The Clinical Utility of the Modified Checklist for Autism in Toddlers with High Risk 18–48 Month Old Children in Singapore

The modified checklist for autism in toddlers (M-CHAT) is a tool developed for 16–30 month old children to screen for autism spectrum disorders (ASD). It is a well-researched tool, but little is known about its utility with Singaporean toddlers and with older children referred for developmental concerns. This study investigated the M-CHAT’s performance with 18–30 month old (N = 173) and >30–48 month old (N = 407) developmentally at-risk Singaporean children, when used with three recommended scoring methods i.e., the total, critical and Best7 scoring methods. The results indicate that the critical and Best7 scoring methods detected most true cases of ASD without inflating the false positive rates in toddlers, and that only the total scoring method performed acceptably for the older children.     

Effectiveness of Using the Modified Checklist for Autism in Toddlers in Two-Stage Screening of Autism Spectrum Disorder at the 18-Month Health Check-Up in Japan

To determine whether the Modified Checklist for Autism in Toddlers (M-CHAT) in conjunction with the routine 18-month health check-up identifies Japanese toddlers with autism spectrum disorder (ASD). Two-stage screening using the M-CHAT was conducted with 1,851 children attending the check-up. Final ASD diagnosis was confirmed at age ≥3 years. Screening identified 20/51 children with ASD: 12/20 true positives were developmentally delayed, whereas 16/22 false negatives were high-functioning. Sensitivity was 0.476, specificity 0.986, positive predictive value 0.455, and likelihood ratio 33.4 for children with ASD. With a few modifications, M-CHAT screening successfully detected toddlers with ASD with and without developmental delay and is a promising screening tool to complement existing community surveillance.     

Reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT)

Early detection and intervention is essential for children with autism spectrum disorders (ASD). Therefore, we examined the reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT), a 23-item, yes–no questionnaire regarding early autistic symptoms completed by parents of children at 18–24 months of age. Herein, the reliability of the M-CHAT was investigated for children 4–20 months of age. The M-CHAT score (the number of failed items) was found to be significantly correlated among 24 mother–father pairs (Pearson's r = .933), representing good inter-rater reliability. The test–retest reliability was satisfactory, with 22 mothers providing almost equal M-CHAT scores on two different occasions (r = .990). Significant correlations were observed between the M-CHAT score and the Childhood Autism Rating Scale-Tokyo version score in 25 two-year-old children (r = .581), indicating good concurrent validity. The M-CHAT score was significantly higher in 20 children later diagnosed with ASD compared with reference children (n = 1167), revealing sufficient discriminant validity. A short version of the M-CHAT using 9 items was proposed and effectively differentiated children with ASD from reference children. The efficacy of the Japanese version of the M-CHAT was demonstrated for first-level screening in the general population.     

Urban and Education Disparity for Autism Spectrum Disorders in Taiwan Birth Cohort Study

This study aimed to determine the optimal cut-off for autism spectrum disorder (ASD) screening in 66-month-old children, and to explore the distribution of ASD screening and diagnosis in Taiwan. The Taiwan Birth Cohort Study dataset was used (N?=?20,095). The Modified Checklist for Autism in Toddlers (M-CHAT) cut-off point of 13/14 was considered optimal for screening of children at 66 months. More children were diagnosed with ASD in urban areas. Parents of children diagnosed with ASD had a higher level of education, but parents of children with a lower level of education were screened as being at higher risk of ASD. Urban disparity and parental level of education effected parental awareness of the illness and the rate of ASD diagnosis.     

The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders

Autism spectrum disorders (ASD) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to screen 3,793 children aged 16–30 months from low- and high-risk sources; screen positive cases were diagnostically evaluated. Re-screening was performed on 1,416 children aged 42–54 months. Time1 Positive Predictive Value (PPV) was .36 for the initial screening and .74 for the screening plus follow-up telephone interview; values were similar for Time2 PPV. When separating referral sources, PPV was low for the low-risk sample but acceptable with the follow-up telephone interview. Children with ASD from the low-risk and high-risk samples were highly similar. Results indicate that the M-CHAT continues to be a promising instrument for the early detection of ASD.     

The French Version of the Modified-Checklist for Autism in Toddlers (M-CHAT): A Validation Study on a French Sample of 24 Month-Old Children

Early ASD screening has the potential to reduce delays between initial parental concerns and diagnosis, and promote early intervention. The aim of this study was to validate the M-CHAT on a French population sample of 24 month-old children. This study included a low-risk sample of 1227 children. A total of 20 children screened positive on the M-CHAT. Twelve out of 20 of these children received a diagnosis of ASD at 36 months, yielding a PPV of 0.60. These results add to the evidence that the M-CHAT is a useful screening instrument and further demonstrates the importance of the follow-up interview in primary care settings. This study provides French practitioners with guidelines regarding the use of the M-CHAT at 24 months.     

