASD) diagnostic assessments, it is becoming increasingly important to find accurate tools to screen for ASD. The current study compares four screening measures that have been in use for some time to a novel mobile-health screening tool, called Cognoa. The Cognoa tool is novel because it integrates parent-report questions with clinical ratings of brief video segments uploaded via parent's smartphones to calculate ASD risk. Two hundred thirty children who were referred to one of three ASD specialty diagnostic centers to see if they had ASD participated in the study. A direct comparison indicated potential advantages for Cognoa not often covered by another single measure/tool.

Autism spectrum disorder (ASD).2014.The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported.For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ]70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85).Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability.Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.

OBJECTIVES: Modified Checklist for Autism in Toddlers (M-CHAT) is widely used internationally to screen autism spectrum disorder (ASD). Three-item Direct Observation Screen (TIDOS) is a novel observational tool which may be used by physicians in a short time as a part of routine well-child visit. It includes the following: (a) Joint Attention, (b) Eye Contact, and (c) Response to Name. We aimed to compare the screening performance of TIDOS and M-CHAT for ASD. MATERIAL AND METHODS: A total of 1345 children aged 16–38 months were examined during well-child care visits at Social Pediatrics Department of Ankara University between May 2015 and May 2016. Five hundred and eleven of 1345 children aged 16—38 months whose parents approved informed consent were enrolled in this study to evaluate the performance of two screening tests: TIDOS and M-CHAT for ASD. The children whose screening tests were positive and controls whose tests were negative had undergone clinical evaluation for the diagnosis of ASD. Clinical evaluation was performed within 2 weeks of the initial M-CHAT, M-CHAT/F, or TIDOS screenings for screening positive children and within 3–9 months for screening randomly selected negative children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those tests were determined. RESULTS: ASD was diagnosed in 5 of the 511 children in a healthy child clinic of a university hospital with the prevalence of approximately 1%. All the children with ASD were boys. The growth parameters (including body weight, height, head circumference) did not have any properties. There were no consanguineous marriages among the parents of children with ASD. The ages of mothers and fathers of the children with ASD were in a range between 31–39 years and 31–46 years, respectively. The sensitivity for diagnosis of ASD was found to be 0.60 for both M-CHAT and M-CHAT/F tests. The specificity of M-CHAT and M-CHAT/F tests for diagnosis of ASD was found to be 0.96 and 0.97, respectively. PPV were found to be 0.14 and 0.18, respectively. The sensitivity for diagnosis of ASD was found to be 0.80 for TIDOS. Specificity and PPV in the diagnosis of ASD were found to be 0.99 and 0.80, respectively. NPV for all tests were above 0.99. CONCLUSION: The current study has demonstrated that TIDOS was more sensitive and had higher PPV than M-CHAT. TIDOS has required little time and might be easily combined to routine physical examination of toddlers attending 18- to 36-month well-child clinic visits.

La prevalencia del Trastorno del Espectro Autista (TEA) ha aumentado, variando entre 0,5 y 1% alrededor del mundo. Se desconoce la prevalencia de TEA en Chile.Objetivo: Estimar la prevalencia de Trastorno del Espectro Autista en 2 comunas urbanas de Santiago de Chile.Sujetos y Método: Estudio epidemiológico transversal. Participaron 272 niños entre 18-30 meses que asistían a control sano en dos Centros de Salud Familiar de dos comunas urbanas de la capital. Se utilizó un muestreo consecutivo y se excluyeron los niños que ya estaban siendo controlados por neurología. Se realizó un tamizaje mediante el Cuestionario de Autismo en Niños - Modificado (MCHAT). Los niños con MCHAT alterado fueron evaluados por neuropediatra en el Hospital Clínico San Borja Arriarán y diagnosticados con Trastorno del Espectro Autista de acuerdo a criterio clínico. Se administró la Escala de Observación para el Diagnóstico del Autismo - Segunda Versión (ADOS-2) como complemento diagnóstico. Se estimó la prevalencia de Trastorno del Espectro Autista con intervalo de confianza a 95%.Resultados: 44 niños tuvieron M-CHAT alterado; de ellos 5 fueron diagnosticados clínicamente con Trastorno del Espectro Autista. Se obtuvo una prevalencia de Trastorno del Espectro Autista de 1,95% (IC95% 0,81-4,63), con una distribución por sexo de 4 niños por 1 niña.Conclusiones: Esta es la primera estimación de prevalencia de Trastorno del Espectro Autista en dos comunas de Santiago, Chile. Se obtuvo una alta prevalencia de esta condición, lo que deja en evidencia la necesidad de obtener recursos para el abordaje multidisciplinario precoz de estos pacientes.

