Universal Screening to Early Identification of Children with Autism
By Nancy Cronin
In the last two of decades there has been a dramatic increase in the number of individuals diagnosed with Autism Spectrum Disorders (ASD) in Maine and across the country. ASDs are lifelong neurological developmental disabilities that profoundly affect the way a person comprehends, communicates and relates to others.
The American Academy of Pediatrics  has reported that studies indicate early intervention services for young children with ASD significantly improves the children’s prognosis and should begin as early as 18 months of age. Research showed that almost all children with ASD benefit from early intervention therapies. The research further indicates that one-third of children receiving early intervention services improved so much that their need for ongoing support was dramatically reduced.
Along with the benefits to the children, early intervention has been shown to save money. In 2007 the Harvard School of Public Health reported that many individuals with ASD require lifelong supports at a cost estimated at $3.2 million per person. In addition, the U.S. Center for Disease Control and Prevention has reported that individuals with ASD had median medical expenditures 8.4 to 9.5 times higher than those without ASD. Several studies have shown that early intervention can reduce those costs by more than half over an individual’s life span.
In 2009 Maine State agencies brought together, through the ASD Systems Change Initiative, a group of families to report their experiences with the process that ultimately let to their children being diagnosed with an ASD. Their collective experience documented multiple systemic barriers which caused significant delays in identifying a diagnosis for their child. In turn, because the diagnosis was delayed, appropriate early intervention treatment was subsequently also delayed.
Currently, physicians who accept MaineCare clients are required to perform surveillance at well-child visits. Surveillance is a long-term, continuous, and cumulative process whereby the medical practitioners are able to identify developmental problems. Screening is a professional administering a standardized brief tool that assesses an individual’s risk for a disorder. According to Dr. Jason Gerber (2010), surveillance alone is not enough because it only identifies 30% of children before school age. Without early identification children will not be able to benefit from early intervention. Because of the low identification rates using surveillance alone, the American Academy of Pediatrics has recommended that all children receive a standardized autism screening at their 18 month well-child visit. Screening should not be confused with a complete evaluation which diagnoses a condition.
The Modified Checklist for Autism in Toddlers, better known as the M-CHAT, is a free screening tool that can be administered to children between the ages of 16 and 30 months-of-age. There are two parts to the screening. The first part is a 23 Yes/No questionnaire that the parents can complete on their own, or the screening can be done as an interview. The M-CHAT, Part 1 will identify 95% of those who are at risk of having an ASD. That said, only half of the children who “fail” Part 1 will have an ASD. So, Part 1 of the M-CHAT has a large false positive rate but a very low false negative rate.
The M-CHAT, Part 1 is comprised of six critical items, meaning the questions relate to core features of ASD, and 17 non-critical items. A child should be referred for the follow-up interview (Part 2) when either two or more critical items are answered atypically or any three non-critical items are answered atypically. The M-CHAT follow-up interview (part 2) was designed to be administered by healthcare paraprofessionals. The professional will ask the parent a series of questions related to the question that was answered atypically. Should there continue to be concerns after the interview, the child should be referred to a diagnostician for further evalutation.
Jacobson, J. W., Mulick, J. A., & Green, G. (1998). Cost benefit estimates for early intensive behavioral intervention for young children with autism - general model and single state case. Behavioral Interventions, 13, 201-226.
Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention
Gerber, Jason MD (2010) Developmental Screening vs. Surveillance in a Military Pediatric Clinic, http://depts.washington.edu/lend/trainees/project/2010/gerber.pdf Site accessed October 19,2011
The Modified Checklist for Autism in Toddlers
The complete M-CHAT can be accessed at: https://www.m-chat.org/
Other resources about Early Identification
and Early Intervention:
Autism Society of America
Autism Society of Maine
Center for Disease Control