From the Guidelines
If a child screens positive on the M-CHAT, the recommended next step is to administer the follow-up interview (M-CHAT-R/F) immediately to clarify responses and reduce false positives. This approach is based on the highest quality evidence available, including a study published in Pediatrics in 2015 1, which estimated that the M-CHAT has a positive predictive value (PPV) as high as 0.57 to 0.65 in low-risk samples. The M-CHAT is designed to identify early signs of autism spectrum disorder, and prompt evaluation is crucial since early intervention leads to better developmental outcomes, as noted in a recommendation statement published in the American Family Physician in 2016 1. Some key points to consider when using the M-CHAT include:
- The M-CHAT should be repeated at the next well-child visit, typically at 24 months if the initial screening was at 18 months, for children who initially screen positive but then screen negative on the follow-up.
- All children should receive routine developmental screening at 18 and 24 months regardless of previous results.
- Delaying referral to repeat screening could postpone access to beneficial services during a critical developmental period.
- Treatments for young children with ASD are primarily behavioral interventions, particularly early intensive behavioral and developmental interventions, which may include approaches incorporating applied behavior analysis principles, parent training components, and play- or interaction-based interventions, as noted in a study published in 2016 1. It is essential to prioritize timely intervention for children with true developmental concerns while avoiding unnecessary referrals, as emphasized in a study published in Pediatrics in 2015 1. By following this approach, healthcare providers can ensure that children with autism spectrum disorder receive prompt evaluation and intervention, leading to better developmental outcomes.
From the Research
Repeating M-CHAT after Positive Screen
- The decision to repeat the M-CHAT after a positive screen is not explicitly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the sensitivity and specificity of the M-CHAT and its revised version, M-CHAT-R/F, as a screening tool for Autism Spectrum Disorder (ASD) 2, 3, 5.
- A systematic review and meta-analysis found that the pooled sensitivity of M-CHAT(-R/F) was 0.83, and the pooled specificity was 0.94, suggesting its utility as an ASD screener 5.
- The M-CHAT-R/F is designed to increase early detection of ASD, allowing for early interventions and improving prognosis 3.
- There is no direct evidence to support a specific timeframe for repeating the M-CHAT after a positive screen, and further research is needed to optimize screening for ASD in the early developmental period 2.
Factors to Consider
- The performance of the M-CHAT-R algorithm compared to the original M-CHAT algorithm, with the M-CHAT-R algorithm decreasing the number of correctly identified ASD children by 12 2.
- The reliability, sensitivity, and specificity of the M-CHAT-R/F in different populations, including the Chilean population 3.
- The importance of considering the experiences and recommendations of autistic individuals in the development and implementation of ASD screening and intervention tools 6.