Stepanka Beranova,1 Jan Stoklasa,2 Iva Dudova,1 Daniela Markova,3 Martina Kasparova,4 Jana Zemankova,5 Tomas Urbanek,6 Tomas Talasek,2 Pasi Luukka,7 Michal Hrdlicka1 1Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, 2Department of Applied Economics, Faculty of Arts, Palacky University, Olomouc, 3Department of Pediatrics and Adolescent Medicine, Charles University First Faculty of Medicine and General University Hospital, Prague, 4Department of Pediatrics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, 5Department of Pediatrics, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, 6Institute of Psychology, Academy of Sciences, Brno, Czech Republic; 7Laboratory of Applied Mathematics, Lappeenranta University of Technology, Lappeenranta, Finland Objective: The objective of this study was to explore the potential of the Infant/Toddler Sensory Profile (ITSP) as a screening tool for autism spectrum disorders (ASD) in prematurely born children.Methods: Parents of 157 children with birth weights

Stepanka Beranova,1 Jan Stoklasa,2 Iva Dudova,1 Daniela Markova,3 Martina Kasparova,4 Jana Zemankova,5 Tomas Urbanek,6 Tomas Talasek,2 Pasi Luukka,7 Michal Hrdlicka1 1Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, 2Department of Applied Economics, Faculty of Arts, Palacky University, Olomouc, 3Department of Pediatrics and Adolescent Medicine, Charles University First Faculty of Medicine and General University Hospital, Prague, 4Department of Pediatrics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, 5Department of Pediatrics, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, 6Institute of Psychology, Academy of Sciences, Brno, Czech Republic; 7Laboratory of Applied Mathematics, Lappeenranta University of Technology, Lappeenranta, Finland Objective: The objective of this study was to explore the potential of the Infant/Toddler Sensory Profile (ITSP) as a screening tool for autism spectrum disorders (ASD) in prematurely born children.Methods: Parents of 157 children with birth weights

Aims To study the at-risk rate for Autism Spectrum Disorders (ASD) on a parent-report questionnaire in toddlers between the ages of 16–24 months. Materials and methods 6237 toddlers from Kerala, India selected by cluster random sampling were surveyed by community nurses using the Modified Checklist for Autism in Toddlers − Revised (M-CHAT-R) translated to Malayalam and culturally adapted. Results 5.5% toddlers were at risk on M-CHAT-R and 2.7% on “Best Seven”. Conclusions M-CHAT-R and its “Best Seven” could be viable community level screening instruments, albeit with further cultural adaptation for a primarily non-English speaking population in India.

A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of 2-year-old children using standardized parent-report instruments. We used data from the French representative Etude Longitudinale Francaise depuis l'Enfance birth cohort, initiated in 2011. The study sample included 9,900 children of nonimmigrant French, 1,403 children of second, and 1,171 children of first generation immigrant women followed-up to age 2 years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI). In fully adjusted linear regression models, maternal immigrant status was associated with M-CHAT scores, with stronger associations in children of first (β-coefficient: 0.19; 95% CI 0.08-0.29) than second generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of first generation immigrant mothers native of North Africa (vs. nonimmigrant French: 0.33; 0.16-0.49) and French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of first generation immigrant mothers, particularly from mostly non-francophone regions. Children of first generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores. Our findings suggest that maternal immigrant status is associated with early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Further research is necessary to test whether these associations persist and to determine the underlying mechanisms. Autism Res 2019, 12: 1845-1859. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We asked immigrant and nonimmigrant mothers in France about early signs of neurodevelopmental problems in their 2-year-old children. Overall, we found that children of immigrants may be at higher risk of showing these early warning signs, as compared to children of nonimmigrants. This is in line with previous studies, which were based on doctors' diagnoses at later ages. However, our results differed depending on the mothers' regions of origin. We found the highest risks in children of first generation immigrants from North and French-speaking Sub-Saharan Africa, who also seemed especially at risk of neurodevelopmental problems combined with low language development.

