Comparison of M-CHAT-R and Itsea Scores in an Early Detection Sample of Children with ASD
Early intervention is associated with positive long-term outcomes for individuals with Autism Spectrum Disorder (ASD; Landa 2018). In response to growing evidence promoting the value of early detection, researchers have developed measures designed to identify ASD in young children. Comparing results from screening tools to more comprehensive questionnaires that characterize developmental domains provides insight into the areas of common dysfunction that screeners identify. Understanding the domains that screening tools are likely to detect can inform the initial conceptualization of the child’s developmental profile.
To compare the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), an effective screener for ASD risk, and the Infant-Toddler Social and Emotional Assessment (ITSEA), a questionnaire to characterize social emotional behaviors, in infants who were diagnosed with ASD. Specifically, to test the hypothesis that an increased M-CHAT-R total score correlates with ITSEA domains and subscales that exhibited a pattern of impairment in the ITSEA ASD validity sample (Social Relatedness and Atypical Item Clusters; Competence Domain; Negative Emotionality, Depression/Withdrawal, Eating subscales; Carter & Briggs-Gowan 2006).
Infants participating in a multi-site early detection study were screened at 18-month checkups with the M-CHAT-R (Robins et al. 2009). Children who screened positive on the M-CHAT-R or another screener or were referred based on provider concern attended a diagnostic evaluation that included the ITSEA (Carter & Briggs-Gowan 2006). Data were included for infants (n=89, age=21.83 (SD=4.65) months) who met ICD-10 criteria for Childhood or Atypical Autism based on the Autism Diagnostic Observation Schedule, Second Edition (Lord et al. 2012) and clinical judgment. The M-CHAT-R is a 20-item screening measure designed to identify risk for ASD. Parents respond to Yes/No questions based on the usual behavior of their child. The ITSEA is a 166-item questionnaire with 4 domains and 17 subscales designed to evaluate social emotional behaviors. Items are rated on a 3 point scale (0=not true/rarely, 1=somewhat true/sometimes, 2=very true/always). Scores were skewed, so Spearman correlations were calculated between M-CHAT-R total scores and ITSEA scores.
Significant associations were found between M-CHAT-R scores and the ITSEA Competence Domain (ρ=-.48, p<.001). With the exception of Prosocial Peer Relations, all subscales within the Competence Domain were related to M-CHAT-R scores (p<.05). Other correlated ITSEA subscales included Peer Aggression (ρ=.25, p=.025), Depression/Withdrawal (ρ=.31, p=.003), Sensory Sensitivity (ρ=.22, p=.040), and Sleep (ρ=.22, p=.039). M-CHAT-R scores also significantly related to Maladaptive (ρ=.23, p=.033), Social Relatedness (ρ=-.37, p<.001), and Atypical (ρ=.47, p<.001) Item Clusters.
Findings support the hypothesis that M-CHAT-R scores for children who are subsequently diagnosed with ASD relate to impairment on the Social Relatedness and Atypical Item Clusters, as well as the Competence Domain and Depression/Withdrawal subscales. Interestingly, the M-CHAT-R scores were also associated with Peer Aggression, Sleep, Sensory Sensitivity, and Maladaptive scores. These findings suggest that the M-CHAT-R is sensitive to some core symptoms of early ASD, including atypical social relatedness, compliance, attention, sensory, and sleep difficulties, but does not reflect other problems that may be present, including negative emotionality or eating problems.