There Is Something about ASD: Cognitive, Symptomatic, and Adaptive-Skills In Four Toddlers Who Failed the MCHAT

Background: Early screening is considered crucial for receiving early intervention in children with Autism Spectrum Disorders (ASD; Kabot, Masi, & Segal, 2003); however, little is known about the differential diagnosis in toddlers who present clinical profiles associated with ASD vs. those who present clinical profiles associated with other psychological symptoms or developmental delays (DD). Few studies have investigated differences in toddlers with ASD and toddlers with other DD (Provost, Lopez, and Heimerl, 2007).

Objectives: The goal of this study is to examine three toddlers who failed the Modified Checklist of Autism in Toddlers (M-CHAT) but did not meet criteria for ASD, and one toddler who failed the M-CHAT and received an ASD diagnosis.  

Methods: Four toddlers (Ages: 28, 20, 20, and 19 months), who failed the M-CHAT, were recruited during their 18- and 24-month well-child visit in a rural area of Southwest Virginia. During part 1 of the study, mothers filled out the M-CHAT. During part 2, mothers were interviewed using a follow-up M-CHAT Interview, the Vineland Adaptive Behavior Scales-II (VASB), and the Autism Diagnostic Interview-Revised (ADI-R). Toddlers were administered the Mullen Scales of Early Learning (MSEL) and the Autism Diagnostic Observation Schedule (ADOS).

Results: Several differences were observed between the child who failed the M-CHAT and met criteria for ASD (Child-ASD) and the children who failed the M-CHAT but did not meet criteria for ASD (Children-A-B-C). First, Children-A-B-C had different psychological and medical histories than Child-ASD. Child-A experienced physical abuse in her first year of life, Child-B was showing behavioral problems, and Child-C was born prematurely. The mother of Child-ASD did not report any history similar to those reported for Children-A-B-C. Second, Children-A-B-C obtained a mixed profile of average and below average scores on the MSEL, whereas Child-ASD obtained below average scores across the MSEL subtests. Similarly, on the VASB, Children-A-B-C received scores that varied from moderately low to adequate, but Child-ASD received scores that varied from moderately low to low on the Social and Communication domains. On the ADOS, Children-A-B-C showed lower scores, indicating fewer deficits, on the social domain only (social domain scores: 6, 2, and 4, respectively) than Child-ASD (social domain score: 9). Similarly, on the ADI-R, Children-A-B-C obtained lower scores, indicating fewer deficits, on both social (scores: 6, 17, and 7, respectively), and communication (scores: 11, 8, and 10, respectively) domains than Child-ASD (social score: 25 and communication score: 14).

Conclusions: Child-ASD showed deficits in social, communication, and cognitive domains and in daily-living skills; Children-A-B-C also presented with remarkable psychological and medical histories. Leckman-Westin, Cohen, and Stueve (2009) argued that research that incorporates a “person-oriented approach,” (i.e., includes multiple measures) might create a better picture of factors contributing to child-mother psychological health (i.e., depression, p. 1177). Perhaps, in clinical settings, children who failed the M-CHAT ought to receive a person-orientated evaluation (i.e., examining multiple domains). This practice will identify children who might be experiencing psychological and developmental difficulties that differ from deficits associated with ASD. In turn, this would help children receive appropriate intervention at an early age.