Background and Hypothesis: According to the CDC, Preterm birth is defined as a baby born before 37 weeks of gestation. 1 In 2016 preterm birth affected 1 in every 10 infant born in the United States.1 Preterm birth has been known to cause many birth defects along with developmental delays and has attributed to 17% of all infant death. Neonatal Follow Up clinics or programs have been instrumental in helping infants catch up developmentally.3 We believe that with the NFC, we will be able to develop a standard for preterm babies and the normalization of their development. Experimental Design or Project Methods: A retrospective chart review was conducted to determine the developmental outcome of infants that were born prior to 37 weeks’ gestation. Infants were divided into extreme, very, and moderate preterm cohorts. Test of Infant Motor Performance (TIMP), Ages and Stages Questionnaire (ASQ), Bayley Scales of Infant Development (BSID) and Modified Checklist for Autism in Toddlers (M-CHAT) scores were used to determine a standard for when preterm babies in each cohort normalize developmentally. Results: Analysis of the data showed that the developmental turning point for each cohort varies. Within the extreme preterm cohort, one can see that there was no clear turning point for development. For the very preterm group, by TIMP 2, one could see a turning point and a decrease in delays. Lastly, moderately preterm cohort, the number of delays was seen tot decrease from the administration of TIMP 2 and continue in this trend. Conclusion and Potential Impact: Through the administration of these developmental tests, physicians are able to track the development of preterm babies. We concluded that with the proper follow up, one can see an improvement in development as early as the administration of TIMP 2. 1) Preterm Birth https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm 2) Suave, R., & Lee, S. K. (2006). Neonatal follow-up programs and follow-up studies: Historical and current perspectives. Paediatrics and Child Health. http://doi.org/10.1093/pch/11.5.267 3) Voller, S. M. B. (2018). Follow-Up Care for High-Risk Preterm Infants. Pediatric Annals, 47(4). http://doi.org/10.3928/19382359-20180325-03

Introduction: Screening for Autism Spectrum Disorders (ASD) using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) increases early detection, allowing early interventions and improving prognosis. This tool is part of the management in case of suspected ASD in several clinical guidelines. The objective of this article was to conduct the concurrent and discriminant validation and the reliability analysis of M-CHAT-R/F in the Chilean population. Patients and Method: This is the second stage of the cross-cultural adaptation of cross-sectional design. M-CHATR/F was applied to a sample of 20 children with suspected ASD and 100 randomly selected healthy control children, aged between 16-30 months. Autism Diagnostic Observation Schedule (ADOS-2), considered as reference, was applied to the 20 patients of the clinical sample, to 20 children of the healthy control sample and to those cases of the healthy control sample with M-CHAT-R/F positive. Cronbach alpha was calculated, as well as M-CHAT-R/F and ADOS-2 correlation, sensitivity, and specificity analyses. Results: In the healthy sample, M-CHAT-R/F was positive in two patients, with one of them positive and the other one negative for ASD with ADOS-2 test. In the clinical sample, MCHAT-R/F was positive in all cases, three of them were negative in the ADOS-2 test. The Alfa reliability of M-CHART-R/T was 0,889, the discriminant sensitivity and specificity were 100% and 98%, and the concurrent ones were 100% and 87.5% respectively. Conclusions: The Chilean M-CHATR/F version was reliable, sensitive and specific, similar to the original test, which opens the possibility for its use in clinical samples and for research. Validating M-CHAT-R/F is an ongoing process which must be further developed

