Screening of children for autism spectrum disorders using Modified Checklist for Autism Spectrum Disorders (MCHAT) in toddlers in the age group 16-30 months: An observational study

Deepa C Metgud; Sherin Paulose

doi:10.4103/ijptr.ijptr_3_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 1 | Issue : 2 | Page : 110-113

Screening of children for autism spectrum disorders using Modified Checklist for Autism Spectrum Disorders (MCHAT) in toddlers in the age group 16-30 months: An observational study

Deepa C Metgud, Sherin Paulose
Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	11-Mar-2019
Date of Decision	26-Jun-2019
Date of Acceptance	19-Jul-2019
Date of Web Publication	23-Dec-2019

Correspondence Address:
Dr. Deepa C Metgud
Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_3_19

Abstract

:
Background and Purpose: Autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders characterized by impaired speech and communication and repetitive behavior. In the past few decades, there has been a gradual increase in the prevalence rates of ASD. The present study intends to find the prevalence of ASD in children between 16 and 30 months in Belagavi using Modified Checklist for ASD in Toddlers (MCHAT) questionnaire. Materials and Methods: This cross-sectional study was conducted on 510 children in the age group of 16–30 months in the Anganwadis and playschools of Belagavi using cluster sampling. The teachers were explained about the details of the study and were asked to gather children between 16 and 30 months along with their primary caretaker. The caretaker were explained about the details of the study, and participants were recruited based on the inclusion and exclusion criteria. Demographic data such as age, gender and socioeconomic status were recorded. The caretakers were given translated Kannada version of MCHAT-revised questionnaire to record their responses based on their child's behavior, and the total score was calculated by the primary investigator. Results: Among the 510 children screened for the risk of ASD, the prevalence was found to be 0.19%. The mean age of the participants was 24.5 ± 5.04 months. The prevalence was found in the upper-middle class in the age group of 28–30 months.Conclusion: The prevalence of ASD in Belagavi was 0.19% in children in the age group of of 16–30 months.

Keywords: Autism spectrum disorder, Prevalence, Modified Checklist for Autism Spectrum Disorder in Toddlers revised questionnaire

How to cite this article:
Metgud DC, Paulose S. Screening of children for autism spectrum disorders using Modified Checklist for Autism Spectrum Disorders (MCHAT) in toddlers in the age group 16-30 months: An observational study. Indian J Phys Ther Res 2019;1:110-3

How to cite this URL:
Metgud DC, Paulose S. Screening of children for autism spectrum disorders using Modified Checklist for Autism Spectrum Disorders (MCHAT) in toddlers in the age group 16-30 months: An observational study. Indian J Phys Ther Res [serial online] 2019 [cited 2023 Jun 2];1:110-3. Available from: https://www.ijptr.org/text.asp?2019/1/2/110/273716

Introduction

Autism or autism spectrum disorder (ASD) is a “complex neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication and by restricted and repetitive behavior.” ASDs are one of the most common neurodevelopmental disorders with highly varied manifestations and poses a diagnostic challenge.^[1],[2] The prevalence of ASD has increased in a highly populated and demographically “young” country like India.^[2] Today, ASDs have a prevalence of 62/10,000 globally, 1 in every 150 children in the U.S.^[3],[4] In northwest India, the prevalence rate is 0.09/100 while it is 9.4% in Puducherry, South India.^[5] Genetic risk factors, intake of valproic acid, and thalidomide during pregnancy, in addition to routine perinatal complications, increased parental age, birth defects associated with dysfunction of the central nervous system, late initiation of breastfeeding, and neonatal seizures have been associated with ASD.^[2],[6]

Autism is a disorder that usually originates in infancy, predominantly, in the first 3 years of life. Parents often become apprehensive when their child fails to communicate with words, though the social impairments are not recognizable in the initial years, they gradually become more evident as they become more ambulatory and compared to other children become more socially sophisticated.^[7] According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the essential characteristics of ASD are persistent deficits of social communication and interaction; restricted and repetitive behaviors, interests, and activities.^[8] The earliest signs of autism start appearing from 6 months onward. Autism is difficult to detect before 24 months, but symptoms begin to show by 12–18 months. The signs and symptoms of ASD often go unnoticed by parents due to lack of awareness, profound ignorance and social stigma leading to atypical development, motor disability, behavioral issues, sensory issues and difficulties in activities of daily living. Studies have shown that most cases of autism have been diagnosed after the age of 4 years. However, if the signs are detected as early as 18 months of age, early intervention can reduce the effects of the disorder.

Studies on ASD have largely focused on specific children populations that have histories of special needs or developmental delays.^[9],[10] In other words, the current scenario of ASD research is largely restricted to clinic-based case reports, case series and retrospective systemic reviews. An extensive search on the prevalence or incidence of ASD in India reveals a dearth of epidemiological data.^[5] The awareness of ASD among the people and pediatricians has increased remarkably in recent years because of increased media coverage and recognition, increased incidence of cases as well as research studies published in professional journals.^[9] Furthermore, parents having children with autistic features have a tough time dealing with their issues. Hence, early detection of ASDs can help them in improving the quality of their child's life and relieve them of their anxieties and support their child to lead a healthier lifestyle while dealing with this disorder.

A number of screening tools for autism are available globally such as Modified Checklist for ASD in Toddlers (MCHAT), pervasive developmental disorders screening test-Stage 1, and screening tool for autism in toddlers and young children but not all tools are suitable for the Indian population. Since age between 2-3 years seems to be best age to identify the risk of autism in children, MCHAT-revised (MCHAT-R) is used in this study. Hence, the present study intended to find the prevalence of ASD in children between 16–30 months in Belagavi using MCHAT questionnaire.

Materials and Methods

This cross-sectional observational study was conducted on 510 children in the age group of 16–30 months. Ethical clearance was obtained from the Institutional Ethical Committee. The sample for the study was drawn from12 Anganwadis and 4 playschools using cluster sampling from a total of 72 wards and 20 playschools in Belagavi, respectively, over a period of 6 months after obtaining permission from competent authorities. Children diagnosed with cerebral palsy, genetic disorders, mental retardation, congenital disorders, metabolic disorders, and parents unwilling to participate in the study were excluded from the study.

The purpose of the study was explained to the teachers of the playschools and Anganwadis and were requested to assemble all the children in the age group of 16–30 months along with their primary caretaker on a scheduled date. The children were then recruited in the study based on the inclusion and exclusion criteria. The principal investigator explained the purpose and the procedure of the study to the primary caretakers and a written informed assent was obtained for their child's participation in the study. A brief demographic data such as gender, height, weight, and head circumference was recorded. The socioeconomic status (SES) of the primary caretaker was recorded according to the Modified Kuppuswamy Scale. The primary caretaker was given a translated Kannada version of MCHAT-R questionnaire to record their responses related to their child's behavior, and the total score was calculated by the principal investigator. If the primary caretakers experienced any difficulty in recording their responses, the principal investigator explained the questions to them. The MCHAT-R screening tool has 20 questions to be scored by the primary caretakers where 1 point is given to each question. For all items except questions 2, 5, and 12, the response “NO” indicates ASD risk. The total score of 0–2 was considered as low risk whereas the medium risk score was 3–7 and high risk scores were 8–20. If the child scored positive on the MCHAT-R, he/she was reassessed using MCHAT-R Follow up questionnaire only on those items that originally failed on MCHAT-R questionnaire.

Data analysis

Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21 (IBM, Armonk, NY, United States of America). Microsoft Excel and Word 2010 were used to generate the graphs and tables.

Results

In the present study, 510 children were screened for the risk of ASD in the age group of 16–30 months. The demographic profile of the participants in the study is depicted in [Table 1] in terms of age, gender, and SES distribution. The overall prevalence of ASD in the age group of 16–30 months was 0.19% which was found in the age category of 28–30 months. [Table 2] shows that the prevalence of ASD based on SES. [Table 3] depicts the severity score of MCHAT-R/F for children identified at risk for ASD.

Table 1: Demographic profile of the study

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Table 2: Prevalence of risk of autism spectrum disorder according to the socioeconomic status

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Table 3: Severity score of the Modified Checklist for Autism Spectrum Disorder in Toddlers-Revised/Follow-Up in children identified at risk

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Discussion

The present study was done to determine the prevalence of ASD in children between 16 and 30 months in Belagavi, Karnataka, where 510 children were screened from different Anganwadis and playschools using MCHAT-R questionnaire. Among the 510 children screened, there was only one male child showing the risk of ASD with a prevalence of 0.1%. A prevalence rate of 9.42% at risk of ASD using MCHAT-R was found in a study conducted on 350 children in the age group of 16–30 months visiting the pediatric outpatient department in JIPMER, Puducherry, India, from June 2014 to August 2014.^[11] A prevalence study was conducted in Kerala, India, using cluster random sampling and screened by community nurses on 6237 toddlers using the Modified Checklist for Autism in Toddlers −Revised (MCHAT-R) reported that toddlers at risk for ASD were 5.5% on MCHAT-R and on “Best Seven” was 2.7%.^[6] In a cross-sectional survey of 11,000 children in the age group of 1–10 years using the Indian Scale for Assessment of Autism from the selected tribal, rural and urban areas of Himachal Pradesh, India, stated a prevalence of 0.9/1000 population and reported that ASD is a rare neurodevelopmental disorder as well as indicated SES as one of the fundamental indicators for ASDs in India.^[5] The present study can be comparable to Raina's study on ASD as there was 0.19% prevalence among the 510 children screened for ASD. However, the present study comprised of a smaller sample in a single city, whereas the previous study was conducted on a larger sample in a vast geographical area consisting of urban, rural, and tribal areas. The prevalence was found in the upper-middle class of the SES, and no prevalence was found in other socioeconomic classes. Low parental SES is associated with an increased prevalence of autistic features among children who were screened at 36 months after birth in a study done in Norway.^[12]

The limitations of the present study was smaller sample size, limited geographical area and short data collection period as compared to other studies conducted previously in India. Future studies may consider a longer data collection period, covering a larger geographical area to find the accurate prevalence of ASD in this age group as well as utilize a diagnostic tool like childhood autism rating tool to confirm the diagnosis of autism.

Conclusion

The prevalence of ASD in Belagavi was 0.19% in 16–30 months children belonging to upper-middle SES.

Acknowledgments

The authors would like to thank the staff and teachers of various Anganwadis and playschools as well as the parents of the all participants for their willingness and cooperation to participate in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	McPartland JC, Reichow B, Volkmar FR. Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2012;51:368-83.
2.	Dalwai SH, Modak DK, Bondre AP, Gajria D. Analysis of tools for diagnosing autism spectrum disorder in the Indian context. Acad J Pediatr Neonatol 2016;1:555-62.
3.	Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcín C, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res 2012;5:160-79.
4.	Christensen DL, Braun KV, Baio J, Bilder D, Charles J, Constantino JN, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR Surveillance Summaries 2018;65:1.
5.	Raina SK, Chander V, Bhardwaj AK, Kumar D, Sharma S, Kashyap V, et al. Prevalence of autism spectrum disorder among rural, urban, and tribal children (1-10 years of age). J Neurosci Rural Pract 2017;8:368-74. [PUBMED] [Full text]
6.	Ts J, Jacob P, Srinath S, Kumar S, Manoj L, Gokul GR, et al. Toddlers at risk for autism spectrum disorders from Kerala, India – A community based screening. Asian J Psychiatr 2018;31:10-2.
7.	Lord C, Cook EH, Leventhal BL, Amaral DG. Autism spectrum disorders. Neuron 2000;28:355-63.
8.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
9.	Gillberg C. Infantile autism and other childhood psychoses in a Swedish urban region. Epidemiological aspects. J Child Psychol Psychiatry 1984;25:35-43.
10.	Williams JG, Higgins JP, Brayne CE. Systematic review of prevalence studies of autism spectrum disorders. Arch Dis Child 2006;91:8-15.
11.	Ravi S, Chandrasekaran V, Kattimani S, Subramanian M. Maternal and birth risk factors for children screening positive for autism spectrum disorders on M-CHAT-R. Asian J Psychiatr 2016;22:17-21.
12.	Lauritsen MB, Pedersen CB, Mortensen PB. Effects of familial risk factors and place of birth on the risk of autism: A nationwide register-based study. J Child Psychol Psychiatry 2005;46:963-71.