Positive Predictive Value of the Modified Checklist for Autism in Toddlers, Revised with Follow-up for Black and White Children

Background: Early diagnosis and intervention improve outcomes for children with Autism Spectrum Disorder (ASD) (Baird et al., 2001; MacDonald, Parry-Cruwys, Dupere, & Ahearn, 2014). However, Minority children are typically diagnosed substantially later than White children, despite similar prevalence and symptom severity (CDC, 2006; Fombonne, 2003). To reduce this gap, universal screening has been proposed as a way to identify all children at risk for ASD early. However, limited research exists exploring the effectiveness of ASD-specific screening tools between racial groups, particularly Black versus White children. Studies that have done this combine across racial minority groups, thereby potentially precluding identification of meaningful differences (e.g., Khowaja, Hazzard, & Robins, 2015; Scarpa et al., 2013).

Objectives: We compared the positive predictive value (PPV) of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins et al., 2014) for Black and White children who screened positive at 18-month well-child visits. Sensitivity and specificity were not measurable in this sample, given that all screen negative cases were not evaluated.

Methods: Participants were 310 children ages 16-21 months, evaluated as part of a larger study on the early detection of ASD. Children who screened positive on the M-CHAT-R/F at their 18-month pediatric well-child care visit were offered a free developmental and diagnostic evaluation by a licensed clinical psychologist or a developmental-behavioral pediatrician and a doctoral student. M-CHAT-R/F PPV for (a) ASD and (b) any developmental disorder was compared for 128 Black and 182 White children. Racial groups were also compared on monthly household income, which was used as a proxy for socioeconomic status.

Results: Racial groups (Black, White) differed on monthly household income (Black group monthly income M = $2,498, SD = $2,453; White group M = $5,838, SD = $2,837), t (241) = 9.74, p < .001. However, M-CHAT-R/F PPV for ASD was similar for Black (PPV = 0.445, CI = 0.37 – 0.53) and White (PPV = 0.431, CI = 0.37- 0.50) children (χ²(1, N = 310) = 0.0736, p = .79). The PPV for any developmental diagnosis (i.e., ASD, Language Disorder, or Global Developmental Delay) was higher for Black children (PPV = 0.890, CI = 0.83 – 0.93) than for White children (PPV = 0.809, CI = 0.75 - 0.86), χ²(1, N = 310) = 4.4707, p = .03).

Conclusions: We explored the predictive utility of the M-CHAT-R/F in detecting Black and White children at risk for ASD and other developmental delays based on an 18-month positive screening. PPV for ASD was similar between the two racial groups and consistent with previously reported values, yet the M-CHAT-R/F appeared to be slightly better at detecting any developmental disorder in Black toddlers. This is one of few studies to specifically compare M-CHAT-R/F performance for Black and White children and suggests that the screener performs adequately irrespective of child race.