Modified Checklist for Autism in Toddlers: Cross-Cultural Adaptation and Validation in Spain

Early detection and treatment have been shown to be effective in reducing disability severity caused by Autistic Spectrum Disorders (ASDs). As Spanish pediatricians have no detection tool, the Modified Checklist for Autism in Toddlers (M-CHAT) was first translated into and culturally adapted to Spanish. Validity and reliability studies were carried out in two different geographical areas of Spain, where M-CHAT was administered to two different samples, namely: 2,480 high- and low-risk children; and 2,055 low-risk children. The results obtained were similar to those yielded by the original M-CHAT studies. Differences were found in positive predictive value, due to the low ASD frequency observed in this study. M-CHAT is still being studied in a large population-based screening program in Spain.     

A new screening programme for autism in a general population of Swedish toddlers

The evidence from early intervention studies of autism has emphasised the need for early diagnosis. Insight into the early presentation of autism is crucial for early recognition, and routine screening can optimise the possibility for early diagnosis. General population screening was conducted for 2.5-year-old children at child health centres in Gothenburg, Sweden, and the efficacy of the screening instruments in predicting a clinical diagnosis of autism was studied. The tools used for autism screening comprised the Modified Checklist for Autism in Children (M-CHAT) and an observation made by trained nurses of the child's joint attention abilities (JA-OBS). From the new screening procedure a "definitive" suspicion of autism spectrum disorder (ASD) was raised in 64 individuals in the study population of 3999 young children. Fifty-four of these were clinically assessed in detail. Forty-eight children had a confirmed diagnosis of ASD, three had severe language disorder, and three (6%) were classified as having typical development. The Positive predictive Value (PPV) for the combination of M-CHAT and the JA-OBS was 90%. The combination of instruments used showed promise for early detection of autism as a routine in the developmental programme at child health centres. Trained medical staff is a basic requirement and enables earlier detection and the use of screening tools beyond routine population screening regardless of the age at which a suspicion of autism is raised.     

Teacher Competence of Delivery of BEST in CLASS as a Mediator of Treatment Effects

This study investigated if training and practice-based coaching in an evidence-based program was associated with higher observed treatment integrity (adherence and competence) and if these treatment integrity components were associated with teacher report of child behavioral outcomes in the BEST in CLASS efficacy trial. Participants were 462 children (M = 4.32 years, SD = 0.53; 65% male; 17.0% Caucasian, 66.0% African-American, 5.0% Hispanic, and 12.0% other) identified as having problem behavior and their 185 teachers (M = 12.09 years teaching experience; 99% female; 47.0% Caucasian, 48.0% African-American, 1.0% Asian/Pacific Islander, 3.0% Hispanic and 1.0% other). Teachers and focal children were randomly assigned to the intervention (teacher n = 92, children n = 230) or control condition (teacher n = 93, child n = 232). Results of a multilevel mediation analysis indicated that the BEST in CLASS intervention had a positive effect on teacher report of child problem behavior (SSIS-RS) and externalizing problems (C-TRF), as well as having a positive effect on teachers’ adherence and competence of delivery of the intervention. There was an indirect effect through competence of delivery for externalizing problems, but not problem behavior. No indirect effects for adherence were found. Implications of these findings and directions for future research are discussed.     

Examination of the Properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in a Population Sample

This study examines the following properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in an unselected low-risk sample: (a) the maximum age for screen administration; (b) the positive screen rate in the absence of follow-up telephone interviews and; (c) the distributional properties of positive screens. Data came from a prospective cohort study (n = 1,604). Results suggest that the M-CHAT can appropriately be administered to children aged 20–48 months. Documented explanations provided by mothers during screening, appear to effectively identify potential screen misclassifications in the absence of the follow-up telephone interviews. This further emphasizes the importance of clinician expertise in verifying positive M-CHAT screens. Results have implications for the administration of the M-CHAT in clinical and research settings.     

