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Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
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OBJECTIVE: This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT. METHODS: Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated. RESULTS: The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis. CONCLUSIONS: The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.
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“mild early language delays are quite common in many conditions and are not specific to autism (Robins et al. 2014, Wetherby et al. 2002)”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Robins et al. 2014
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“Specifically, the original MCHAT-R/F validation study found that a positive screen relates to a 47.5% risk of autism and a much higher (94.6%) risk of any developmental disorder (Robins et al., 2014).”
From Parenting Stress, Child Social Functioning, and Part C Early Intervention in Predominantly Low-Income Families of Children With or at High Risk for Developmental Delay From Minoritized Racial and Ethnic Groups (2023) · cites this paper as Robins et al., 2014
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“Study personnel re-administered the M-CHAT-R/F (Robins et al., 2014) following standard procedures to all potentially eligible families to ensure its standard administration and invited those with positive screens to participate.”
From Parenting Stress, Child Social Functioning, and Part C Early Intervention in Predominantly Low-Income Families of Children With or at High Risk for Developmental Delay From Minoritized Racial and Ethnic Groups (2023) · cites this paper as Robins et al., 2014
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“It has been shown that universal early autism-specific screening can decrease the average age of diagnosis (Robins et al., 2014)”
From Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers (2026) · cites this paper as Robins et al., 2014
In the citing paper
“Studies demonstrate that ASD risk can be measured as young as 12 to 24 months using parent report screening tools such as the CSBS IT-Checklist and M-CHAT at well-baby check-ups with follow-up confirmation at ASD specialty clinics [179, 180].”
From The ASD Living Biology: from cell proliferation to clinical phenotype (2019) · cites this paper as [180]
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“yet most screening studies9,10,41,42 validate diagnoses only once, usually at approximately the age of screening, leaving unclear the degree to which an initial diagnosis persists at later ages.”
From Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months (2019) · cites this paper as [10]
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Metadata
- Authors
- Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D.
- Affiliations
- Georgia State University (US)
- University of Connecticut (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2013-12-23
- Volume
- 133
- Issue
- 1
- Pages
- 37-45
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3876182
- OpenAlex
- W2137207936
- Cited by
- 1,081
- References
- 36
- Citations by year
- 2026: 107 · 2025: 85 · 2024: 127 · 2023: 113 · 2022: 94 · 2021: 118 · 2020: 97 · 2019: 85 · 2018: 84 · 2017: 44 · 2016: 56 · 2015: 43 · 2014: 23 · 2013: 2
- FWCI
- 22.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD039961)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- M-CHAT-R/F, autism spectrum disorder, autism screening, toddlers, screening validity, developmental delay, early intervention, age at diagnosis, universal screening, well-child care
- MeSH terms
- Algorithms, Developmental Disabilities, Child Development Disorders, Pervasive, Child, Preschool, Decision Support Techniques, Female, Follow-Up Studies, Humans, Infant, Male, Psychological Tests, ROC Curve, Reproducibility of Results, Early Diagnosis, Checklist
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