Marryat Jane, Davis Naomi O, Lerebours Reginald, Carpenter Kimberly L H, Compton Scott, Eichner Brian, Franz Lauren, Kollins Scott H, Spanos Marina, Dawson Geraldine
Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC, 27705, USA.
Department of Biostatistics and Bioinformatics, Duke University, 415 Chapel Drive, Durham, NC, 27705, USA.
J Autism Dev Disord. 2024 Jul 12. doi: 10.1007/s10803-024-06453-9.
Early detection and intervention are associated with improved outcomes for autistic children. Thus, it is important to understand factors influencing early screening tools designed to detect autism. This study examined the relationship between caregiver-reported emotional and behavioral symptoms and children's scores on a commonly used autism screening questionnaire, the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F).
Toddlers were recruited from four primary care clinics between 2018 and 2021. Their caregivers completed the M-CHAT-R/F as well as the Child Behavior Checklist (CBCL), a well-validated, normed measure of emotional and behavioral functioning. Correlational and group analyses were evaluated to examine relationships between CBCL scales and M-CHAT-R/F scores.
1765 toddlers were recruited for the study. CBCL scores for the internalizing, externalizing, autism, ADHD, and anxiety scales were all modestly positively correlated with M-CHAT-R/F scores. Compared to toddlers with elevated autism scale scores only, toddlers with elevations in both autism and ADHD/externalizing scales had higher M-CHAT-R/F scores. In contrast, no significant difference in scores were found between toddlers with elevated autism scale scores only compared to those with elevated scores on both autism and internalizing scales.
Findings suggest that, for children with elevated autism behaviors, the presence of externalizing symptoms, including ADHD-related concerns, is associated with elevated scores on the M-CHAT-R/F. In contrast, internalizing symptoms did not show an association with elevated M-CHAT-R/F scores among toddlers with elevated autism-related behaviors. Interpretation of the M-CHAT-R/F should include consideration of co-occurring psychiatric conditions, especially externalizing conditions such as ADHD.
早期发现和干预与自闭症儿童改善的预后相关。因此，了解影响旨在检测自闭症的早期筛查工具的因素很重要。本研究考察了照顾者报告的情绪和行为症状与儿童在常用的自闭症筛查问卷《幼儿自闭症修正检查表-修订版及随访》（M-CHAT-R/F）上的得分之间的关系。
2018年至2021年期间从四家初级保健诊所招募幼儿。他们的照顾者完成了M-CHAT-R/F以及儿童行为检查表（CBCL），这是一种经过充分验证且有常模的情绪和行为功能测量工具。进行相关性分析和组间分析以考察CBCL各量表与M-CHAT-R/F得分之间的关系。
1765名幼儿被纳入本研究。内化、外化、自闭症、注意力缺陷多动障碍（ADHD）和焦虑量表的CBCL得分均与M-CHAT-R/F得分呈适度正相关。与仅自闭症量表得分升高的幼儿相比，自闭症和ADHD/外化量表得分均升高的幼儿M-CHAT-R/F得分更高。相比之下，仅自闭症量表得分升高的幼儿与自闭症和内化量表得分均升高的幼儿之间在得分上未发现显著差异。
研究结果表明，对于自闭症行为得分升高的儿童，外化症状的存在，包括与ADHD相关的问题，与M-CHAT-R/F得分升高有关。相比之下，在自闭症相关行为得分升高的幼儿中，内化症状与M-CHAT-R/F得分升高没有关联。对M-CHAT-R/F的解读应包括考虑共病的精神疾病状况，尤其是ADHD等外化性疾病。
