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ESAT and M-CHAT as screening instruments for autism spectrum disorders at 18 months in the general population: issues of overlap and association with clinical referrals

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Abstract

The Modified Checklist for Autism in Toddlers (M-CHAT) and the Early Screening of Autistic Traits (ESAT) were designed to screen for autism spectrum disorders in very young children. The aim of this study was to explore proportions of children that screened positive on the ESAT or the M-CHAT and to investigate if screening positive on the ESAT and M-CHAT is associated with clinical referral by 18 months and other aspects of children’s development, health, and behavior. In this study, the mothers of 12,948 18-month-old children returned a questionnaire consisting of items from the ESAT and M-CHAT, plus questions about clinical and developmental characteristics. The M-CHAT identified more screen-positive children than the ESAT, but the ESAT was associated with more clinical referrals and tended to identify more children with medical, language, and behavioral problems. A post hoc analysis of combining the two instruments found this to be more effective than the individual instruments alone in identifying children referred to clinical services at 18 months. Further analysis at the level of single items is warranted to improve these screening instruments.

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Acknowledgments

The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (Contract No. N01-ES-75558), NIH/NINDS (Grant No. 1 UO1 NS 047537-01 and Grant No. 2 UO1 NS 047537-06A1). We are grateful to all the participating families in Norway who take part in this ongoing cohort study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Psychiatry (966), Nijmegen Centre for Evidence-Based Practice, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Karin T. Beuker, Sophie Swinkels & Nanda N. J. Rommelse

  2. Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands

    Karin T. Beuker, Sophie Swinkels, Nanda N. J. Rommelse & Jan K. Buitelaar

  3. Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway

    Synnve Schjølberg

  4. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

    Kari Kveim Lie

  5. Department of Cognitive Neuroscience, Nijmegen Centre for Evidence-based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Jan K. Buitelaar

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  1. Karin T. Beuker
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Correspondence to Karin T. Beuker.

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Beuker, K.T., Schjølberg, S., Lie, K.K. et al. ESAT and M-CHAT as screening instruments for autism spectrum disorders at 18 months in the general population: issues of overlap and association with clinical referrals. Eur Child Adolesc Psychiatry 23, 1081–1091 (2014). https://doi.org/10.1007/s00787-014-0561-8

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  • DOI: https://doi.org/10.1007/s00787-014-0561-8

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