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Zheng RM, Chan SP, Law EC, Chong SC, Aishworiya R. Validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in primary care clinics in Singapore. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1758-1771. [PMID: 37882198 PMCID: PMC11191374 DOI: 10.1177/13623613231205748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT Systematic screening for autism in early childhood has been suggested to improve eventual outcomes by facilitating earlier diagnosis and access to intervention. However, clinical implementation of screening has to take into account effectiveness and feasibility of use within a healthcare setting for accurate diagnosis of autism. In Singapore, autism screening using a structured screening tool is not currently employed as a part of routine well-child visits for children in primary care clinics. In this study, 5336 children (aged 17-20 months) were screened for autism using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during their 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by nursing staff at each clinic. Children screened positive and a portion of those screened negative then underwent diagnostic assessments to determine whether they met the diagnostic criteria for autism. In total, 113 (2.1%) were screened positive, of which 54 (1.0%) met the criteria for autism. Children who screened positive and received a diagnosis accessed autism-specific intervention at an average age of 22 months. Nurses and physicians rated the acceptability and practicality of the M-CHAT-R/F highly. Therefore, the M-CHAT-R/F questionnaire was an effective and feasible tool for autism screening among 18-month-old children in this study. Future studies will be designed to determine the optimal age of screening and role of repeated screening in Singapore, as well as to better understand any potential improved outcomes nationwide compared with pre-implementation of autism screening.
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Affiliation(s)
| | - Siew Pang Chan
- National University Heart Centre, Singapore
- National University of Singapore, Singapore
| | - Evelyn C Law
- National University of Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore
- National University Hospital, Singapore
| | - Shang Chee Chong
- National University of Singapore, Singapore
- National University Hospital, Singapore
| | - Ramkumar Aishworiya
- National University of Singapore, Singapore
- National University Hospital, Singapore
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Chu CL, Su WS, Iao LS, Wu CC, Hou YM. Comparison between the Clancy Behavior Scale and the Modified Checklist for Autism in Toddlers in Taiwan. CHILDREN (BASEL, SWITZERLAND) 2024; 11:557. [PMID: 38790552 PMCID: PMC11119399 DOI: 10.3390/children11050557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
(1) Background: Precise diagnosis and early intervention are crucial for toddlers with autism spectrum disorder (ASD) to achieve a better prognosis. This study investigated the efficacy of the Clancy Behavior Scale (CBS) and Modified Checklist for Autism in Toddlers (M-CHAT) in detecting ASD among toddlers under 30 months of age. (2) Methods: A total of 215 toddlers (117 with ASD and 98 with development delays) aged between 18 and 29 months participated in this study. All the primary caregivers of these toddlers were recruited to complete the CBS and M-CHAT. (3) Results: The findings indicated that the accuracy of the CBS and M-CHAT was promising, and the short forms of these two instruments performed better than their full versions. The CBS:9 critical items presented a sensitivity of 0.75 and a specificity of 0.74, while the M-CHAT:14 brief items showed a sensitivity of 0.72 and a specificity of 0.85. (4) Conclusions: The diagnostic accuracy of high-risk ASD toddlers improved via the combination of CBS and M-CHAT, particularly when the information gathered from these two instruments were consistent. The findings may provide implications for enhancing the early detection of ASD.
