Impact of a digital Modified Checklist for Autism in Toddlers-Revised on likelihood and age of autism diagnosis and referral for developmental evaluation.
Samantha Major, Kathleen Campbell, Steven Espinosa and 5 others
PMID 32466674WHAT IT FOUND
Toddlers who screened positive for autism using a digital M-CHAT-R were five times more likely to receive a developmental referral by age 4 than those screened with paper.
The digital tool improved referral rates but did not significantly change the age at which children were referred.
Key findings
01Children screened with the digital M-CHAT-R had 5.35 times increased odds of receiving a developmental referral by 48 months compared to those screened with the paper version.
02There was no statistically significant difference in the age at referral or the time from positive screen to referral between the digital and paper groups.
03Ethnic and racial minority patients were more likely to screen positive on the M-CHAT-R than white patients.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is a secondary analysis of a quality improvement project, not a randomized controlled trial, so unmeasured factors could have influenced referral rates. The sample size is small, particularly for the referral events, leading to wide confidence intervals. The digital screener was not used in its fully validated format for inclusion criteria (follow-up questions were excluded from the initial positive screen definition to avoid bias), which may affect the specificity of the positive screens. The study took place in a single clinic with established universal screening policies, so results may not generalize to clinics without such infrastructure. Loss to follow-up is possible if patients moved or sought care outside the system, though chart review was used to mitigate this.
Declared interests
Author GD has financial relationships with multiple pharmaceutical companies and is associated with DASIO, LLC, which develops autism screening technology. Authors SE, KC, GD, and GS have developed technology that has been licensed, and they and Duke University have benefited financially.
The easy way to misread this
Do not conclude that the digital screener led to earlier diagnosis. While the mean age at referral was lower in the digital group, this difference was not statistically significant, and the study was underpowered to detect small changes in timing.