Large-Scale Use of the Modified Checklist for Autism in Low-Risk Toddlers

OBJECTIVE: The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autismspecific screening instrument in a large, geographically diverse pediatrics-based sample. METHODS: The M-CHATand the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18 989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation. RESULTS: Results indicated that 54% of children who screened positive on the M-CHATand M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of $3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of $7. CONCLUSIONS: This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers. Pediatrics 2013;131:e1121–e1127 AUTHORS: Colby Chlebowski, PhD,a Diana L. Robins, PhD,b Marianne L. Barton, PhD,c and Deborah Fein, PhDcd aDepartment of Psychiatry, University of California, San Diego, San Diego, California; bDepartment of Psychology, Georgia State University, Atlanta, Georgia; Departments of cPsychology and d Pediatrics, University of Connecticut, Storrs, Connecticut