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Affiliation(s)
- Ching-Lin Chu
- Department of Educational Psychology & Counseling, National Pingtung University, Pingtung 900391, Taiwan;
| | - Wen-So Su
- Department of Psychology, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
| | - Lai-Sang Iao
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK
| | - Chin-Chin Wu
- Department of Psychology, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
| | - Yuh-Ming Hou
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chai-Yi 60002, Taiwan
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Wallis KE, Guthrie W. Screening for Autism: A Review of the Current State, Ongoing Challenges, and Novel Approaches on the Horizon. Pediatr Clin North Am 2024; 71:127-155. [PMID: 38423713 DOI: 10.1016/j.pcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Screening for autism is recommended in pediatric primary care. However, the median age of autism spectrum disorder (ASD) diagnosis is substantially higher than the age at which autism can reliably be identified, suggesting room for improvements in autism recognition at young ages, especially for children from minoritized racial and ethnic groups, low-income families, and families who prefer a language other than English. Novel approaches are being developed to utilize new technologies in aiding in autism recognition. However, attention to equity is needed to minimize bias. Additional research on the benefits and potential harms of universal autism screening is needed. The authors provide suggestions for pediatricians who are considering implementing autism-screening programs.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Segre G, Cargnelutti C, Bersani C, Njogu W, Roberti E, Campi R, De Vita MV, Morino G, Canevini MP, Bonati M. Early detection of neurodevelopmental disorders in African children living in informal settlements in Nairobi. BMJ Paediatr Open 2023; 7:e002117. [PMID: 37890890 PMCID: PMC10619007 DOI: 10.1136/bmjpo-2023-002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Children in low-income and middle-income countries (LMICs) are at a substantially increased risk of delayed physical, emotional and sociocognitive outcomes, with consequential neurodevelopmental disorders. Evidence based, cost-effective and culturally appropriate screening tools are recommended for early identification of developmental disorders. METHODS The present study aims to assess the feasibility of early screening for neurodevelopmental disorders in children living in informal settlements in Nairobi, Kenya (Korogocho). The selected tools (ie, the CDC checklist and the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)), widely used in high-income countries, are applied in two different populations: one from Kenya (LMIC) and one from Italy, to compare the different scores. RESULTS Of 509 children screened, 8.6% were classified at-risk based on the results of the screening tools. Significant risk factors are history of low birth weight and Apgar score, presence of neurological disorders, malnutrition and/or rickets, younger age of the child and older age of the mother. Caesarean section delivery, first pregnancy and mothers' older age were common risk factors among the Kenyan and the Italian samples. The Italian sample had a significantly greater rate of missed milestones. CONCLUSIONS Our data demonstrate the feasibility of using the CDC and M-CHAT-R tools in informal settlement dwellers. Further studies are needed to explore the opportunity for early diagnosis of developmental disorders in LMICs.
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Affiliation(s)
- Giulia Segre
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Cecilia Cargnelutti
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Carlotta Bersani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | | | - Elisa Roberti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Rita Campi
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | | | | | - Maurizio Bonati
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Aishworiya R, Ma VK, Stewart S, Hagerman R, Feldman HM. Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening. Pediatrics 2023; 151:e2022059393. [PMID: 37203373 PMCID: PMC10233738 DOI: 10.1542/peds.2022-059393] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/20/2023] Open
Abstract
CONTEXT The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is used worldwide to screen for autism spectrum disorder (ASD). OBJECTIVE To calculate psychometric properties of the M-CHAT-R/F for subsequent diagnosis of ASD. DATA SOURCES Systematic searches of Medline, Embase, SCOPUS, and Trip Pro databases from January 2014 to November 2021. STUDY SELECTION Studies were included if they (1) used the M-CHAT-R/F (2) applied standard scoring protocol, (3) used a diagnostic assessment for ASD, and (4) reported at least 1 psychometric property of the M-CHAT-R/F. DATA EXTRACTION Two independent reviewers completed screening, full-text review, data extraction, and quality assessment, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was used to derive pooled estimates and assess for between-study heterogeneity. RESULTS Of 667 studies identified, 15 with 18 distinct samples from 10 countries (49 841 children) were used in the meta-analysis. Pooled positive predictive value (PPV), was 57.7% (95% confidence interval [CI] 48.6-66.8, τ2 = 0.031). PPV was higher among high-risk (75.6% [95% CI 66.0-85.2]) than low-risk samples (51.2% [95% CI 43.0-59.5]). Pooled negative predictive value was 72.5% (95% CI 62.5-82.4 τ2 = 0.031), sensitivity was 82.6% (95% CI 76.2-88.9) and specificity 45.7% (95% CI 25.0-66.4). LIMITATIONS Negative predictive value, sensitivity, and specificity were calculated based on small sample sizes because of limited or no evaluation of screen-negative children. CONCLUSIONS These results support use of the M-CHAT-R/F as a screening tool for ASD. Caregiver counseling regarding likelihood of an ASD diagnosis after positive screen should acknowledge the moderate PPV.