Autism-risk screening in the first 3 years of life in Taiwan Birth Cohort Pilot Study

To increase public awareness and sensitivity, a two-stage screening with a community-based approach is proposed, with the use of the broadband Taiwan Birth Cohort Study (TBCS) developmental instrument in the first stage and the narrowband Modified Checklist of Autism in Toddlers (M-CHAT) in the second stage. Thus, the purpose of this study was to use the M-CHAT as the lead criteria in the investigation of whether the TBCS developmental instrument can be used in first-stage detection of autism spectrum disorder (ASD) at 6, 18, and 36 months. The TBCS dataset, which included 1783 children in the first stage, 1620 in the second stage, and 1630 in the third stage was used for this study. The M-CHAT and the TBCS 6, 18 and 36 months’ developmental scales were collected. Using the M-CHAT, 292 (18.0%) children were screened out as being at high risk for ASD; using this as the lead criteria, the cutoff points of 65/66 for the 6 months’ scale, 42/43 for the 18 months’ scale and 51/52 for the 36 months’ scale, with negative predictive values of 83.44%, 84.21% and 85.35%, respectively, were established. With the cutoff points, TBCS developmental instrument can be used as a community-based first-stage screening instrument at 6, 18, and 36 months. Early diagnosis and intervention optimizes the long-term prognosis of ASD and also decreases family stress. Follow-up of these children and further evaluation using standard diagnostic assessments will help us in understanding the accuracy of the TBCS developmental instrument and M-CHAT use in the community.     

Sensitivity and Specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A Community-Based Study

The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxiety disorders (AD). Participants were 119 students aged 9–18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical interview (K-SADS-PL). Forty-four participants had positive diagnosis for at least one AD. The total score of the SCARED significantly differentiated anxious from non-anxious children with an optimal cutoff point of 22 (sensitivity = 81.8 %; specificity = 52.0 %). SCARED subscales of social phobia and separation anxiety disorder, but not generalized anxiety disorder, revealed better discrimination proprieties than total scores to screen for that specific disorder (p < .05). Both total and specific SCARED scores presented moderate sensitivity and specificity for detecting AD in a community sample. Investigators interested in screening for specific AD, rather than the group of AD, may benefit from using the specific subscales.     

The Modified Checklist for Autism in Toddlers: Reliability in a Diverse Rural American Sample

This study investigated the psychometric properties of the modified checklist for autism in toddlers (M-CHAT) in a diverse rural American low-socioeconomic status (SES) sample. Four hundred and forty-seven English (n = 335) and Spanish (n = 112) speaking caregivers completed the M-CHAT during their toddler’s 18- or 24-month well visit in a Southwest Virginia pediatric clinic. The M-CHAT did not show acceptable internal consistency in groups with low maternal education or minority status. Caregivers reporting low maternal education and minority status were more likely to endorse items suggestive of autism. These results indicate that the M-CHAT may require modifications to be more internally consistent and accurate across ethnic and educational groups in rural areas with low levels of SES. Recommendations to increase the utility of the M-CHAT are discussed.     

Panic Disorder in Children and Adolescents with Noncardiac Chest Pain

Adults with panic disorder (PD) often present to medical settings with noncardiac chest pain (NCCP), but less is known about children and adolescents with this complaint. We sought to characterize PD in youth with NCCP and compare features with PD in youth in psychiatric outpatient settings. Using a semi-structured diagnostic interview we evaluated 132 youth (ages 8–17) with NCCP recruited from two medical settings. Twenty-seven (20.5 %) met full DSM-IV criteria for PD, eleven of which were children (<13 years). Most frequent panic symptoms were somatic complaints, although cognitive symptoms were also common. Only 14.8 % had clinically significant agoraphobia. Comorbid anxiety disorders and major depression were common. Overall, clinical features of PD among youth with NCCP are similar to PD in psychiatric settings. Interventions for PD may benefit youth who present initially with NCCP. Systematic psychiatric screening could increase detection of PD and improve care for this population.     

Normative performance of healthy older individuals on the Modified Mini-Mental State (3MS) examination according to ethno-racial group,gender, age,and education level

Objective: To present normative performance data on the Modified Mini-Mental State (3MS) examination for healthy community-dwelling older individuals according to gender, age, education level, and ethno-racial group. Method: More than 19,000 generally healthy older men and women without a diagnosis of dementia were recruited from the general population in Australia and the U.S. for the ASPirin in Reducing Events in the Elderly (ASPREE) study. The 3MS exam was administered as part of the baseline screening and individuals scoring above 77 were eligible to participate. Results: The sample comprised 16,360 Australian whites, 1080 U.S. whites, 895 African-Americans and 316 Hispanic/Latinos. The median age of participants was 74 years (range 65–98), with an average of 12 years of education and 56% were female. Increasing age and fewer years of completed education were associated with lower scores on the 3MS. Women scored higher than men in most age and education categories. Differences across ethno-racial groups were found. With factor analysis, four factors were identified which accounted for 35% of the between-person variance in 3MS scores for white Australians. Conclusions: This large cohort of older individuals provides some of the most comprehensive 3MS normative data to be generated for whites (Australian and U.S.), Hispanic/Latinos and African-Americans, by age, gender, and educational attainment. These findings will serve as important reference standards for monitoring cognitive function in generally healthy older individuals, becoming increasingly important as this fraction of the population increases.     