Introduction Few studies have used eye tracking as a screening tool for autism spectrum disorder (ASD) in preterm infants. Objectives To evaluate fixation time on social and non-social figures and percentage of preterm babies who gazed at the images. Methods This was a cross-sectional study of 31 preterm infants born weighing ≤ 2,000 g in which eye gaze was evaluated at 6 months of corrected age. Six boards with social and non-social figures were projected on a computer screen, successively, evaluating time and percentage of preterm babies who gazed at each board. The Modified Checklist for Autism in Toddlers (M-CHAT) was answered at 18 months of corrected age. Results Preterm infants showed longer visual fixation time on social figures compared with non-social images, regardless of the position of the social figure on the board. Similar percentages of preterm infants gazed either at social or non-social figures, at social figures with a direct or an indirect look, and at the eyes or mouth of the social figures. No preterm infant screened positive on the M-CHAT. Conclusion At 6 months of corrected age, preterm infants show the ability to gaze in an eye-tracking test, with preference for social figures, suggesting that this tool could be useful as another screening instrument for ASD.

BACKGROUND: Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS: Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children’s Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS: Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F’s sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS: Universal screening in primary care is possible when supported by electronic administration. In this “real-world” cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.

* Abbreviations: ASD — : autism spectrum disorder M-CHAT/F — : Modified Checklist for Autism in Toddlers With Follow-up PPV — : positive predictive value The lengthy diagnostic odyssey experienced by families of children with autism spectrum disorder (ASD) remains a major barrier to early access to ASD therapeutic services. Although accelerating this process has been identified as a top priority,1 there is a polarized debate about whether ASD screening can accomplish this. The American Academy of Pediatrics recommends that all children be assessed by using an ASD screening tool at 18 and 24 months old.2 In contrast, the US Preventive Services Task Force concluded that there was “insufficient evidence to recommend screening for ASD in children aged 18 to 30 months for whom no concerns of ASD have been raised.”3 The issue has been debated passionately,4–6 but without resolution, in part because of limited community-level data regarding screening feasibility, accuracy, and outcomes. The current study by Guthrie et al7 contributes important findings that further inform this debate. The authors demonstrated that universal screening was feasible, with >90% of toddlers screened through a large primary care network by integrating the Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up (M-CHAT/F) into routine primary health care. Physicians were prompted to administer the … Address correspondence to Lonnie Zwaigenbaum, MD, MSc, Autism Research Centre, Glenrose Rehabilitation Hospital, University of Alberta, E209, 10230 111th Ave, Edmonton, AB T5G 0B7, Canada. E-mail: lonniez{at}ualberta.ca

Currently, Autism Spectrum Disorder (ASD) is a highly prevalent disorder. However, children with ASD receive treatment lately. Although screening tools are available, these tools can only be operated by medical staff. Some parents of children with ASD may not be able to take their children to get the appropriate medical treatments. These may be the results of time constraint, money expense, travel difficulty, and even unknowingly which medical condition their children are having. The consequence is that the children miss the opportunity to receive proper treatments and to have appropriate developments as early as possible. Thus this article proposed the development of both web and mobile applications that helped parents access the ASD screening for their children more conveniently. The ASD screening tool was a Thai version of Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (CM-CHAT-R/F)TM. Based on the field trial results of 20 participants, comparing the results of the application screening with the diagnosis from a child and adolescent psychiatrist or a developmental pediatrician, the application had a sensitivity and specificity of 90%.

The study assessed the feasibility of using a Turkish-version of the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R/F) as a screening tool for an urban low risk population of young children. M-CHAT-R/F was completed for 6,712 children between ages 16 to 36 months living in Istanbul, Turkey. Autism Diagnostic Observation Schedule-2 was served as the main measure for diagnosis. M-CHAT-R/F screen was positive for 9.8% of children. At follow up interview, 39.7% of initial screen-positive children met criteria for ASD. The study identified 57 (1 in 117) children with ASD (0.8%; 95% CI: 0.063%−1.05%). M-CHAT-R/F performed comparably in Turkey as in United States. Implications of the study for future universal screening for autism in Turkey is also discussed.

OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children’s receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.