Sociodemographic Predictors of M-CHAT Responses Among Children Who Screened Positive

Background: Children from minority and low-income backgrounds are likely to be diagnosed with autism spectrum disorder (ASD) at a later age (Mandell, Novak, & Zubritsky, 2005). The Modified Checklist for Autism in Toddlers, Revised, with Follow-up (M-CHAT R/F; Robins, Fein, & Barton, 2009), is a parent completed screening questionnaire. If universally administered, the M-CHAT R/F may help reduce racial and ethnic disparities in age of identification. However, among children who screen positive on the M-CHAT-R/F), little is known about whether sociodemographic factors further predict item-level responses or total M-CHAT-R/F scores.

Objectives: The current study aims to examine whether sociodemographic factors predict both item-level responses and total scores on the M-CHAT-R/F.

Methods: Participants are children aged 15-30 months who screened positive on the M-CHAT R/F at the baseline visit of a NIMH-funded multi-site comparative effectiveness trial (N=310; see Table 1). The population is largely low-income, majority-minority, with public insurance. Research assistants read parents the M-CHAT-R/F and demographic questionnaires at the time of enrollment. A priori hypotheses stated that parent and child sociodemographic factors would predict M-CHAT-R/F item-level responses. Multivariable logistic regression models included all sociodemographic factors (child race; ethnicity; sex; insurance; maternal education level; and – as a proximal marker for low income-- enrollment in Women, Infant, Child [WIC] nutritional program) simultaneously. Because the data were aggregated from a multi-site study, analyses controlled for clinical site of enrollment.

Results: Statistically significant results of multivariable logistic regression models are reported in Table 2. Total M-CHAT R/F score was not significantly associated with any sociodemographic factors. Child ethnicity and insurance type were not significantly associated with item-level responses. However, at the item level, parents were more likely to report wondering if their child was deaf (M-CHAT-R/F item 2) if the child’s race was white rather than black or Asian. Across races, mothers who completed college were less likely to wonder if their child was deaf. Parents of females were more likely to report that their child attempts to copy what they do (M-CHAT-R/F item 15). Low income families (as measured by WIC enrollment) were less likely to agree that their child looks around to see what parents turn around for (M-CHAT-R/F item 16).

Conclusions: These findings suggest that sociodemographic variables may affect either early ASD presentation or parent perceptions. Future research should investigate further differences in cognitive and behavioral functioning as they pertain to sociodemographic variables as well as ways these variables may affect interpretation of M-CHAT-R/F items.