- Universal primary care-based screening for autism spectrum disorder (ASD) using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) had low accuracy, especially in certain groups.
- 91% of all children were screened.
- ASD prevalence: 2.2%.
- M-CHAT/F performance:
- Sensitivity: 38.8%.
- Specificity: 94.9%.
- Positive predictive value: 14.6%.
- Negative predictive value: 98.6%.
- Sensitivity was higher in toddlers who were:
- Older (aged 21-26 months; 48.8%).
- Screened twice (51.1%).
- Positive predictive value was lower in girls (7.7%).
- Specificity and positive predictive value lower in toddlers:
- Who were black, Asian, other race, multiracial (90.4%-93.8% and 10.8%-13.4%).
- From lower-income households (92.3% and 11.8%).
- Prospective cohort study among 25,999 children aged 16-26 months having follow-up through age ≥4 years.
- Universal, primary care-based screening conducted using M-CHAT/F, supported by electronic administration, integration into electronic health records.
- Main outcome: M-CHAT/F performance against reference standard of diagnosis in electronic health record.
- Funding: Allerton Foundation; Eagles Charitable Foundation; National Institute of Mental Health; National Institutes of Health.
- Unclear generalisability.
- Diagnostic data available only through age 4-8 years.
- Not all eligible children had follow-up interview.