Validation of the Electronic Modified Checklist for Autism in Toddlers, Revised with Follow-Up: A Nonrandomized Controlled Trial.

Researchers compared online versus paper versions of the M-CHAT-R/F autism screening tool in nearly 18,000 toddlers. Both versions were highly accurate at identifying autism risk. The online version worked better for children at medium risk and eliminated waiting time between screening steps. It also had no missing data and was easier to use. Parents should know that both screening methods are reliable for identifying early autism signs during routine check-ups.

This nonrandomized controlled trial compared web-based versus paper-phone administration of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in 17,900 toddlers screened during routine well-child visits. Both modalities demonstrated high sensitivity and specificity for autism screening. The web-based version showed superior performance for medium-risk children, with greater accuracy in predicting autism risk after follow-up and elimination of delays between initial screening and follow-up. The electronic format also provided increased screening fidelity with no data loss, while maintaining similar evaluation attendance rates and time to evaluation.

The study supports the validity of web-based M-CHAT-R/F for universal autism screening while highlighting trade-offs between electronic feasibility and clinician-administered follow-up accuracy.

Web-based M-CHAT-R/F represents a valid, efficient alternative to paper administration for universal autism screening. Healthcare systems should consider electronic implementation to improve screening fidelity and reduce delays, while balancing this with the potential benefits of skilled clinician follow-up interviews for optimal accuracy.

Nonrandomized design limits causal inference. Study does not report specific sensitivity/specificity values. Long study period (2009-2016) may introduce temporal confounding. Generalizability may be limited to urban/suburban primary care settings.

To examine the classification rates and screening properties, including sensitivity and specificity, of the web-based Modified Checklist for Autism in Toddler, Revised with Follow-Up (M-CHAT-R/F) compared with paper-phone administration, and to determine the extent to which electronic M-CHAT-R/F streamlines screening, increases screening fidelity, increases diagnostic evaluation participation, and decreases waiting time from screening to evaluation compared with paper-phone modality. Primary-care practices in urban and suburban settings administered either the web-based or paper-phone M-CHAT-R/F using a prospective nonrandomized control design. Toddlers (n = 17 900) were screened between 2009 and 2016 at routine well-child check-ups. Toddlers who screened at risk on the M-CHAT-R/F were invited to complete diagnostic evaluations; 176 children were diagnosed with autism.

The χ, Fisher exact, and t-tests, as well as regression and screening properties, were used to compare outcome distributions, screening properties, and implementation by modality. Classification rates of the initial M-CHAT-R into low, medium, and high risk were significantly different across modalities with very small effect sizes. Sensitivity and specificity were high across both modalities. For children in the medium-risk range, the web-based modality had a greater rate of predicting risk for autism after Follow-Up compared with the paper-phone modality, and the web eliminated delay between initial screen and Follow-Up.

The web-based modality showed increased screening fidelity, no data loss, and similar rates of evaluation attendance and time to evaluation from Follow-Up administration. The web-based M-CHAT-R/F is a valid tool for universal autism screening. Systems-level decisions should balance the increased feasibility of the electronic administration with the increase in Follow-Up accuracy provided by skilled clinician interview.