Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study

Abstract

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated.
 Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia.
 Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value.
 Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions.
 Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.

Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised)

“…Most of the 51 studies (n = 40 [78%]) used concurrent detection methods, defined as evaluation to confirm ASD status within 6 months of screening. These studies included (1) additional rigorous false-negative case detection approaches, such as asking pediatric physicians to note ASD concerns, using additional screening tools for all or a subset of the sample (n = 21), or both; or (2) evaluation of all children regardless of screening results (n = 17) . In addition, 2 studies used strategies that were classified as weak concurrent false-negative case confirmation strategies, defined as strategies that resulted in few children who had not screened positive being invited for an evaluation .…”

“…Twenty-four of the 51 studies (47%) recruited low-likelihood (LL) children, which included screening at well-child visits, childcare centers, kindergarten, or preschool. Twenty-two studies (43%) used high-likelihood (HL) samples, including children referred to community health services or for ASD-specific evaluations because of parent or practitioner concern about development, those at elevated likelihood for ASD according to another screening result, those receiving services through an early intervention system, those with Down syndrome, those with a history of prematurity or low birth weight, and those with older siblings who had received a diagnosis of ASD . In addition, 5 studies administered the M-CHAT(-R/F) to a mixed sample comprising both LL and HL children .…”

“…Specificity similarly ranged from 0.27 to 1.00, with a pooled specificity of 0.94 (95% CI, 0.89-0.97). See Table 1 for screening metrics for each identified study, Table 2 for HSROC model results, and Figure 2 for a forest plot of included studies, sorted by sensitivity . The SROC plot of the overall model is depicted in eFigure 2 in Supplement 1.…”

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