Autism Screening and Conditional Cash Transfers in Chile: Using the Quantitative Checklist (Q-CHAT) for Early Autism Detection in a Low Resource Setting

Diagnosis of Autism Spectrum Conditions (ASC) can be an extended procedure since ASC tend to both vary greatly across individual symptoms and diagnostic pathways with serious challenges to opportune access and diagnosis in low resource settings. We adapted the Q-CHAT-25 for use in a routine health check-ups programme at Chilean primary health clinics by developing a 10-item version of this questionnaire recruiting n = 287 (F: 112/M: 175) participants (Controls: n = 125, F: 58/M: 67; Developmental Delay: n = 149, F: 53/M: 96; Autism Spectrum Conditions: n = 13, F: 1/M: 12). Our findings show that the Q-CHAT-10 can be successfully applied in health-check programmes. The results for the Q-CHAT-10 show high internal consistency (Cronbach's [alpha]: 0.85) and good overall performance, significantly correlating (r = 0.79, p < 0.0001) with the Q-CHAT-25. The Q-CHAT-10 had a sensitivity of 92.86% and a specificity of 76.86% in the Developmental Delay sample. The positive predictive value was 48% with a positive likelihood ratio of 4.01 and a negative likelihood ratio of 0.09 with a post-test probability of disease of 19%. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 is a cost-effective measure that improves diagnosis of Autism Spectrum Conditions in those participating in conditional cash transfer programmes in low- and middle-income countries or low resource setting in high income countries.