Use of M-CHAT-R/F-A to Screen for ASD in Albania

The current study examined the screening and evaluation of 2,594 toddlers between 16 and 36 months of age for Autism Spectrum Disorder (ASD) to determine the clinical utility of Modified Checklist for Autism in Toddlers-Albanian version(M-CHAT-R-A). Of these children, 253 (9.75%) toddlers screened positive on the initial screening at pediatric well child visits in Albanian speaking communities in Albania. Follow up interviews were conducted by phone on failed items, as on the English version of the M-CHAT-R/F. Interviews were completed with 127 (50%) of the screened positive toddlers; 50% (n=126) of the 253 screened positive toddlers were lost to follow-up due to parent refusal or inability to contact. A total of 26 toddlers (21%) continued to screen positive after follow-up, qualifying them for a free developmental and diagnostic evaluation, 20 of whom received an evaluation. Autism Diagnostic Observation Schedule (ADOS) results indicated that 16% (n=3) of toddlers met criteria for ASD, 74% (n=14) met Autism criteria, and 11% (n=2) were classified as Non-ASD. Positive Predictive Value (PPV) of the 2-Stage M-CHAT-R-A for ASD or Autism was 0.895 (95% CI: 0.65-0.98) and 1.00 (95% CI: 0.79-1.00) for other developmental delays, with no typical children found in the evaluated sample. Results indicated that removal of three items, using a cut-off of 5 failed items on initial screening, and a cut-off of 2 failed items on follow-up interview would increase reliability and decrease false positive rates. Further research is needed to confirm the performance of this version of the screener and proposed cut-offs. Results also suggest that key presenting features of autism are comparable between the original population on which the M-CHAT and M-CHAT-R were developed and the Albanian population, despite difference in culture, language, and location.