Benutzerin:Quod-erat-demonstrandum./Artikelwerkstatt/Checklist for Autism in Toddlers

Die Checklist for Autism in Toddlers (CHAT) ist ein psychologischer Fragebogen, anhand dessen bei Kindern im Alter von 18 bis 24 Monaten eine frühzeitige Einschätzung des Risikos für eine spätere Autismus-Spektrumsstörung ermöglicht wird. Der Test beinhaltet 14 Fragen (Items) und wird von Eltern und (Kinder-)Arzt gemeinsam beantwortet, dies dauert nur etwa fünf Minuten. Der CHAT zeigt studienübergreifend eine gute Reliabilität und Validität in der Beurteilung des frühkindlichen Autismus-Risikos. Einige Studien legen allerdings nahe, dass die Validität des Tests (die Verlässlichkeit und Übertragbarkeit/Allgemeingültigkeit seiner Einschätzung) beim sozioökonomischen Status und Bildungsstand der Eltern an Grenzen stößt. Gleiches gilt leider auch für seine überarbeitete Fassung, den M-CHAT.

Entwicklungsgeschichte

The CHAT was initially developed in the early 1990s to screen for autism in children as young as 18 months. Prior to this point, diagnosis of autism was rare in children younger than 3 years old. Additionally, no specialized screening tool had been developed to detect early signs of autism in young children. This clinical standard for the diagnosis of autism was seen as potentially detrimental because interventional supports early on in life had shown improved outcomes in development. The construction of the CHAT drew off of the theoretical basis that certain developmental markers are rarely seen in individuals with autism, yet these behaviors are often demonstrated in typical development by 15 months of age, and therefore the absence of these behaviors could indicate a potential autism diagnosis at an early age. Specifically, the CHAT aims to distinguish the presence of joint attention and pretend play.

Question breakdown, scoring, and interpretation

The first 9 questions (part A) of the CHAT identify common play habits and behaviors for infants between ages 18–24 months, and the last five questions (part B) concern the child’s behavior and reaction to certain stimuli initiated by the physician. In parts A and B, the parent and physician, respectively, indicate whether or not the child displays these behavioral characteristics.

Domain Breakdown

5 of the 14 questions on the CHAT are key items that factor into risk classification. The 5 key items are as follows:

• A5- Pretend play
• A7- Protodeclaractive pointing
• B2- Following a point
• B3- Pretending
• B4- Producing a point

Scoring

Questions from The Checklist for Autism in Toddlers ( CHAT ) are assessed using a scoring mechanism of key items that splits results into three groups based on risk:

• High Risk: A choice response of “no” for the key items of “pretend play” ( A5), “protodeclarative pointing” ( A7), “following a point” (B2), “pretending” ( B3), and “producing a point” ( B4), classifies the individual as being in the high risk autism group. Individuals who fall into this group should refer to a developmental clinic to discern an official diagnosis.
• Medium Risk: A choice response of “no” for the key items of “protodeclarative pointing” ( A7), and “producing a point” ( B4) classifies the individual as being in the medium risk autism group. Individuals who fall into this group should be retested a month later or refer to a developmental clinic.
• Low Risk: Children who do not fall in either medium or high risk groups are classified as low risk for autism, but should still be retested a month later for reliability.

Further reading

• Fred Volkmar, Matthew Siegel, Marc Woodbury-Smith, Bryan King, James McCracken, Matthew State, AACAP Committee on Quality Issues: Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. In: Journal of the American Academy of Child and Adolescent Psychiatry. 53. Jahrgang, Nr. 2, Februar 2014, S. 237–57, doi:10.1016/j.jaac.2013.10.013, PMID 24472258 (jaacap.com). 

External links

• CHAT English version
• EffectiveChildTherapy.org guidelines on autism spectrum disorders

Vorlage:Psychology sidebar

The Modified Checklist for Autism in Toddlers (M-CHAT) is a psychological questionnaire that evaluates risk for autism spectrum disorder in children ages 16–30 months. The 20-question test is filled out by the parent, and a follow-up portion is available for children who are classified as medium- to high-risk for autism spectrum disorder. Children who score in the medium to high-risk zone may not necessarily meet criteria for a diagnosis. The checklist is designed so that primary care physicians can interpret it immediately and easily. The M-CHAT has shown fairly good reliability and validity in assessing child autism symptoms in recent studies.

Question breakdown, scoring, and interpretation

The first section of the M-CHAT identifies 20 behavioral characteristics of the autism spectrum and asks if the child has experienced any of them. If the parent reports a sufficient number of characteristics for the child in this section, a follow-up form outlining specific questions pertaining to that characteristic would be administered by the researcher. It does not have to be completed for characteristics the child does not possess. The follow-up form asks questions based on a flow-chart format, ultimately categorizing the child as “pass” or “fail” for each characteristic.

Domain breakdown

For the first section, a response of “no” for all questions except 2, 5, and 12 indicate risk of autism spectrum disorder. A response of “yes” indicates ASD risk for the remaining three questions.

For the follow-up section, the flowchart format will direct the researcher in determining whether or not the child’s behavior is suggestive of ASD. If the parent describes abnormal behavior, the child will fail that item.

Interpretation of subscale scores

A total score of 2 and below on the first part of the M-CHAT indicate low autism risk, but children under 24 months should nevertheless be tested again after their second birthday. A total score of 3-7 indicates medium risk and prompts administration of the follow-up form. Even with the follow-up form, some children who fail the M-CHAT will not be diagnosed with ASD, but may still be at risk for other developmental disorders. A total score of 8 or higher indicates high autism risk, and the follow-up form can be bypassed for immediate referral to a professional for diagnosis.

The follow-up form has its own scaling. If the child fails at least two items, the child should be referred to a professional for diagnosis.

Psychometrics

Reliability and validity

The revised version of M-CHAT, known as the M-CHAT-R/F, has been demonstrated to have high validity and reliability for screening toddlers for autism spectrum disorder. A child whose score was greater than 3 at the first screening (18 months) and greater than 2 at the followup (24 months) had a 47.5% risk of being diagnosed with autism spectrum disorder.

Limitations

The M-CHAT suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey.

The M-CHAT is a screener for potential symptoms for autism spectrum disorder in children, and cannot be administered as a diagnostic tool. Many pediatricians have been found to underdetect cognitive and emotional/behavioral disorders in children. This underdetection is due to failure to use standardized test, reliance on clinical impressions, the restricted sample of behavior obtained, and the atypical behavior of children in a doctor's office.

Factors such as socioeconomic status and parent education level have been found to impact the generalizability of both the M-CHAT and the Checklist for Autism in Toddlers (CHAT) as a reliable and valid screener for children of all backgrounds.

Controversies

Longitudinal studies suggest that the M-CHAT may be a poor screening tool for children 18 months of age and younger.

See also

• Autism
• Autism spectrum
• Pervasive developmental disorders
• EffectiveChildTherapy.Org guidelines for autism spectrum disorder
• AACAP Practice Parameters for autism spectrum disorder
• M-CHAT.org
• Validation of the Modified Checklist for Autism in Toddlers
• M-CHAT Questionnaire
• Lineagen

References

Category:Communication disorders Category:Mental and behavioural disorders Category:Neurological disorders Category:Neurological disorders in children Category:Pervasive developmental disorders Category:Clinical psychology tests Category:Psychological testing Category:Psychological tools