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Affiliation(s)
- Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Van Kim Ma
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute
- Department of Pediatrics, School of Medicine
| | - Susan Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute
- Department of Pediatrics, School of Medicine
| | - Heidi M. Feldman
- Department of Pediatrics, Stanford University, Palo Alto, California
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Wieckowski AT, Williams LN, Rando J, Lyall K, Robins DL. Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised): A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:373-383. [PMID: 36804771 PMCID: PMC9941975 DOI: 10.1001/jamapediatrics.2022.5975] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/11/2022] [Indexed: 02/22/2023]
Abstract
Importance The Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F)-henceforth referred to as M-CHAT(-R/F)-are the most commonly used toddler screeners for autism spectrum disorder (ASD). Their use often differs from that in the original validation studies, resulting in a range of estimates of sensitivity and specificity. Also, given the variability in reports of the clinical utility of the M-CHAT(-R/F), researchers and practitioners lack guidance to inform autism screening protocols. Objective To synthesize variability in sensitivity and specificity of M-CHAT(-R/F) across multiple factors, including procedures for identifying missed cases, likelihood level, screening age, and single compared with repeated screenings. Data Sources A literature search was conducted with PubMed, Web of Science, and Scopus to identify studies published between January 1, 2001, and August 31, 2022. Study Selection Articles were included if the studies used the M-CHAT(-R/F) (ie, original or revised version) to identify new ASD cases, were published in English-language peer-reviewed journals, included at least 10 ASD cases, reported procedures for false-negative case identification, screened children by 48 months, and included information (or had information provided by authors when contacted) needed to conduct the meta-analysis. Data Extraction and Synthesis The systematic review and meta-analysis was conducted within the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality Assessment of Diagnostic Accuracy Studies-2 tool evaluated bias in sample selection. Data extraction and quality assessment were performed by 2 authors independently. The overall diagnostic accuracy of the M-CHAT(-R/F) was assessed with the hierarchic summary receiver operating characteristic (HSROC) model. Main Outcomes and Measures Sensitivity, specificity, diagnostic odds ratios, and HSROC curves of M-CHAT(-R/F). Results The review included 50 studies with 51 samples. The pooled sensitivity of M-CHAT(-R/F) was 0.83 (95% CI, 0.77-0.88), and the pooled specificity was 0.94 (95% CI, 0.89-0.97). Heterogeneity analyses revealed greater diagnostic accuracy for low- vs high-likelihood samples, a concurrent vs prospective case confirmation strategy, a large vs small sample size, use of M-CHAT(-R/F) Follow-up, and non-English vs English only. Conclusions and Relevance Overall, results of this study suggest the utility of the M-CHAT(-R/F) as an ASD screener. The wide variability in psychometric properties of M-CHAT(-R/F) highlights differences in screener use that should be considered in research and practice.
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Affiliation(s)
| | - Lashae N. Williams
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Juliette Rando
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
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Cultural Adaptation and Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in Moroccan Arabic dialect. L'ENCEPHALE 2023; 49:15-20. [PMID: 34852926 DOI: 10.1016/j.encep.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023]
Abstract
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.