Prevalence and Incidence of Autism Spectrum Disorder in an Israeli Population

The prevalence of autism spectrum disorders has been steadily rising. In most parts of the world, rates as high as 1 % are reported, including in the United States. In Israel, previously reported prevalence rates have been in the 0.2 % range, and were based on parental reporting of diagnosis. In this study, records from one of the largest Israeli Health Maintenance organizations were used to calculate both incidence and prevalence of autism spectrum disorder (ASD) in Israel. Israeli prevalence of ASD was calculated at 0.48 % for 1–12 years olds and 0.65 % for 8 year old children in 2010, higher than previous Israeli reports, but still lower than prevalence estimates for the US. Incidence calculations ranged from 0.65 to 0.84 per 1,000 children for children 1–12 year olds. Reasons for these differences are suggested and discussed.     

Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30 Weeks’ Gestation

Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test—II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at <?30 weeks’ gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18–36 months. Medical charts were abstracted 3.5 years later and showed that 4% (n?=?24) of children had an ASD diagnosis. BITSEA competence (sensitivity?=?.74; specificity?=?.76) and ASD (sensitivity?=?.70; specificity?=?.73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity?=?.73; specificity?=?.64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings.     

Predictive value of subclinical autistic traits at age 14–15 months for behavioural and cognitive problems at age 3–5 years

It is unclear whether subclinical autistic traits at very young age are transient or stable, and have clinical relevance. This study investigated the relationship between early subclinical autistic traits and the occurrence of later developmental and behavioural problems as well as problems in cognitive and language functioning. Parents of infants aged 14–15 months from the general population completed the Early Screening of Autistic Traits Questionnaire (ESAT). Three groups of children with high, moderate, and low ESAT-scores (total n = 103) were selected. Follow-up assessments included the CBCL 1½–5 at age 3 years, and the SCQ, the ADI-R, the ADOS-G, a non-verbal intelligence test, and language tests for comprehension and production at age 4–5 years. None of the children met criteria for autism spectrum disorder at follow-up. Children with high ESAT-scores at 14–15 months showed significantly more internalizing and externalizing problems at age 3 years and scored significantly lower on language tests at age 4–5 years than children with moderate or low ESAT-scores. Further, significantly more children with high ESAT-scores (14/26, 53.8%) than with moderate and low ESAT-scores (5/36, 13.9% and 1/41, 2.4%, respectively) were in the high-risk/clinical range on one or more outcome domains (autistic symptoms, behavioural problems, cognitive and language abilities). Subclinical autistic traits at 14–15 months predict later behavioural problems and delays in cognitive and language functioning rather than later ASD-diagnoses. The theoretical implications of the findings lie in the pivotal role of early social and communication skills for the development of self-regulation of emotions and impulses. The practical implications bear on the early recognition of children at risk for behavioural problems and for language and cognitive problems.     

Prevalence of intracranial large artery stenosis and occlusion in patients with acute ischaemic stroke or TIA

Intracranial large artery stenosis and occlusion disease has been considered to be the cause of 8–10 % of ischaemic strokes in North America, and 30–50 % of strokes and more than 50 % of transient ischaemic attacks in Chinese population. So far we do not know the real prevalence of intracranial disease (ID) and the distribution of its risk factors in European population. We aimed to determine the prevalence and risk factors of ID in a European stroke population with computed tomography angiography (CTA). A retrospective study of consecutive ischaemic patients at the Stroke Unit of Utrecht, The Netherlands, from September 2006 to August 2008 was conducted. We assessed the presence of occlusion and/or stenosis of intracranial Internal Carotid Artery (ICA) and Middle Cerebral Artery on post-contrast 30-mm reconstruction axial CTA images. We analyzed the proportion of patients with ID, and the association of ID with risk factors and stroke subtype. In 220 patients (187 with stroke, 33 with TIA; mean age was 65 years, 57.3 % were male), intracranial stenosis was found in 6.4 % (95 % CI 3.9–10.4), intracranial occlusion in 34.5 % (95 % CI 28.6–41.0), and both occlusion and stenosis in 2.3 % (95 % CI 1.0–5.2). Multivariate analysis showed that the variables independently associated with ID were: extracranial ICA atherosclerosis (OR, 24.64; 95 % CI 6.30–96.38) and stroke subtypes TACS–PACS (OR, 7.61; 95 % CI 3.31–17.49). In conclusion, prevalence of intracranial stenosis in our study may well be consistent with previous observations in European and non-European population. ID may have been an underestimated condition in ischaemic Caucasian population.     

Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia

Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0–15), median ESS 5 (0–13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea–hypopnea index ≥5/h (median: 20/h [0–79]); 32 % (18/56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients.