Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns

Objective

To test the hypothesis that children born preterm are more likely to screen positive on the M-CHAT for an autism spectrum disorder.

Study design

We compared the M-CHAT positive rate of those with cerebral palsy, cognitive impairment, and vision and hearing impairments to those without such deficits.

Results

Relative to children who could walk, the odds for screening positive on the M-CHAT were increased 23-fold for those unable to sit or stand independently and more than 7-fold for those requiring assistance to walk. Compared with children without a diagnosis of cerebral palsy, those with quadriparesis were 13 times more likely to screen positive, and those with hemiparesis were 4 times more likely to screen positive. Children with major vision or hearing impairments were 8 times more likely to screen positive than those without such impairments. Relative to those with a Mental Development Index (MDI) of >70, the odds for screening positive were increased 13-fold for those with an MDI of <55 and more than 4-fold for those with an MDI of 55 to 69.

Conclusions

Major motor, cognitive, visual, and hearing impairments appear to account for more than half of the positive M-CHAT screens in extremely low gestational age newborns. Even after those with such impairments were eliminated, 10% of children—nearly double the expected rate—screened positive.

Abbreviations: ASD, Autism spectrum disorder, BSID-II, Bayley Scales of Infant Development, 2nd edition, CP, Cerebral palsy, ELGAN, Extremely low gestational age newborn, GMFCS, Gross Motor Functional Classification System, M-CHAT, Modified Checklist for Autism in Toddlers, MDI, Mental Development Index, PDI, Psychomotor Development Index, PPV, Positive predictive value, VABS, Vineland Adaptive Behavior Scales