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Chang JC, Lai MC, Chien YL, Cheng CY, Wu YY, Gau SSF. Psychometric properties of the Mandarin version of the autism diagnostic observation Schedule-Generic. J Formos Med Assoc 2023:S0929-6646(23)00008-6. [PMID: 36732136 DOI: 10.1016/j.jfma.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/PURPOSE The diagnosis of autism spectrum disorder (ASD), involving multiple components of clinical assessments, is challenging. The Autism Diagnostic Observation Schedule-Generic (ADOS-G), one of the standardized and validated instruments for ASD diagnostic evaluation, has been widely used in many countries. With the preparation of the Mandarin version of the ADOS-G (Mandarin-ADOS-G), this study aims to examine its psychometric properties, including reliability and validity. METHODS The sample included 554 individuals clinically diagnosed with ASD (477 males, 86.1%) and 50 typically developing (TD) individuals (29 males, 58.0%) who were assessed with different modules of the Mandarin-ADOS-G between 4.1 and 34.0 years old with a mean age of 13.0 years (Module 1, n = 40; Module 2, n = 46; Module 3, n = 275; Module 4, n = 243). We evaluated the inter-rater reliability, test-retest reliability, internal consistency, and concurrent validity with the Chinese Autism Diagnostic Interview-Revised (ADI-R) and Social Responsiveness Scale (SRS) caregiver-report and self-report forms. The discriminative validity of Mandarin-ADOS-G was also examined. RESULTS The Mandarin-ADOS-G demonstrated good inter-rater reliability (agreement of ADOS classification 0.91), good test-retest reliability (intraclass correlations 0.55-0.73), and low to high good internal consistency (Cronbach's alpha 0.27-0.86). The concurrent validity showed significant correlations with ADI-R (Pearson correlations 0.22-0.37) and the SRS caregiver-report form (Pearson correlations 0.15-0.23). Moreover, all Mandarin-ADOS-G domains successfully differentiated autistic individuals from TD individuals (all p-values <0.001). CONCLUSION The Mandarin-ADOS-G is a reliable and valid instrument for assisting the diagnosis of ASD in the Mandarin-speaking population.
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Affiliation(s)
- Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Chuan Lai
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chung-Yuan Cheng
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Yu Wu
- YuNing Psychiatric Clinic, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Cheong PL, Tsai JM, Wu YT, Lu L, Chiu YL, Shen YT, Li YJ, Tsao CH, Wang YC, Chang FM, Huang YH, Sun CW. Cultural Adaptation and Validation of Mullen Scales of Early Learning in Taiwanese children with Autism Spectrum Disorder, Global Developmental Delay, and Typically Developing Children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104158. [PMID: 35032783 DOI: 10.1016/j.ridd.2021.104158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 11/09/2021] [Accepted: 12/23/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Mullen Scales of Early Learning (MSEL) is a standardized comprehensive developmental assessment tool for children aged 0-68 months. However, few Asia-based studies have explored cultural and linguistic adaptations of the MSEL or investigated its psychometric properties in populations with autism spectrum disorder (ASD). AIMS This study evaluated the reliability and validity of the MSEL-Taiwan version (MSEL-T) for Taiwanese children with ASD, global developmental delay (GDD), and typical development (TD). METHODS AND PROCEDURES The MSEL items were translated and modified according to the language and culture in Taiwan. In total, 191 children (ASD, 69; GDD, 36; and TD, 86) aged 19-68 months were assessed using the MSEL-T and Peabody Developmental Motor Scales 2 (PDMS-2) at enrollment, followed by the assessments of Vineland Adaptive Behavior Scale-Chinese version (VABS-C) at the age of 36 months or later. OUTCOMES AND RESULTS All subscales were verified to have good interrater reliability and internal consistency, and subscale scores indicated moderate to high correlations with PDMS-2 and VABS-C scores. Significant differences in MSEL-T scores were observed between same-aged pairs of children with TD and GDD and between pairs of children with TD and ASD. CONCLUSIONS AND IMPLICATIONS The findings provide evidence of validity and reliability of the MSEL-T. And it is suggested that the culturally and linguistically adapted MSEL-T is a good tool for the clinical assessment of children with and without ASD.
