Validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in primary care clinics in Singapore.
Ruth Mingli Zheng, Siew Pang Chan, Evelyn C Law and 2 others
PMID 37882198WHAT IT FOUND
The M-CHAT-R/F accurately identified autism in Singapore primary care, with high sensitivity and positive predictive value.
Nurses and physicians found it feasible to use routinely, even without research staff support, suggesting it can be integrated into standard well-child visits.
Key findings
01The M-CHAT-R/F demonstrated high sensitivity (88.6%) and positive predictive value (90.7%) for autism when evaluated against ADOS-2 results.
02Healthcare professionals reported high feasibility and acceptability of the tool, with agreement on its practicality improving over time even after research support ended.
03Systematic screening identified children with developmental disorders who would have been missed by physician clinical evaluation alone.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
A significant proportion (44.2%) of children who screened positive did not attend follow-up diagnostic evaluations, which likely overestimates the positive predictive value. The study only used the English version of the tool, potentially excluding caregivers not proficient in English, although English literacy is high in the sampled population. Negative predictive value may be underestimated because calculations were based only on children who underwent diagnostic evaluation, not assuming all un-evaluated negatives were true negatives. The study did not include autism community members or caregivers in the design phase.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National University Health System Primary Care Physician Research Development Seed Grant and the Octava Foundation Grant.
The easy way to misread this
Do not interpret the high sensitivity as proof that a negative M-CHAT-R/F screen at 18 months guarantees a child will not develop autism. The study found false negatives, and the authors note that social communication difficulties can become more pronounced after this age, supporting the need for repeated screening.