| Summary: | 碩士 === 高雄醫學大學 === 心理學系碩士班 === 104 === Background and purposes: Children with autism spectrum disorders (ASDs) show developmental and behavioral impairments before the age of two. However, the diagnosis won’t be made until three years old or later. This situation will bring negative impacts to early intervention. Therefore, dealing with the issue of delayed diagnosis, we need to develop an early screening tool with good validity. The Modified Checklist for Autism in Toddlers (M-CHAT) is a well-known and used screening tool; there are a lot of studies discovering its validity. However, there are no related validity studies in Taiwan. Considering needs of early diagnosis, the present study aims to discover the validity of using M-CHAT to detect children with ASDs less than 4 years old in Taiwan.
Methods: There were 236 children aged from 18 to 47 months old recruited in this study, including 113 ASDs children and 123 developmental delay (DD) children. We invited parents to fill up M-CHAT Chinese version while waiting for diagnostic assessments. Analysing the screening validity of criteria suggested by former researchers, including any 3 items of the 23 items, failing 2 items of 6 discriminate items, and failing 2 of 7 critical items. Besides, we would like to discover if there’s a new or better criteria for screening clinical sample in Taiwan.
Results: The validity of criteria suggested by former researchers, including (1) any 3 items of the 23 items, yielded a sensitivity of .88 and specificity of .53; (2) failing 2 items of 6 discriminate items yielded a sensitivity of .46 and specificity of .94; (3) failing 2 of 7 critical items yielded a sensitivity and specificity of .57 and .89, respectively. These results were incongruent with former researches; screening validity didn''t reach the standard of a fine screening tool. Additionally, we found that using any 4 of the 23 items yielded a sensitivity of .77 and specificity of .72. This result reached the standard of a fine screening tool. Meanwhile, through discriminated analysis and analysis of covariance (ANCOVA) we found a short version with 14 items overlapped between these two methods, and using the cutoff of 3 point, yielded a sensitivity of .71 and specificity of .82. This result also reached the standard of fine screening tool. Furthermore, we divided our subjects into two different age groups: 18-30 months old and 31-47 months old. For the 18-30 months group, using the criterion as any 4 of the 23 items yielded the sensitivity and specificity of .79 and .74, respectively; using a short version with 3 failing items in 14 critical items yielded the sensitivity and specificity as .74 and .86, respectively. For 31-47 months group, using criterion any 4 items of the 23 items, yielded the sensitivity and specificity of .75 and .70, respectively; using the short version with failing 3 items in 14 critical items yielded the sensitivity and specificity as .68 and .77, respectively.
Conclusion: The validity of using M-CHAT to screen clinical samples less than 4 years old in Taiwan seemed acceptable. Distinguishing different age groups, we found that M-CHAT had better performance screening those within the age of 18-30 months than 31-47 months. There as were 5 items overlapping among different criteria, including item 2 (social interest), item 7 (pointing for interest), item 9 (showing), item 13 (imitation), and item 15 (following pointing), supporting early social interaction impairments are key points to ASDs early screening. The clinical field in Taiwan lacked ASDs level two screening tools, so the results of this study supported the utility of M-CHAT screening clinical samples and support ASDs early screening works in Taiwan.
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