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Affiliation(s)
- Pou-Leng Cheong
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Hospital, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City, 300, Taiwan, ROC; Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 University Road, Hsinchu, 300, Taiwan, ROC; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Jung-Mei Tsai
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 1, Changde St., Zhongzheng Dist., Taipei City, 100229, Taiwan, ROC.
| | - Lu Lu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 1, Changde St., Zhongzheng Dist., Taipei City, 100229, Taiwan, ROC
| | - Yi-Lun Chiu
- Department of Social Work, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC
| | - Yi-Ting Shen
- Department of Psychology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan, ROC
| | - Yao-Jen Li
- Insititute of Epidemiology and Prevention Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC
| | - Chih-Hsuan Tsao
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC; Department of Foreign Languages and Literatures, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC
| | - Yi-Chung Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 10617, Taiwan, ROC
| | - Fu-Mei Chang
- Department of Clinical Psychology, Songde Branch, Taipei City Hospital, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan, ROC
| | - Yen-Hsun Huang
- Being Alive Clinic, 1F., No. 6-1, Ln. 38, Sec. 2, Nangang Rd., Nangang Dist., Taipei City, 115028, Taiwan, ROC; Department of Clinical Psychology, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 242062, Taiwan, ROC
| | - Chia-Wei Sun
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 University Road, Hsinchu, 300, Taiwan, ROC
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DuBay M, Watson LR, Méndez LI, Rojevic C. Psychometric Comparison of the English and Spanish Western-Hemisphere Versions of the Modified Checklist for Autism in Toddlers-Revised. J Dev Behav Pediatr 2021; 42:717-725. [PMID: 34840315 DOI: 10.1097/dbp.0000000000000968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Michaela DuBay
- Speech Communication Disorders Program, Department of Human Services, School of Education and Human Services, University of Virginia, Charlottesville, VA
| | - Linda R Watson
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Lucía I Méndez
- Department of Communication Sciences and Disorders, School of Health and Human Sciences, University of North Carolina, Greensboro, NC
| | - Carolina Rojevic
- Occupational Therapy Department, University of California at San Francisco Benioff Children's Hospital, Oakland, CA
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Pierce K, Gazestani V, Bacon E, Courchesne E, Cheng A, Barnes CC, Nalabolu S, Cha D, Arias S, Lopez L, Pham C, Gaines K, Gyurjyan G, Cook-Clark T, Karins K. Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis. J Pediatr 2021; 236:179-188. [PMID: 33915154 DOI: 10.1016/j.jpeds.2021.04.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the impact of a new approach, Get SET Early, on the rates of early autism spectrum disorder (ASD) detection and factors that influence the screen-evaluate-treat chain. STUDY DESIGN After attending Get SET Early training, 203 pediatricians administered 57 603 total screens using the Communication and Symbolic Behavior Scales Infant-Toddler Checklist at 12-, 18-, and 24-month well-baby examinations, and parents designated presence or absence of concern. For screen-positive toddlers, pediatricians specified if the child was being referred for evaluation, and if not, why not. RESULTS Collapsed across ages, toddlers were evaluated and referred for treatment at a median age of 19 months, and those screened at 12 months (59.4% of sample) by 15 months. Pediatricians referred one-third of screen-positive toddlers for evaluation, citing lack of confidence in the accuracy of screen-positive results as the primary reason for nonreferral. If a parent expressed concerns, referral probability doubled, and the rate of an ASD diagnosis increased by 37%. Of 897 toddlers evaluated, almost one-half were diagnosed as ASD, translating into an ASD prevalence of 1%. CONCLUSIONS The Get SET Early model was effective at detecting ASD and initiating very early treatment. Results also underscored the need for change in early identification approaches to formally operationalize and incorporate pediatrician judgment and level of parent concern into the process.
