Comparison of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) Positive Predictive Value by Race.
Yael G Dai, Katelynn S Porto, Mary Skapek and 4 others
PMID 32125566WHAT IT FOUND
The M-CHAT-R/F screening tool works equally well for Black and White toddlers.
While Black children were more likely to fail specific items before the follow-up interview, the overall accuracy in predicting autism or other developmental delays did not differ by race.
Key findings
01The Positive Predictive Value (PPV) for ASD was similar between Black and White children, and this remained true after controlling for maternal education and screening format.
02Before the follow-up interview, Black children were significantly more likely than White children to screen positive on the item asking about unusual finger movements near the eyes.
03When the follow-up interview was included, item-level differences in predictive value for ASD did not remain significant after statistical correction.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study only included children who screened positive and agreed to an evaluation, so it cannot assess sensitivity or specificity for the general population. Race was used as a proxy for culture, which may not capture the diversity of developmental expectations and reporting styles within these groups. The sample size was relatively small (285 children), which limits the power to detect subtle differences in item-level performance.
Declared interests
Three authors are co-owners of M-CHAT LLC, which receives royalties from companies using the screener, though the authors state the data in this manuscript did not incur royalties.
The easy way to misread this
Do not assume the screener is perfect for all demographics based on this study. It only examined Black and White children, and the results reflect the performance of the full two-stage process. Skipping the follow-up interview may still leave you with different initial response patterns between groups.