a pen and a notebook full of notes

The new evaluation could speed up the evaluation process.

What could make screening for autism spectrum disorders (ASD) easier? Researchers from Georgia State University used simpler language and fewer questions to update a popular autism screening tool. They tested an evaluation that was more accurate and easier to use than its predecessor. The new screening might help more children with ASD be accurately identified and speed up the diagnostic process.

The Modified Checklist for Autism in Toddlers (M-CHAT) has been around since the 1990s. Although it originated in Britain, American clinicians adapted the test in 1999 and it has been a standard since. This study focused on what an updated and simplified version of the M-CHAT could do. To modernize the test, the researchers eliminated some questions and reworded others. They adapted questions that do not translate well or that are not easy to understand by people with limited education. Thus, questions about “peek-a-boo” were removed and questions that use particularly British phrasing like “Does your child take an interest?” were adapted to be better understood by Americans from diverse backgrounds.

The updated M-CHAT uses a two-step screening process. In the first stage, parents answer 20 yes-no questions about children’s behavior like “When you smile at your child, does he or she smile back at you?” When parents answer affirmatively to a certain number of questions, they are immediately referred to a doctor. Screenings can be completed in a single day.

The new test was used to evaluate 16,071 toddlers in Georgia and Connecticut during routine 18- and 24-month doctor visits.

The results indicate that the updated M-CHAT is more effective at identifying toddlers with autism. Children who scored above the test’s thresholds in each phase had approximately a 50% chance of being diagnosed with autism and a 95% chance of being diagnosed with a developmental delay. Toddlers at-risk for autism per the updated M-CHAT were 114 times more likely to be later diagnosed than children with a negative test score. Finally, the test may be better at identifying toddlers with ASD than its predecessor. The scores suggest a 0.67% prevalence of autism, compared with 0.45% with the old screening.

Ultimately, the updated screening may lessen the wait time for receiving autism diagnoses. While the test identifies less false positives, it may inadvertently screen out some children who really do have ASD. The American Academy of Pediatrics recommends using screens and observing early warning signs when evaluating children.

This research is published in the journal Pediatrics.

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