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Affiliation(s)
- Karen Pierce
- Department of Neurosciences, University of California, San Diego, La Jolla, CA.
| | - Vahid Gazestani
- Department of Neurosciences, University of California, San Diego, La Jolla, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Elizabeth Bacon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Eric Courchesne
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Amanda Cheng
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | | | - Srinivasa Nalabolu
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Debra Cha
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Steven Arias
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Linda Lopez
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Christie Pham
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Kim Gaines
- San Diego Regional Center, San Diego, CA
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12
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Wang LJ, Tsai ZY, Chang LS, Kuo HC. Cognitive development of children with Kawasaki disease and the parenting stress of their caregivers in Taiwan: a case-control study. BMJ Open 2021; 11:e042996. [PMID: 34083326 PMCID: PMC8183223 DOI: 10.1136/bmjopen-2020-042996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute form of febrile vasculitis that occurs in early childhood. The multisystemic vasculitis common in patients with KD may influence blood perfusion in the brain, and thus caregivers of children with KD may feel stress with regard to caring for them. Intravenous immunoglobulin (IVIG) infusion is the standard treatment for acute KD, and the most serious complication of KD is coronary artery aneurysms (coronary artery lesion (CAL)). This study aimed to investigate the relationships between KD heterogeneity and the risk of patients' cognitive impairment or caregivers' parenting stress. DESIGN A case-control study with consecutive sampling. SETTING A medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan). PARTICIPANTS This study consisted of 176 patients with KD (mean age: 5.5 years, 60.8% boys) and 85 healthy children (mean age: 6.4 years, 54.1% boys). PRIMARY AND SECONDARY OUTCOME MEASURES Based on the children's age, each patient with KD and control subject was administered an assessment using the Mullen Scales of Early Learning or the Wechsler Intelligence Scale, and parenting function of their caregivers was assessed using the Parenting Stress Index (PSI)-Short Form. RESULTS We observed no significant differences in any developmental index, cognitive function or parenting stress between patients with KD and controls. Among the children with KD, IVIG administration nor CAL was associated with children's cognitive scores. However, the caregivers of patients who had CAL suffered from greater PSI total scores than those of patients without CAL. Furthermore, the caregivers who had education levels of a master's degree or above showed less parenting stress than those who had an education level of college or lower. CONCLUSION Caregivers' education is associated to parenting stress, and caregivers of patients with KD who developed CAL may feel stress about the unpredictable sequela caused by CAL for their children. Such caregivers may require support to fulfil their parenting roles.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Kaohsiung, Taiwan
| | - Zi-Yu Tsai
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
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13
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Wu YT, Tsao CH, Huang HC, Yang TA, Li YJ. Relationship Between Motor Skills and Language Abilities in Children With Autism Spectrum Disorder. Phys Ther 2021; 101:6124061. [PMID: 33522583 DOI: 10.1093/ptj/pzab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 10/08/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Few studies have examined the relationship between language abilities and specific motor skills in toddlers with autism spectrum disorder (ASD). The aim of this study was to compare the relationship of receptive language (RL) and expressive language (EL) abilities with motor functioning in toddlers with ASD aged 24 to 36 months and their peers with typical development (TD). Furthermore, the study compared multidimensional motor functioning in toddlers with ASD with delayed RL and EL development and toddlers with ASD and typical RL and EL development. The predictive powers of the motor skills were examined for the group with delayed RL and EL development. METHODS The language abilities of 38 toddlers with ASD and 38 age-matched toddlers with TD were evaluated using the Receptive and Expressive Language Subscales of the Mullen Scale of Early Learning, and their motor skills were assessed using the Peabody Developmental Motor Scales, Second Edition. RESULTS Significant correlations between language ability and motor functioning were observed in the ASD and TD groups. The ASD group with delayed RL and EL development had lower scores for multidimensional motor functioning than the ASD group with typical RL and EL development and the TD group. Moreover, the risks of delayed EL and RL development could be predicted by the lower motor scores in toddlers with ASD. CONCLUSIONS The positive correlation between language abilities and motor functioning in toddlers with ASD indicated potential connections between the early onsets of motor and speech-language impairments in these toddlers. IMPACT The results may have implications for the development of motor-based interventions targeting language development in young children with ASD.
