Development and validation of an early screening tool for young children with autism spectrum disorders: the checklist for Chinese toddlers with autism
Aug 2026· Frontiers in Psychiatry· Vol 17· 0 citations· 70 references
Medicine
TL;DR
Preliminary evidence indicates that the Checklist for Chinese Toddlers with Autism exhibits sound psychometric properties and may serve as an early screening tool for Chinese children with ASD aged 12–24 months, however, external validation is still required to establish its generalizability.
Abstract
This study aimed to develop and validate the Checklist for Chinese Toddlers with Autism, a culturally adapted early screening tool for autism spectrum disorder in children aged 12–24 months. The scale was developed by synthesizing early ASD symptom characteristics, reviewing international screening instruments, incorporating interviews with 15 medical professionals, and consulting eight experts in developmental behavioral pediatrics, child psychology, and psychometrics. The final scale comprises three dimensions (reciprocal social behaviors, social communication, interest behaviors and sensory perception) and 20 items assessed via behavioral observation. Initial validation involved 809 children (aged 12–24 months) to evaluate reliability and validity of the scale, and then determine a cutoff point to differentiate the severity levels of ASD. Further, the scale was applied in 4786 children from the neighborhood child health care clinics to test the screening value of the checklist. The results indicated that a cutoff score of 12 yielded optimal performance, with high sensitivity (0.95) and specificity (0.82). Community-based screening confirmed its efficacy in distinguishing between high likelihood and low likelihood children for ASD. Preliminary evidence indicates that the Checklist for Chinese Toddlers with Autism exhibits sound psychometric properties and may serve as an early screening tool for Chinese children with ASD aged 12–24 months, however, external validation is still required to establish its generalizability.
The preliminary reliability and validity of the Modified Checklist for Autism in Toddlers–School Age version (M-CHAT-S), a novel screener designed for early school-age children, with separate versions for verbally fluent and minimally verbal children, are evaluated.
A. D. de Marchena, A. Wieckowski, Alexia F Dickerson et al.· Autism· 0 citations
Behavioral observation through examiner-child structured interactive play, particularly metrics related to eye contact, effectively differentiates toddlers with iASD.
Dan Ai, Binyue Hu, Qiuhong Wei et al.· BMC Psychiatry· 0 citations
Autism spectrum disorder (ASD) prevalence is increasing globally, including in low- and middle-income settings. Early screening is essential; however, screening tools require local validation. The Screening Tool for Autism in Toddlers and Young Children (STAT) has been incorporated into Vietnam’s Ministry of Health guidelines, yet its diagnostic performance has not been formally evaluated. This cross-sectional study validated the STAT among 86 children aged 24–36 months with language delay attending a tertiary pediatric hospital in Ho Chi Minh City between December 2022 and August 2023. STAT results were compared with DSM-5-based clinical diagnoses, the diagnostic reference standard. The STAT was administered by certified speech therapists, and STAT results were not disclosed to the child psychologist conducting the DSM-5-based diagnostic evaluation. Diagnostic accuracy indices and receiver operating characteristic (ROC) analysis were performed to evaluate diagnostic performance and explore alternative cut-off values. The findings showed a predominance of male children (65.1%) and a high prevalence of ASD (74.4%). At the recommended cut-off of ≥ 2, STAT demonstrated high sensitivity (89.1%) but moderate specificity (50.0%), with positive and negative predictive values of 83.8% and 61.1%, respectively. The area under the ROC curve was 0.7656 (95% CI: 0.639–0.883), indicating fair overall discriminative ability. In an exploratory analysis, a data-derived cut-off of 2.5 yielded the highest Youden Index, with sensitivity of 73.4% and specificity of 68.2%. The exploratory 2.5 threshold requires independent validation before any change to the recommended ≥ 2 threshold is considered. Overall, these findings provide preliminary evidence supporting the existing STAT cut-off of ≥ 2 in similar high-risk clinical populations, while larger multicenter and community-based studies are needed to confirm the performance and generalizability of this cut-off. First validation of STAT in Vietnamese toddlers with language delay. Recommended cut-off ≥ 2 showed sensitivity of 89% and specificity of 50%. AUC 0.7656 indicates fair overall discriminative ability. Exploratory cut-off 2.5 showed sensitivity of 73.4% and specificity of 68.2%.
Thi Bich Ngoc Nguyen, Hieu K. T. Ngo, G. Dinh et al.· Egyptian Pediatric Associati...· 0 citations
BACKGROUND
The Autism Behavior Checklist (ABC) evaluates symptoms in individuals with Autism Spectrum Disorders (ASD) within a school setting. The purpose of this study was to evaluate the validity of the ABC Mexican version.
METHODS
Participants were children (n = 133, aged 2-17). All parents were interviewed with the autism diagnostic interview-revised (ADI-R) to confirm an ASD diagnosis and then answered the ABC checklist. The sample for the ABC test-retest analysis consisted of 19 parents with unaffected typically developing children between 2 and 17 years old.
RESULTS
Children and adolescents (n = 133) with a mean age of 6.9 years (standard deviation [SD] 3.7), 83.5% were males. The ABC total mean score was 69.3 (SD 25). The Internal consistency through the Cronbach Alfa coefficient was α = 0.83 < p = 0.001 for the 57 ABC items. The 10-day test-retest reliability showed a Pearson correlation coefficient of r = 0.98, p < 0.001. The Spearman correlation coefficients between the ABC subscales and the ADI-R ranged from (rs = 0.494) to (rs = 0.816). Criterion validity with a cutoff of 30 resulted in a sensitivity of 87% and a specificity of 37%. The best Kappa coefficient was 0.285 between the ABC and the ADI-R.
CONCLUSIONS
The Mexican ABC has good psychometric properties. Further studies should investigate its value in educational settings.
L. Albores-Gallo, Karen L. Varela-Orozco, Ofelia Roldán-Ceballos et al.· Boletín Médico del Hospital...· 0 citations
Background The development and implementation of culturally appropriate, easy-to-administer, open-source assessment tools are critical for advancing autism detection and research in low- and middle-income countries. Methods The ASD-PEDS, an open-source semi-structured observational tool for assessing autism-related behaviors in young children, was adapted for use in Kenya via iterative refinement throughout the process of forward–backward translation (English–Kiswahili), cognitive interviews with clinicians and caregivers, and field testing to ensure cultural relevance. Results Cognitive interviews revealed culturally normative early social communication and play skills aligned with key behaviors assessed by the ASD-PEDS. Field testing further identified targets for adaptation including development of bilingual administration guidelines and cultural modifications to assessment activities. During field testing, ASD-PEDS categorical risk matched the child’s diagnosis in 100% of cases, demonstrating initial alignment with clinical classification. Conclusions With minor adaptations, the ASD-PEDS demonstrates preliminary feasibility as an observational assessment tool to support standardized autism evaluation of young children in low-resource settings. Given the early-stage nature of this adaptation study, findings should be interpreted as preliminary. Study of psychometric performance in a heterogeneous larger sample of children is a necessary next step for cultural validation.
Kristin D. Fauntleroy-Love, Chelagat Saina, E. Oyungu et al.· Frontiers in Psychiatry· 0 citations
A shorter version of the Screening Tool for Autism in Two-Year-Olds (STAT) that takes 5 to 10 min that could help clinicians more efficiently identify autism among toddlers already referred for developmental evaluation, facilitating timely referral for formal diagnostic confirmation and subsequent access to intervention services.
