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Research Review

Revised Autism Screening Tool Offers More Precise Assessment

An updated screening tool that physicians administer to parents to help determine if a very young child has autism has been shown to be much more accurate than earlier versions at identifying children who could benefit from further evaluation, according to researcher supported by the National Institutes of Health. The findings appear in Pediatrics.

The Modified Checklist for Autism in Toddlers — Revised, with Follow-Up (M-CHAT–R/F) is a free, two-step screening tool used to detect children likely to have autism. It is intended for use at regular well-child checkups for children aged 16 to 30 months. With the M-CHAT–R/F, health care providers can classify a child’s risk of having autism as low, medium, or high on the basis of parents’ answers to 20 questions.

“This checklist can more accurately identify children likely to have autism so they can get the treatment and support they need,” says Alice Kau, PhD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the institute that funded the study. “Given that the typical autism diagnosis occurs at age 4, it also offers the possibility of detecting autism much earlier—during regular doctor’s visits when a child is 18 months or 2 years old. And earlier intervention has been shown to improve outcomes for children with autism.”

A score in the high-risk range warrants a referral for further evaluation for possible autism. For a child determined to be at medium risk, M-CHAT–R/F includes a follow-up questionnaire used soon after the original evaluation to obtain additional information needed to more definitively classify the child as either high risk or low risk.

Based on the M-CHAT–R/F classifications, the researchers found that a smaller proportion of children received a medium- or high-risk assessment (7%) than with earlier versions of the checklist (9%). However, more total cases of autism were detected with the revised checklist than with earlier versions (67 cases per 10,000 screened vs. 45 cases per 10,000 screened).

Of the more than 16,000 children evaluated with the screening tool, 93% of the children screened were considered low risk, 6% were in the medium-risk range, and 1% were considered high risk.

Of all the children who determined by the test to be at risk after the M-CHAT–R/F follow-up, 95% were eventually found to have some form of developmental delay, including more than 47% with autism spectrum disorder.

The researchers updated the tool by adding examples, rephrasing some questions, and dropping others that previously did not elicit strong responses. Using the revised tool, the researchers worked with health care providers to screen more than 15,000 toddlers considered at low risk for autism.

“Earlier tools cast a wider net, but these refinements will allow health care providers to focus energy where it is needed most and will reduce the number of families who go through additional testing but which ultimately do not need treatment interventions,” says Deborah Fein, PhD, of the University of Connecticut and the study’s senior author.

The free autism screening tool is available online in more than 45 languages.

— Source: National Institutes of Health