Meta-analysis: commonly used screening checklist can play a role in diagnosing autism, but has significant limitations

A meta-analysis of studies on the efficacy of the widely used M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up) concludes that while the test is useful, it has significant limitations

The M-CHAT-R/F is commonly used by pediatricians to screen children for autism spectrum disorders (ASD) during their 18-month and 24-month checkups. If a child receives a positive screening result, a provider usually recommends further evaluation. 

Ramkumar Aishworiya and colleagues analyzed data from 15 studies involving 49,841 children from 10 different countries. Participants underwent standard testing using the M-CHAT-R/F and then received a diagnostic assessment for autism. 

The researchers found that among the children as a whole, there was a 57.7 percent chance of an autism diagnosis following a “positive” screen. For children who had a higher likelihood of autism, such as those with an autistic sibling, the predictive value was 75.6 percent. For those with no increased likelihood, the predictive value was 51.2 percent. 

They also found that the overall negative predictive value for the M-CHAT-R/F was 72.5 percent, meaning that about one quarter of children flagged as “negative” by the checklist received an autism diagnosis after further assessment. 

Study coauthor Van Ma comments, “I think the most important takeaway from this study is that the M-CHAT-R/F is a screening tool with limitations. It has a role in screening for autism but is not meant to replace clinical judgment and comprehensive diagnostic assessment.”

Citations

“Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening,” Ramkumar Aishworiya, Van Kim Ma, Susan Stewart, Randi Hagerman, and Heidi M. Feldman, Pediatrics, May 19, 2023 (online). Address: Ramkumar Aishworiya, Khoo Teck Puat–National University Children’s Medical Institute, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, [email protected]. 

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“New study finds common autism screening tool is effective but has limitations,” news release, UC Davis Mind Institute, May 22, 2023.