Department of Psychology, Georgia State University, PO Box 5010, Atlanta, GA 30302-5010.
Pediatrics. 2014 Jan;133(1):37-45. doi: 10.1542/peds.2013-1813. Epub 2013 Dec 23.
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.
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.
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.
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.
本研究验证了改良版孤独症幼儿检查表修订版（M-CHAT-R/F），这是一种用于低风险幼儿的筛查工具，并证明其比原始 M-CHAT 具有更好的实用性。
在亚特兰大市区和康涅狄格州的 18 个月和 24 个月的儿童常规保健访视中对幼儿进行了筛查。M-CHAT-R 显示有风险的幼儿的父母完成了随访；那些继续显示出风险的儿童则接受了评估。
M-CHAT-R/F 的可靠性和有效性得到了证明，并通过使用受试者工作特征曲线确定了最佳评分。最初总分为≥3 分且随访后≥2 分的儿童，其患自闭症谱系障碍（ASD）的风险为 47.5%（95%置信区间：0.41-0.54），任何发育迟缓或发育问题的风险为 94.6%（95%置信区间：0.92-0.98）。总评分比其他评分更有效。建议使用基于 3 个风险水平的算法，以最大限度地提高临床实用性，降低诊断年龄和早期干预的开始时间。与 M-CHAT 相比，M-CHAT-R 能更高地检出 ASD，同时也减少了需要随访的儿童数量。本研究中的儿童比全国平均诊断年龄提前 2 年被诊断出患有 ASD。
M-CHAT-R/F 可以在幼儿中检测出许多 ASD 病例；使用两阶段筛查器的医生可以确信，大多数筛查阳性的病例都需要评估并转介进行早期干预。与最近的监测结果相比，广泛实施普遍筛查可以将 ASD 的诊断年龄降低 2 年，从而为早期干预提供更多时间。
