Developmental characteristics and accuracy of autism screening among two-year-old toddlers in the ECHO program

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Shuster, C. L., Brennan, P. A., Carter, B. S., Check, J., D’Sa, V., Graff, J. C., Helderman, J., Hofheimer, J. A., Joseph, R. M., Murphy, L., O’Connor, T. G., O’Shea, T. M., Pievsky, M., Sheinkopf, S. J., Shuffrey, L. C., Smith, L. M., Wu, P. C., Lester, B. M., Outcomes, o. b. o. p. c. f. E. i. o. C. H.,..., & Giardino, A. (2024). Developmental characteristics and accuracy of autism screening among two-year-old toddlers in the ECHO program. Pediatric Research, 96(4), 1052-1061. https://doi.org/10.1038/s41390-024-03193-5

Publication date: 15 Apr 2024 Added to AutiHub: 9 Oct 2026 Type: Article Article language: English
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Authors

Publication authors
76
Publication authors identified as autistic
1 / 76 (1.3%)
  1. Coral L. Shuster
  2. Patricia A. Brennan
  3. Brian S. Carter
  4. Jennifer Check
  5. Viren D’Sa
  6. J. Carolyn Graff
  7. Jennifer Helderman
  8. Julie A. Hofheimer
  9. Robert M. Joseph
  10. Laura Murphy *
  11. Thomas G. O’Connor
  12. T. Michael O’Shea
  13. Michelle Pievsky
  14. Stephen J. Sheinkopf
  15. Lauren C. Shuffrey
  16. Lynne M. Smith
  17. Pei-Chi Wu
  18. Barry M. Lester
  19. on behalf of program collaborators for Environmental influences on Child Health Outcomes
  20. ECHO Components—Coordinating Center
  21. P. B. Smith
  22. L. K. Newby
  23. L. P. Jacobson
  24. D. J. Catellier
  25. R. Gershon
  26. D. Cella
  1. ECHO Awardees and Cohorts
  2. A. N. Alshawabkeh
  3. J. Cordero
  4. J. Meeker
  5. J. Aschner
  6. S. L. Teitelbaum
  7. A. Stroustrup
  8. S. Merhar
  9. A. Lampland
  10. A. Reynolds
  11. M. Hudak
  12. G. Pryhuber
  13. P. Moore
  14. L. Washburn
  15. D. Koinis Mitchell
  16. S. Deoni
  17. A. L. Dunlop
  18. C. Karr
  19. Frances Tylavsky
  20. A. Mason
  21. Q. Zhao
  22. S. Sathyanarayana
  23. N. Bush
  24. K. Z. LeWinn
  25. B. Lester
  26. B. Carter
  1. S. Pastyrnak
  2. C. Neal
  3. R. K. Miller
  4. H. Simhan
  5. C. Buss
  6. P. Wadhwa
  7. K. Huff
  8. R. Vaidya
  9. R. Obeid
  10. C. Rollins
  11. K. Bear
  12. M. Lenski
  13. R. Singh
  14. M. Msall
  15. J. Frazier
  16. S. Gogcu
  17. A. Montgomery
  18. K. Kuban
  19. L. Douglass
  20. H. Jara
  21. J. Herbstman
  22. J. Stanford
  23. C. Porucznik
  24. A. Giardino

Abstract

BACKGROUND: The Modified Checklist for Autism in Toddlers (M-CHAT) is a common pediatric screening tool with mixed accuracy findings. Prior evidence supports M-CHAT screening for developmental concerns, especially in toddlers born preterm. This study examined M-CHAT accuracy in a large, nationwide sample. METHODS: 3393 participants from the Environmental influences on Child Health Outcomes (ECHO) program were included. Harmonized M-CHAT (M-CHAT-H) results were compared with parent-reported autism diagnosis and autism-related characteristics to assess accuracy for term and preterm children, together and separately. Generalized estimating equations, clustering for ECHO cohort and controlling for demographic covariates, were used to examine associations between developmental and behavioral characteristics with M-CHAT-H accuracy. RESULTS: Sensitivity of the M-CHAT-H ranged from 36 to 60%; specificity ranged from 88 to 99%. Positive M-CHAT-H was associated with more developmental delays and behavior problems. Children with severe motor delays and more autism-related problems were more likely to have a false-negative M-CHAT-H. Children with fewer behavior problems and fewer autism-related concerns were more likely to have a false-positive screen. CONCLUSION: The M-CHAT-H accurately detects children at low risk for autism and children at increased risk with moderate accuracy. These findings support use of the M-CHAT-H in assessing autism risk and developmental and behavioral concerns in children. IMPACT: Previous literature regarding accuracy of the Modified Checklist for Autism in Toddlers (M-CHAT) is mixed but this study provides evidence that the M-CHAT performs well in detecting children at low risk for autism and consistently detects children with developmental delays and behavioral problems. The M-CHAT moderately detects children at increased risk for autism and remains a useful screening tool. This study examines M-CHAT accuracy in a large-scale, nationwide sample, examining associations between screening accuracy and developmental outcomes. These findings impact pediatric screening for autism, supporting continued use of the M-CHAT while further elucidating the factors associated with inaccurate screens.

Bibliography cited by this reference

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Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 18 Oct 2026 01:01.

Cited references
31
With a DOI
26
Without a DOI, from raw bibliography text
5
0 / 31 (0.0%) cited references include at least one author identified as autistic.
References with data to complete
5 / 31 (16.1%)
References with detected author names
26 / 31 (83.9%)
Without detected author names
5
Without a structured title
5
Without a stable identifier
5
References with raw author names still to review
5
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
357
From DOI or external metadata
357
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
11
84 / 357 (23.5%) names are linked to an author already present in AutiHub. 273 / 357 (76.5%) names are not yet linked.
Names linked to a person identified as autistic
0 / 357 (0.0%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 0 / 84 (0.0%). Distinct people identified as autistic: 0 / 260 (0.0%).
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