Revised Screening Tool Detects Autism Earlier

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Harvard Medical School
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Revised Screening Tool Detects Autism Earlier

News from Harvard Medical School

December 23, 2013

News Review From Harvard Medical School -- Revised Screening Tool Detects Autism Earlier

A revised version of a commonly used screening tool for autism spectrum disorders (ASDs) can improve early detection of ASD in toddlers, says a new study. The Modified Checklist for Autism in Toddlers (M-CHAT) is one of the most widely used screening tools for ASD in the United States. The American Academy of Pediatrics recommends that toddlers be screened at their 18- and 24-month well-child visits. The earlier ASD can be detected, the better the outcomes. Researchers made some changes to the M-CHAT to improve its ability to detect ASD in toddlers. They tested the new version on 16,115 toddlers. It detected ASD at a higher rate and 2 years earlier compared to the original version of the screening tool. The journal Pediatrics published the study.

By Henry H. Bernstein, D.O.
Harvard Medical School


What Is the Doctor's Reaction?

No parent wants to hear his or her child may have autism. This could mean raising a child who has different behaviors, interests and activities, along with communication difficulties and poor social skills. 

Autism is a brain development problem that starts early in life. It is much more common than it used to be. Almost 1 in 88 children have it. This has more and more parents worried. 

Autism Spectrum Disorder (ASD) can range anywhere from mild to severe. Signs of ASD are usually seen before the age of 3. If a child has autism, it is important to get help as soon as possible. Making the right diagnosis is not easy to do. Most children with ASD are not diagnosed until after their fourth birthday. 

The American Academy of Pediatrics recommends that pediatricians check all children for ASD at their 18- and 24-month checkups. The M-CHAT (Modified Checklist for Autism in Toddlers) with Follow-Up is a commonly used tool to do so. It involves 2 stages:

    1. A parent answers 20 yes-or-no questions that takes less than 5 minutes.
    2. If these answers suggest a concern (the child screens positive), the parent is asked more follow-up questions. These provide more information and examples of at-risk behaviors in the child.

A new study from the journal Pediatrics looked at an improved version called the M-CHAT-R/F. The R stands for "revised." Compared with the old one, the revised M-CHAT-R/F:

  • Lists questions in a different order
  • Removed some items that were not helpful for screening
  • Uses simpler words
  • Is easier for parents to understand 

Over 16,000 toddlers were screened with the M-CHAT-R/F.  Children who tested positive on both parts were referred to an expert to try to make a clear diagnosis. Researchers found:

  • About 1 in 2 children who tested positive on both screening steps were then diagnosed with ASD.
  • The new version was able to diagnose children with ASD 2 years earlier than usual. 

The researchers then compared the M-CHAT-R/F to the original screening tool. They found it:

  • Was much better at detecting ASD
  • Lowered the number of children needing the follow-up step
  • Decreased the number of false positives (children who screened positive, but ended up not having ASD) 

The researchers think the M-CHAT-R/F works well in screening young children for ASD. It appears doctors (and families) can be confident that this revised version:

  • Works better than previous version
  • Takes less time to use in the doctor's office
  • Does not cost a lot of money


What Changes Can I Make Now?

 The first few years of your child's life are key parts of their development. This is when he or she will find out how to play, learn, speak, behave and move. Here are some things you can do to help your young child's development:

  • Have a safe and loving home.
  • Make sure your child eats healthy foods.
  • Read often to your child.
  • Play with your child.
  • Sing or play music for your child. 

Checkups with the doctor are important times to see how well your child is developing. At each visit, the doctor will:

  • Ask about the skills your child has gained so far
  • Check for developmental problems (like ASD) and screen for it at certain times
  • Tell you what to expect at each age and how to help your child develop on target 

Remember, you know your child best. If you think there might be a problem with your child's development, talk about it with your doctor. Share any concerns. Do not wait! 

Autism is complex. It involves many areas of the brain. Signs of ASD to look out for are:

  • Repetitive behaviors (for example, hand flapping or rocking)
  • Delayed language skills
  • Delayed fine motor skills
  • Lack of eye contact
  • Anti-social behavior

If your child has ASD or any developmental problem, the doctor will work with you to help your child reach his or her full potential. You can get help to address your child's special needs. This might include therapy to improve speech, life skills and social skills.


What Can I Expect Looking to the Future?

You can expect your doctor to talk about your child's development at every checkup. Your child should be screened for ASD and other developmental problems with the M-CHAT-R/F, usually at 18 and 24 months of age.   

More research is needed on using the improved M-CHAT-R/F with high-risk populations (for example, children with older siblings already diagnosed with ASD). In addition, researchers will keep looking at which screening questions are best at finding children that need to be referred.

Last updated December 23, 2013

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