Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study

  • Hendra Salim Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali
  • Soetjiningsih Soetjiningsih Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali
  • I Gusti Ayu Trisna Windiani Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali
  • I Gede Raka Widiana Department of Internal Medicine, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali
Keywords: M-CHAT; autism; screening; validity


Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated.

Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia.

Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program  software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value.

Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions.

Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.


1. Johnson CP, Myers SM, American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120:1183–215. DOI: 10.1542/peds.2007-2361.
2. Volkmar F, Wiesner L. Autism and related disorders. In: Carey WB, Crocker AC, Coleman WL, Elias ER, Feldman HM, editors. Developmental-behavioral pediatrics. 4th ed. Philadelphia: Saunders Elsevier; 2009. p. 675-85.
3. Alisjahbana EM. Asuhan dini tumbuh kembang anak. In: Siswanto MT, editor. Simposium penatalaksanaan mutakhir bidang Ilmu Kesehatan Anak untuk mencapai tumbuh kembang optimal, 21–22 Juli 2000. Bandung: IDAI cabang Jawa Barat; 2000. p.34-53.
4. Yuwono J. Memahami anak autistik (Kajian teoritik dan empirik). Bandung: Penerbit Alfabeta; 2009. p. 1-36.
5. Robins DL, Fein D, Barton ML, Green JA. The modified checklist for autism in toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord. 2001;31:131–44. DOI: 10.1023/a:1010738829569.
6. Dumont-Mathieu T, Fein D. Screening for autism in young children: The Modified Checklist for Autism in Toddlers (M-CHAT) and other measures. Ment Retard Dev Disabil Res Rev. 2005;11:253-62. DOI: 10.1002/mrdd.20072.
7. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee; Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics. 118:1808–9]. Pediatrics. 2006;118:405–20. DOI: 10.1542/peds.2006-1231.
8. Lemeshow S, Hosmer DW Jr, Klar J, Lwanga SK?. Adequacy of sample size in health studies?. Chichester: World Health Organization; 1990. p. 1-4.
9. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;8:307-10. PMID: 2868172.
10. Pusponegoro HD, Wirya IGN. W, Pudjiadi AH, Bisanto J, Zulkarnain SZ. Uji diagnostik. In: Sastroasmoro S, Ismael S, editors. Dasar-dasar metodologi penelitian klinis. 3rd ed. Jakarta: Sagung Seto; 2008. p. 193-216.
11. Dahlan MS. Analisis Penelitian diagnostik. Jakarta: Sagung Seto; 2009. p. 19-30.
12. Akobeng AK. Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr. 2007;96:487-91. DOI: 10.1111/j.1651-2227.2006.00179.x.
13. Kogan MD, Blumberg SJ, Schieve LA, Boyle CA, Perrin JM, Ghandour RM, et al. Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics. 2009;124:1395-403. DOI: 10.1542/peds.2009-1522.
14. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators; Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorders - Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. MMWR Surveill Summ. 2012;61:1-19. PMID: 22456193.
15. Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011;168:904-12. DOI: 10.1176/appi.ajp.2011.10101532.
16. Canal-Bedia R, García-Primo P, Martín-Cilleros MV, Santos-Borbujo J, Guisuraga-Fernández Z, Herráez-García L, et al. Modified checklist for autism in toddlers: cross-cultural adaptation and validation in Spain. J Autism Dev Disord. 2011;41:1342-51. DOI: 10.1007/s10803-010-1163-z.
17. Seif Eldin A, Habib D, Noufal A, Farrag S, Bazaid K, Al-Sharbati M, et al. Use of M-CHAT for a multinational screening of young children with autism in the Arab Countries. Int Rev Psychiatry. 2008;20:281-9. DOI: 10.1080/09540260801990324.
18. Chlebowski C, Robins DL, Barton ML, Fein D. Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics. 2013;131:e1121-7. DOI: 10.1542/peds.2012-1525.
19. Robins DL. Screening for autism spectrum disorders in primary care settings. Autism. 2008;12:537-56. DOI: 10.1177/1362361308094502.
20. Pintunan P, Chonchaiya W, Pruksananonda C. Screening Thai children who have delayed language development with M-CHAT (a modified checklist for autism in toddlers) and CHAT (checklist for autism in toddlers) Section B. Thai J Pediatr. 2009;48:221-9.
21. Robins DL, Dumont-Mathieu TM. Early screening for autism spectrum disorders: update on the modified checklist for autism in toddlers and other measures. J Dev Behav Pediatr. 2006;27:111-9. DOI: 10.1097/00004703-200604002-00009.
22. Aakre KJ, Paul K, Barry S. Developmental screening “preferred tool list” for children birth to three years. Burlington: Vermont Child Health Improvement Program; 2010. p. 6-25.
23. Tsai WC, Soong WT, Shyu YI. Toddler autism screening questionnaire: development and potential clinical validity. Autism. 2012;16:340-9. DOI: 10.1177/1362361311429694.
How to Cite
Salim H, Soetjiningsih S, Windiani IGA, Widiana IG, ASPR P. Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study. PI [Internet]. 18Jun.2020 [cited 20Jun.2024];60(3):160-. Available from:
Developmental Behavioral & Community Pediatrics
Received 2019-09-25
Accepted 2020-06-18
Published 2020-06-18