The Short Quantitative Checklist for Autism in Toddlers (Q-CHAT-10) As an Early “Red Flag” Screen for Autism Spectrum Disorder: A High-Risk Sibling Cohort Study

Poster Presentation
Friday, May 11, 2018: 11:30 AM-1:30 PM
Hall Grote Zaal (de Doelen ICC Rotterdam)
S. Raza1, L. A. Sacrey2, K. Reid1, S. E. Bryson3, J. A. Brian4, I. M. Smith5, W. Roberts6, P. Szatmari7, T. Vaillancourt8, C. Roncadin9, N. Garon10 and L. Zwaigenbaum1, (1)University of Alberta, Edmonton, AB, Canada, (2)Autism Research Centre, Edmonton, AB, CANADA, (3)Dalhousie University, Halifax, NS, Canada, (4)Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada, (5)Dalhousie University / IWK Health Centre, Halifax, NS, CANADA, (6)isand, Toronto, ON, Canada, (7)The Hospital for Sick Children, Toronto, ON, Canada, (8)University of Ottawa, Ottawa, ON, Canada, (9)Autism Spectrum Disorder Service, McMaster Children's Hospital - Hamilton Health Sciences, Hamilton, ON, Canada, (10)Mount Allison University, Sackville, NB, Canada
Background: Identifying early risk markers of Autism Spectrum Disorder (ASD) is crucial in order to facilitate earlier detection of ASD and implement targeted interventions to improve functional outcomes. To support utilization in community practice, the development of brief screening tools are warranted. One such screening tool is the Quantitative Checklist for Autism in Toddlers (Q-CHAT), which was developed as an adaptation of the original Checklist of Autism in Toddlers (CHAT). A recent abbreviated version (Q-CHAT-10; Allison et al., 2012) shows promise, but further evaluation of this screen is warranted.

Objectives: The objective of this study was to examine the classification properties of the short Quantitative Checklist for Autism in Toddlers (Q-CHAT-10) as a rapid screen for ASD in a high-risk (HR) sibling population.

Methods: Participants were drawn from an ongoing longitudinal study of early development of ASD, and included 90 high-risk (HR) infants with an older sibling with ASD. For the purpose of evaluating the Q-CHAT-10, the group was further stratified into three groups: (1) HR toddlers who received an ASD diagnosis at 36 months (HR-ASD; n=19); (2) HR toddlers who meet the criteria for the broader autism phenotype (HR-broader autism phenotype (HR-BAP); n=31) and; (3) HR toddlers that do not meet the criteria for the broader autism phenotype (HR-typically developing (HR-TD); n=40). Criteria for BAP were: (1) does not meet criteria for an ASD diagnosis; (2) two or more Mullen subtests at ≥ 1.5 standard deviations (SD) below the mean; and/or (2) one or more Mullen subtests at ≥ 2 SD below the mean; and/or (4) ADOS ≥ 3. Parent-Report Questionnaire: The Q-CHAT-10 is a 10-item questionnaire shortened from the Q-CHAT that assesses a broad range of ASD symptomology. Primary caregivers of HR toddlers completed the Q-CHAT-10 at 18 and 24 months. Statistical Analyses: Performance on the Q-CHAT-10 was compared between groups (HR-ASD, HR-BAP, HR-TD) at 18 and 24 months using two one-way ANOVAs. Group effects were explored using Benjamini & Hochberg (1995) corrections for multiple comparisons. To assess predictive ability, the sensitivity and specificity of 18- and 24-month Q-CHAT-10 scores were examined relative to the 36-month ASD diagnoses, at an individual level using the suggested cut-point of 3 (Allison et al., 2012).

Results: Higher total score on the Q-CHAT-10 differentiated the HR-ASD group from HR-BAP and HR-TD groups at both 18 (q≤0.009) and 24 months of age (q≤0.001), indicating greater frequency of ASD symptoms at these time points. Estimates of sensitivity and specificity of the Q-CHAT-10 were 0.58 and 0.72 at 18 months, and 0.59 and 0.84 at 24 months, respectively.

Conclusions: While the Q-CHAT-10 was able to distinguish groups of children with ASD from other HR toddlers who are typically developing or who exhibit the broader autism phenotype, individual classification by the Q-CHAT-10 for ASD versus not ASD was relatively poor in this limited sample. Thus, while the Q-CHAT-10 was able to identify group differences, individual classification was not sufficient to support screening in this HR sibling cohort.