# Brief Report: Single and Repeat Screening with the Modified Checklist for Autism in Toddlers-Revised in Young Children at Higher Likelihood for Autism Spectrum Disorder

## TL;DR

This study compares single and repeated autism screening in young children at higher risk for autism, finding that repeat screening improves detection without reducing accuracy.

## Contribution

The study demonstrates that repeat use of the M-CHAT-R screening tool increases sensitivity in high-risk children without sacrificing specificity.

## Key findings

- Sensitivity and specificity of the M-CHAT-R were high (75-95%) in children at higher likelihood for ASD.
- Repeat screening improved sensitivity with minimal impact on specificity.
- Parents of high-likelihood children showed greater consistency in reporting ASD symptoms across screening tools.

## Abstract

Purpose: To compare the utility of single versus repeated autism screening in a sample at higher likelihood (HL) for ASD, following both screen positives and all screen negatives to diagnostic outcome. Methods: Using a prospective infant sibling design, the current study followed 135 toddlers at HL for ASD and conducted diagnostic evaluations on the full sample at 18, 24, and 36 months. The psychometric properties of the M-CHAT-R using both concurrent and predictive diagnostic evaluations were compared in a group screened once (at 18 months only, n = 60) or twice (at both 18 and 24 months, n = 75). The study also examined consistency in reporting of ASD symptoms across the M-CHAT-R and a developmental concerns interview, comparing the HL group to a group with lower likelihood (LL) for ASD (n = 88). Results: Sensitivity and specificity of the M-CHAT-R were high (75 − 95%), consistent with previous research. Positive predictive value (43 − 76%) was higher in this HL group than in previous community samples. Repeat screening improved sensitivity with little cost to specificity. At both 18 and 24 months, HL parents were more consistent in their reporting on the M-CHAT-R and a concerns interview than LL parents. Conclusion: The M-CHAT-R has strong psychometric properties when used with groups at HL for ASD, suggesting that scores over the screening cutoff of 3 should lead to prompt diagnostic evaluation referrals in children with older siblings on the spectrum.