Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners.
Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners.
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DOI：
10.1186/s13229-021-00480-4
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发表时间：
2022-01-03
期刊：
影响因子：
6.2
通讯作者：
Baron-Cohen S
中科院分区：
文献类型：
--
作者：
Sturner R;Howard B;Bergmann P;Attar S;Stewart-Artz L;Bet K;Allison C;Baron-Cohen S
建议在18个月和24个月的儿科井访视时进行自闭症筛查。修订版幼儿自闭症检查表（M-CHAT-R）的作者建议在阳性时进行随访（M-CHAT-R/F）。M-CHAT-R/F对于18个月大的婴儿的准确性可能低于24个月大的婴儿，并且在包括筛查阴性儿童的样本中，对于两年前的识别准确性尚不清楚。由于自闭症症状可能会逐渐出现，因此根据全方位的反应选项对项目进行顺序评分，例如在幼儿自闭症定量检查表（Q-CHAT-10）的10项版本中，可能比二分法（即，是/否）项或Q-CHAT-10项的通过/未通过评分。本研究的目的是确定和比较M-CHAT-R/F和Q-CHAT-10的准确性，并描述顺序评分的Q-CHAT-10（Q-CHAT-10-O）的准确性，用于预测在18个月时筛查的儿童样本中的自闭症。 这是一项社区儿科验证研究，招募了筛查阳性儿童（n = 167）以及年龄和实践匹配的筛查阴性儿童（n = 241），在2岁之前完成诊断评估。自闭症的临床诊断是基于研究可靠的测试人员对筛查结果不知情的亲自诊断自闭症评估的结果，并根据标准指南使用自闭症诊断观察表-第二版（ADOS-2）幼儿模块和马伦早期学习量表（MSEL）。 虽然与M-CHAT-R相比，M-CHAT-R/F具有更高的特异性和PPV，但Q-CHAT-10-O显示出比M-CHAT-R/F和Q-CHAT-10更高的灵敏度。许多家长拒绝参与，样本中受过高等教育的家长占了很大比例。结果不能推广到老年人。目前推荐的18个月访视时两阶段M-CHAT-R/F的局限性包括敏感性低，随访访视中PPV改善的平衡获益最小。顺序，而不是二分法，自闭症筛查项目的评分似乎是有益的，在这个年龄。采用顺序评分的Q-CHAT-10-O显示出优于M-CHAT-R/F的优势，其项目数量为一半，不需要随访访谈，灵敏度提高。然而，Q-CHAT-10-O的灵敏度低于M-CHAT-R（无随访），特异性低于两阶段程序。这种局限性是一致的认识，筛查需要重复超过这个年龄。在线版本包含补充材料，可通过10.1186/s13229-021-00480-4获得。
Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months. This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines. While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age. The online version contains supplementary material available at 10.1186/s13229-021-00480-4.
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