Ariffin R A, Ismail J, Abd Rahman F N, Wan Ismail W S, Ahmad N, Abdul Ghafar A, Yang W W, Masra F, Kamal Nor N
Child Development Centre (CDC), Department of Pediatrics, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
Department of Pediatrics, Faculty of Medicine, Universiti Sains Islam Malaysia (USIM), Nilai, Malaysia.
Front Pediatr. 2024 Dec 23;12:1384292. doi: 10.3389/fped.2024.1384292. eCollection 2024.
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition diagnosed clinically based on phenotypic characteristics and criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Due to its significant social, emotional, and psychological impacts, early identification and diagnosis are crucial for starting early intervention and improving outcomes. A screening tool is imperative in identifying young children at risk so timely intervention can be instituted. The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a reliable and valid screening tool used worldwide, with the previous iteration used for a long time in Malaysia. To enhance ASD screening in Malaysia, the latest version of M-CHAT-R/F was translated into Malay and evaluated for reliability and validity, as majority of the population speaks Malay, while the tool is originally in English. This study is a cross-sectional study performed in the Universiti Kebangsaan Malaysia (UKM) hospitals, between May 1st, 2020, to June 30th, 2022.
The English version of the M-CHAT-R/F was translated into Malay using forward and backward translation methods. Content and face validity were ascertained and a pilot study was performed for internal reliability. A total of 244 children attending clinics and wards in UKM hospitals aged 16-30 months were recruited based on three categories: children with typical development, suspected cases, and established cases of ASD. All caregivers of the recruited children were asked to complete the Malay M-CHAT-R/F. Reliability and validation assessments were performed.
Malay M-CHAT-R/F was found to be a reliable tool with good internal consistency (Cronbach's alpha = 0.906, < 0.001). The Receiver Operating Characteristic (ROC) curve showed that cut-off scores of 2 on Malay M-CHAT-R/F lead to successful ASD classification with Area Under the Curve (AUC) = 0.887, < 0.001 with a 95% CI (0.840, 0.933).
The assessment of the Malay M-CHAT-R/F showed satisfactory psychometric properties. Based on this study, the Malay M-CHAT-R/F is a reliable and valid screening tool to screen for ASD in children aged 16-30 months. Translating the M-CHAT-R/F into Malay is expected to improve community outreach and screening, which is essential for early diagnosis and timely intervention for children with ASD in Malaysia.
自闭症谱系障碍（ASD）是一种异质性神经发育疾病，临床上依据诸如《精神疾病诊断与统计手册》（DSM - 5）中的表型特征和标准进行诊断。由于其对社会、情感和心理有重大影响，早期识别和诊断对于开展早期干预及改善预后至关重要。一种筛查工具对于识别有风险的幼儿必不可少，这样才能及时进行干预。改良幼儿自闭症检查表（修订版及随访版，M-CHAT-R/F）是一种在全球范围内使用的可靠且有效的筛查工具，其先前版本在马来西亚已使用很长时间。为加强马来西亚的ASD筛查，鉴于该国大多数人口讲马来语，而该工具原本是英文的，因此将M-CHAT-R/F的最新版本翻译成马来语并对其可靠性和有效性进行评估。本研究是一项横断面研究，于2020年5月1日至2022年6月30日在马来西亚国民大学（UKM）医院开展。
采用正向和反向翻译方法将M-CHAT-R/F的英文版翻译成马来语。确定了内容效度和表面效度，并进行了内部信度的预试验。根据三类招募了244名年龄在16 - 30个月的UKM医院门诊和病房患儿：发育正常儿童、疑似病例和确诊的ASD病例。要求所有招募患儿的照料者完成马来语版的M-CHAT-R/F。进行了信度和效度评估。
发现马来语版M-CHAT-R/F是一种可靠的工具，具有良好的内部一致性（Cronbach's alpha = 0.906，P < 0.001）。受试者工作特征（ROC）曲线显示，马来语版M-CHAT-R/F得分为2时可成功进行ASD分类，曲线下面积（AUC） = 0.887，P < 0.001，95%置信区间为（0.840，0.933）。
对马来语版M-CHAT-R/F的评估显示出令人满意的心理测量特性。基于本研究，马来语版M-CHAT-R/F是一种可靠且有效的筛查工具，可用于筛查16 - 30个月儿童的ASD。将M-CHAT-R/F翻译成马来语有望改善社区推广和筛查工作，这对于马来西亚ASD儿童的早期诊断和及时干预至关重要。
