Autism spectrum disorder screening in children aged 16-30 months using the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R)

Main Article Content

Clarissa Josephine Aditya
Jenni Kim Dahliana
Ariani Dewi Widodo
Rini Sekartini

Abstract

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with a global prevalence of 7.6 in 1,000 children. The Modified Checklist for Autism in Toddlers - Revised (M-CHAT-R) is one of many screening tools for ASD. It is fast, easy to use, and has been translated and validated in the Indonesian language.


Objective To determine the prevalence of ASD in Indonesia and its risk factors.


Methods A cross-sectional study was conducted from March to October 2020. In the first protocol (March to July 2020), 219 children aged 16-30 months from 20 hospital walk-in clinics in five districts of Jakarta were included. Subjects’ parents filled out the M-CHAT-R questionnaire during their visit. A series of questions were asked to provide information about probable risk factors associated with ASD: gender, family history of ASD, preterm birth, low birth weight (LBW), and history of seizures. The second protocol (August to October 2020) was completed by parents via an online form, where 746 children aged 16-30 months were enrolled. Therefore, a total of 965 subjects were eligible for statistical analysis.


Results Of 965 subjects, 56.58% were males. Subjects’ mean of age was 22.59 (SD 4.15) months. M-CHAT-R screening showed that 34 (3.52%) subjects were at high risk of developing ASD. Only male gender was significantly associated with ASD.


Conclusion We screened for ASD in healthy 16-30-month-old Indonesian children. The rate of high-risk M-CHAT-R score was 3.52%. Male gender was a significant risk factor for high-risk M-CHAT-R results.

Article Details

How to Cite
1.
Aditya C, Dahliana J, Widodo A, Sekartini R. Autism spectrum disorder screening in children aged 16-30 months using the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). PI [Internet]. 20Sep.2021 [cited 8Dec.2021];61(5):247-2. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2626
Section
Developmental Behavioral & Community Pediatrics
Received 2021-03-16
Accepted 2021-09-20
Published 2021-09-20

References

1. Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, et al. The changing epidemiology of autism spectrum disorders. Annu Rev Public Health. 2017;38:81–102. DOI: 10.1146/annurev-publhealth-031816-044318.
2. Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45:601–13. DOI: 10.1017/S003329171400172X.
3. Hodges H, Fealko C, Soares N. Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Transl Pediatr. 2020;9(Suppl 1):S55-S65. DOI: 10.21037/tp.2019.09.09.
4. Szatmari P, Chawarska K, Dawson G, Georgiades S, Landa R, Lord C, et al. Prospective longitudinal studies of infant siblings of children with autism: lessons learned and future directions. J Am Acad Child Adolesc Psychiatry. 2016;55:179–87. DOI: 10.1016/j.jaac.2015.12.014.
5. Johnson CP, Myers SM, and the 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.
6. Muhle R, Trentacoste S, Rapin I. The genetics of autism. Pediatrics. 2004;113:e472-86. DOI: 10.1542/peds.113.5.e472.
7. Arndt TL, Stodgell CJ, Rodier PM. The teratology of autism. Int J Dev Neurosci. 2005;23:189–99. DOI: 10.1016/j.ijdevneu.2004.11.001.
8. Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013;309:1696–703. DOI: 10.1001/jama.2013.2270.
9. Croen LA, Connors SL, Matevia M, Qian Y, Newschaffer C, Zimmerman AW. Prenatal exposure to β2-adrenergic receptor agonists and risk of autism spectrum disorders. J Neurodev Disord. 2011;3:307–15. DOI: 10.1007/s11689-011-9093-4.
10. Harrington JW, Allen K. The clinician’s guide to autism. Pediatr Rev. 2014;35:62–78. DOI: 10.1542/pir.35-2-62.
11. Robins DL, Casagrande K, Barton M, Chen CMA, Dumont-Mathieu T, Fein D. Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics. 2014;133:37-45. DOI: 10.1542/peds.2013-1813.
12. Yuen T, Penner M, Carter MT, Szatmari P, Ungar WJ. Assessing the accuracy of the Modified Checklist for Autism in Toddlers: a systematic review and meta-analysis. Dev Med Child Neurol. 2018;60:1093–100. DOI: 10.1111/dmcn.13964.
13. Nguyen QT. ASD Screening in The Primary Care Setting: The MCHAT-R & Beyond [Internet]. 2019 [cited 2020 Nov 17]. Available from: https://physicians.utah.edu/echo/pdfs/2019-02-20-screening-asd-in-primary-care.pdf.
14. Windiani IGAT, Soetjiningsih S, Adnyana IGAS, Lestari KA. Indonesian Modified Checklist for Autism in Toddler, Revised with follow-up (M-CHAT-R/F) for autism screening in children at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2016;5:133–7. DOI: 10.15562/bmj.v5i2.240.
15. She J, Liu L, Liu W. COVID-19 epidemic: disease characteristics in children. J Med Virol. 2020;92:747–54. DOI: 10.1002/jmv.25807.
16. Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA. 2014;311:1770–7. DOI: 10.1001/jama.2014.4144.
17. Harrison MS, Goldenberg RL. Global burden of prematurity. Semin Fetal Neonatal Med. 2016;21:74–9. DOI: 10.1016/j.siny.2015.12.007.
18. Rohsiswatmo R, Amandito R. Optimalisasi pertumbuhan bayi prematur dan pasca prematur di Indonesia; mengacu pada pedoman nutrisi bayi prematur di RSCM. Sari Pediatr. 2019;21:262–70. DOI: 10.14238/sp21.4.2019.262-70.
19. Wang C, Geng H, Liu W, Zhang G. Prenatal, perinatal, and postnatal factors associated with autism: a meta-analysis. Medicine (United States). 2017;96:e6696. DOI: 10.1097/MD.0000000000006696.
20. Agrawal S, Rao SC, Bulsara MK, Patole SK. Prevalence of autism spectrum disorder in preterm infants: a meta-analysis. Pediatrics. 2018;142:e20180134. DOI: 10.1542/peds.2018-0134.
21. Amiet C, Gourfinkel-An I, Bouzamondo A, Tordjman S, Baulac M, Lechat P, et al. Epilepsy in autism is associated with intellectual disability and gender: evidence from a meta-analysis. Biol Psychiatry. 2008;64(7):577-82. DOI: 10.1016/j.biopsych.2008.04.030.
22. Woolfenden S, Sarkozy V, Ridley G, Coory M, Williams K. A systematic review of two outcomes in autism spectrum disorder - epilepsy and mortality. Dev Med Child Neurol. 2012;54(4):306-12. DOI: 10.1111/j.1469-8749.2012.04223.x.
23. Lukmanji S, Manji SA, Kadhim S, Sauro KM, Wirrell EC, Kwon CS, et al. The co-occurrence of epilepsy and autism: a systematic review. Epilepsy Behav. 2019;98:238–48. DOI: 10.1016/j.yebeh.2019.07.037.
24. Lee BH, Smith T, Paciorkowski AR. Autism spectrum disorder and epilepsy: Disorders with a shared biology. Epilepsy Behav. 2015;47:191-201. DOI: 10.1016/j.yebeh.2015.03.017.
25. Kuban KC, Joseph RM, O'Shea TM, Allred EN, Heeren T, Douglass L, et al; Extremely Low Gestational Age Newborn (ELGAN) Study Investigators. Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years. J Pediatr. 2016;173:69-75.e1. DOI: 10.1016/j.jpeds.2016.02.048.