PM2001: Determining and Characterizing the Presence of Prior Concerns in Toddlers Who Fail an Autism Screener in Primary Care

Background: The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a frequently used screening questionnaire for autism in children between 18-30 months. However, in 2016, the US Preventive Services Task Force (USPSTF) concluded that the current evidence for universal autism screening was insufficient to assess the balance of benefits and harms in children “who have not been diagnosed with autism or developmental delay and for whom no concerns of autism have been raised by parents or health care professionals”, and decided against recommending universal autism screening until more data are collected.

This study aims to evaluate the proportion of toddlers from a community-based sample who screened positive with the M-CHAT-R/F for whom caregivers or providers had no prior concerns; to understand the nature of concerns and when those concerns emerged in those with prior concerns; and to assess whether presence of prior concerns differs by family or child characteristics.

Methods: Retrospective review of the electronic medical records of 243 children seen in the Duke University Health System who screened positive for autism using the M-CHAT-R/F between 7/26/2018 and 8/11/2021.

Results: In 56 (23.14%) participants, the caregiver and/or provider had an autism concern prior to the positive MCHAT-R/F. In 160 (66.15%) there was a prior language concern, and in 104 (42.98%) a prior motor concern. In combination, 192 (79.34%) participants had a prior concern for either language, motor, or autism. In addition, 210 (86.78%) participants had some other developmental concern prior to the positive M-CHAT-R/F score. Only 12 (4.96%) children had no prior concerns. Autism concerns arose at a mean age of 19.16 months (SD = 5.7), language at 16.36 months (SD = 4.61), and motor at 6.09 months (SD = 1.58). The average number of prior concerns was 2.9 (SD = 1.58). Excluding those with no concerns, prior speech therapy increased the mean number of concerns by 25%, occupational therapy (OT) by 38%, and physical therapy by 23%. Of note, children with OT who were full-term had a greater number of concerns than those who with OT and were not full-term. In the toddlers with autism concerns, there were no significant differences by race, ethnicity, education, income, or sex. Demographic factors did not impact number of concerns.

Conclusion: These data demonstrate that caregivers and providers commonly have autism and/or developmental concerns prior to a positive M-CHAT-R/F screening. This suggests that a positive M-CHAT-R/F screen is unlikely in the setting of no prior concerns and will likely not lead to a significant further emotional impact or burden.