Sangare Modibo, Toure Hamza B, Toure Amadou, Karembe Adama, Dolo Housseini, Coulibaly Yaya I, Kouyate Modibo, Traore Kadiatou, Diakité Seidina A, Coulibaly Souleymane, Togora Arouna, Guinto Cheick Oumar, Awandare Gordon A, Doumbia Seydou, Diakite Mahamadou, Geschwind Daniel H
Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali.
West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana.
eNeurologicalSci. 2019 Mar 11;15:100188. doi: 10.1016/j.ensci.2019.100188. eCollection 2019 Jun.
Early screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention. ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized that their use in Mali may require a prior validation.
To validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social communication questionnaire (SCQ) in the Malian sociocultural context for ASD screening.
We administered M-CHAT-R and SCQ in 947 toddlers aged 16-30 months old at the district and community health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged ≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated for cultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined for both M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-R and SCQ for ASD screening in Bamako.
We found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of 87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have found four out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context.
M-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train a descent number of Malian physicians in chief and pediatricians at the district hospitals across the country to integrate the early ASD screening into the national health system.
M-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali.
早期筛查对于自闭症谱系障碍（ASD）的早期诊断和干预至关重要。ASD筛查工具大多是基于西方文化背景构建的。我们推测在马里使用这些工具可能需要事先进行验证。
在马里社会文化背景下验证用于ASD筛查的改良版幼儿自闭症检查表修订版（M-CHAT-R）和社会沟通问卷（SCQ）。
我们在巴马科的地区和社区卫生中心对947名16至30个月大的幼儿进行了M-CHAT-R和SCQ测试，并在巴马科的精神科对120名年龄≥4岁的患者（60名自闭症患者和60名年龄及性别匹配的对照）进行了测试。ASD中度至高度风险的幼儿接受了M-CHAT-R/F测试以及由ASD多学科团队进行的临床评估。马里人类学家对M-CHAT-R和SCQ的文化适宜性进行了评估。确定了M-CHAT-R和SCQ的敏感性、特异性、阳性预测值和阴性预测值。在ASD研讨会上，卫生专业人员接受了关于如何在巴马科使用M-CHAT-R和SCQ进行ASD筛查的培训。
我们发现M-CHAT-R的敏感性为50%，特异性为100%，阳性预测值为100%，阴性预测值为87%。SCQ的敏感性为71%，特异性为72%，阳性预测值为73%，阴性预测值为70%。我们发现M-CHAT-R的20个项目中有4个在马里背景下文化上不合适。
M-CHAT-R和SCQ可用于马里的早期自闭症筛查。未来，我们计划在全国各地区医院培训相当数量的马里主任医师和儿科医生，将早期ASD筛查纳入国家卫生系统。
M-CHAT-R在马里对ASD具有完美的特异性，SCQ具有相当的诊断准确性。