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Affiliation(s)
- Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsuan Tsao
- Department of Foreign Languages and Literatures, National Taiwan University, Taipei, Taiwan.,Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Ching Huang
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Tian-Ai Yang
- Department of Guidance and Counseling, National Changhua University of Education, Chunghua, Taiwan
| | - Yao-Jen Li
- Insititute of Epidemiology and Prevention Medicine, National Taiwan University, Taipei, Taiwan
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14
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Dai YG, Porto KS, Skapek M, Barton ML, Dumont-Mathieu T, Fein DA, Robins DL. Comparison of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) Positive Predictive Value by Race. J Autism Dev Disord 2021; 51:855-867. [PMID: 32125566 PMCID: PMC7483574 DOI: 10.1007/s10803-020-04428-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Yael G Dai
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
| | - Katelynn S Porto
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Mary Skapek
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Marianne L Barton
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Thyde Dumont-Mathieu
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Deborah A Fein
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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15
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Oner O, Munir KM. Modified Checklist for Autism in Toddlers Revised (MCHAT-R/F) in an Urban Metropolitan Sample of Young Children in Turkey. J Autism Dev Disord 2020; 50:3312-3319. [PMID: 31414260 DOI: 10.1007/s10803-019-04160-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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 6712 children between ages 16 and 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.
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Affiliation(s)
- Ozgur Oner
- Department of Child Psychiatry, Bahcesehir University School of Medicine, Istanbul, Turkey.
| | - Kerim M Munir
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Yang YC, Lu L, Jeng SF, Tsao PN, Cheong PL, Li YJ, Wang SY, Huang HC, Wu YT. Multidimensional Developments and Free-Play Movement Tracking in 30- to 36-Month-Old Toddlers With Autism Spectrum Disorder Who Were Full Term. Phys Ther 2019; 99:1535-1550. [PMID: 31392998 DOI: 10.1093/ptj/pzz114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/28/2019] [Accepted: 03/31/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few studies have investigated multidimensional developments and free-play movement performance in toddlers with an early diagnosis of autism spectrum disorder (ASD). OBJECTIVE This study compared cognitive, motor, and behavioral developments and free-play movement performance in toddlers with ASD who were full term (FT-ASD), toddlers who were full term and are typically developing (FT-TD), and toddlers who were born preterm and had a very low birth weight (VLBW-PT). DESIGN This was a prospective cross-sectional study. METHODS Forty-five 30- to 36-month-old age-matched toddlers were recruited and divided into FT-ASD, FT-TD, and VLBW-PT groups. Their developments were examined using the Mullen Scales of Early Learning; the Peabody Developmental Motor Scales, Second Edition; the Child Behavior Checklist for Ages 1.5 to 5; and the Repetitive Behavior Scale-Revised. In addition, the toddlers' free-play movements were tracked in laboratory settings using an automatic movement tracking system. RESULTS Toddlers with FT-ASD exhibited lower cognitive and motor scores and a higher degree of behavioral problems compared with toddlers with FT-TD or VLBW-PT. Furthermore, the movement tracking data in a free-play setting revealed that toddlers with FT-ASD displayed a higher degree of turning velocity, a higher moving time, and a higher frequency of moving toward the peripheral region compared with toddlers with FT-TD or VLBW-PT. Moreover, several motor developmental and movement-tracking indicators were found to correlate with behavioral problems and cognitive scores in toddlers with FT-ASD. LIMITATIONS The study results may have been affected by the small sample size, the cross-sectional design, and tracking only the whole body without subtle movements or segmental motions. CONCLUSIONS The findings suggest varied aspects of co-occurring developmental conditions and movement-based problems in toddlers with FT-ASD. Using standardized and sensitive measures for the early assessment of perceptuo-motor impairments is necessary for timely early intervention for such toddlers.
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Affiliation(s)
- Yu-Ching Yang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu Lu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Children Hospital, Taipei, Taiwan
| | - Pou-Leng Cheong
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yao-Jen Li
- Institute of Epidemiology and Prevention Medicine, National Taiwan University
| | - Shih-Ya Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
| | - Hsiao-Ching Huang
- School and Graduate Institute of Psychology, National Taiwan University
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Room 317, Floor 3, No. 17, Xu-Zhou Road, Taipei 10055, Taiwan; and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital
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