According to a new study from the UC Davis MIND Institute
Sacramento, Calif. – New study by UC Davis MIND Institute Researchers and others have found that an autism screening tool widely used in the United States and around the world is effective, but has limitations. The findings highlight the need for providers to use their own judgment and be clear with parents about the limitations of the tool, called the M-CHAT-R/F (Modified Childhood Autism Checklist, revised with follow-up).
Researchers analyzed more than a dozen studies on the screening tool from around the world, which included tens of thousands of children. Their work was recently published American Academy of Pediatrics.
The M-CHAT-R/F is a tool commonly used by pediatricians to screen children for autism worldwide. It includes a set of questions that providers ask parents or caregivers about their children’s development, and usually takes about five minutes to administer. If a child receives a positive screening result, the provider will usually recommend further evaluation.
false flags
The team found that the tool typically flagged children as positive for autistic traits who, after a full evaluation, did not receive an autism diagnosis, even though most had other developmental challenges. In addition, a significant portion of the children who were classified as negative for autistic traits were later diagnosed with autism.
“Although M-CHAT-R/F has a clear role in autism screening, these findings remind clinicians that a positive screen is not equivalent to an autism diagnosis,” said the lead author. Aishwarya Ramkumar, Assistant Professor in the Department of Pediatrics at the National University of Singapore. Ramkumar is also an ITPND (International Training Program in Neurodevelopmental Disabilities) Fellow at the MIND Institute.
“When doctors advise parents and caregivers after a positive screening, they should be clear that the child still needs a final evaluation.”
Autism is a developmental disability that includes differences in the brain. According to the Centers for Disease Control and Prevention, 1 in 36 American children has autism. Individuals with autism may communicate, learn, and behave differently, and their abilities may vary widely. In the United States, the American Academy of Pediatrics recommends screening for autism at 18 and 24 months of age.
Screening tools help identify children who are most likely to have developmental concerns. said Fan Ma, a developmental-behavioral pediatrics fellow at the MIND Institute and co-author of the paper.
Study design and results
The meta-analysis included 13 studies, covering a total of 49,841 children from 10 countries. The studies were conducted between January 2014 and November 2021 and included standard scoring for the M-CHAT-R/F and post-screening assessment of the autism diagnosis.
Among all children, the pooled predictive value, or accuracy of the M-CHAT-R/F in correctly identifying autism, was 57.7%. This means that there is a 57.7% chance of being diagnosed with autism after a ‘positive’ screen. The number differed when the children were grouped. For example, in children with a higher likelihood of developing autism, such as those with an autistic sibling, the predictive value was 75.6%. Among children with no increased likelihood, the predictive value was 51.2%.
The overall negative predictive value was 72.5%. This means that nearly a quarter of those who were marked “negative” after screening received an autism diagnosis after further evaluation.
Ramkumar stresses that service providers should not consider the scan tool as final.
“Clinical evaluation is important, regardless of the results of the M-CHAT-R/F. It is also important to remember that not all children with autism have traits in early childhood, and instead, they may only appear later. A negative screening,” she said. Simultaneously does not necessarily exclude autism.
M-CHAT-R/F
The M-CHAT-R/F is the most popular autism screening tool, but most previous studies have focused on earlier versions of them or included them in their analysis.
early diagnosis
“Early diagnosis of autism is critical to improving outcomes, so we thought it was very important to review the usefulness of this widely used tool for autism screening in young children,” Ramkumar explained. “We recognized the value of assembling a large sample size to guide clinicians regarding the use of the M-CHAT-R/F.”
Ramkumar notes that they only included studies where children who were screened negative for autism also received a full diagnostic evaluation, rather than simply being assumed not to have the condition. However, most studies had small numbers of children who fit this profile.
What do the results mean for healthcare providers?
said the paper’s senior author, Heidi Feldman, professor and chair of the department of developmental behavioral pediatrics at Stanford University. “It is very important for clinicians to carefully consider the results of a screening test, not to worry parents unnecessarily nor to reassure parents inaccurately.”
The authors all stress that individual service provider judgment is key.
“I think the most important takeaway from this study is that M-CHAT-R/F is a screening tool with limitations,” explained Ma. It plays a role in autism screening but is not intended to replace clinical judgment and comprehensive diagnostic evaluation.”
Other study authors included Susan Stewart and Randy Hagerman of the University of California, Davis.
Funding was provided by the National Institutes of Health (UL1 TR001860, P50HD103526) and the Health Resources and Services Administration (T77MC25733, T77MC09796).
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