Journal of Isfahan Medical School

Journal of Isfahan Medical School

Validity, reliability and factor structure of the Persian version of the Modified Autism Checklist in Toddlers (M-CHAT)

Document Type : Original Article(s)

Authors
Fereshteh Shakibaei 1
Molood Alimirzaei 2
Amrolah Ebrahimi 3
Masoumeh Yazdanipour 4
Hamid Nasiri Dehsorkhi 5
1 Associated Professor, Child and Adolescent Psychiatrist, Autism research group, Behavioral Sciences Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
2 PhD in educational measurement and evaluation, Faculty of Psychology and Education, University of Tehran, Iran
3 Associate Professor, Behavioral Sciences Research Center, Department of Health Psychology,, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 PhD. Student, Department of Psychology and Education of Children with Special Needs, University of Isfahan, Isfahan, Iran
5 Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran and Department of Clinical Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.
10.48305/jims.v43.i846.1892
Abstract
Introduction: Autism spectrum disorder (ASD) is one of the neurodevelopmental disorders of childhood, but small percentage of children with ASD are diagnosed before the age of three. The aim of this study was to investigate the psychometric properties of the Persian version of the Modified Autism Checklist in Infants.
Methods: This study was conducted on a population of toddlers from specialized centers and hospitals in Isfahan. Inclusion criteria included a diagnosis of autism, age between 18-36 months, Persian language proficiency, and parental consent. Exclusion criteria included unwillingness to participate, incomplete checklist, neurological disorders, and severe disabilities. The Persian version of the checklist was initially translated by expert translators, then reviewed, and the final version was administered to 318 toddlers.
Results: Construct validity analysis identified three underlying factors explaining 43% of the variance. Convergent validity was assessed using CHAT, PDDS, and the CHAT versions completed by doctors and parents. Diagnostic validity demonstrated the tool's ability to differentiate between typical and ASD toddlers. The omega coefficients for the reliability of the three factors were 0.920, 0.773, and 0.680, respectively. The sensitivity and specificity of the tool were higher in identifying boys with autism. The area under the ROC curve was 0.85 for girls and 0.90 for boys. Cut-off points were determined to be 6 for girls and 4 for boys.
Conclusion: The M-CHAT-R/F has desirable psychometric properties, although some items require revision. The tool performs well across different gender groups and can be effectively used for early diagnosis of autism in toddlers.

Highlights

Fereshteh Shakibaei: Google Scholar

Amrollah Ebrahimi : Google Scholar, PubMed

Masoumeh Yazdanipour : Google Scholar

Hamid Nasiri-Dehsorkhi: Google Scholar

Keywords
Modified Checklist for Autism in Toddlers
psychometric properties
autism spectrum disorder
early diagnosis

Subjects

1.     Sung M, Goh TJ, Tan BLJ, Chan JS, Liew HSA. Comparison of DSM-IV-TR and DSM-5 criteria in diagnosing autism spectrum disorders in Singapore. J Autism Dev Disord 2018; 48(10): 3273-81.
2.     Sadock BJ, Sadock VA, Ruiz P. Comprehensive textbook of psychiatry. Philadelphia: Lippincott Williams & Wilkins; 2000.
3.     Rey GF, Rodríguez JS, Llinares ML, Vicens P, Llauradó CC, Torné MT, et al. A systematic review of instruments for early detection of autism spectrum disorders. International Journal of Psychology and Psychological Therapy 2019; 19(1): 29-38.
4.     Al Maskari TS, Melville CA, Willis DS. Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries. International journal of mental health systems 2018; 12: 1-19.
5.     Allison C, Baron-Cohen S, Wheelwright S, Charman T, Richler J, Pasco G, et al. The Q-CHAT (Quantitative CHecklist for Autism in Toddlers): a normally distributed quantitative measure of autistic traits at 18–24 months of age: preliminary report. J Autism Dev Disord 2008; 3 2008; 38(8): 1414-25.
6.     Matson JL, Wilkins J, Sharp B, Knight C, Sevin JA, Boisjoli JA. Sensitivity and specificity of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): Validity and cutoff scores for autism and PDD-NOS in toddlers. Research in Autism Spectrum Disorders 2009; 3(4): 924-30.
7.     Hedley D, Young R, Angelica M, Gallegos J, Marcin Salazar C. Cross-cultural evaluation of the Autism Detection in Early Childhood (ADEC) in Mexico. Autism 2010; 14(2): 93-112.
8.     Robins DL, Fein D, Barton ML, Green JA. The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord 2001; 31(2): 131-44.
9.     Inada N, Koyama T, Inokuchi E, Kuroda M, Kamio Y. Reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT). Research in Autism Spectrum Disorders 2011; 5(1): 330-6.
10.  Albores-Gallo L, Roldán-Ceballos O, Villarreal-Valdes G, Betanzos-Cruz BX, Santos-Sánchez C, Martínez-Jaime MM, et al. M‐CHAT Mexican version validity and reliability and some cultural considerations. ISRN Neurol 2012; 2012: 408694.
11.  Baron-Cohen S, Allen J, Gillberg C. Can autism be detected at 18 months?: The needle, the haystack, and the CHAT. Br J Psychiatry 1992; 161(6): 839-43.
12.  Beaudry I. Book Mark: PDDST-II: Pervasive Developmental Disorders Screening Test-II: Early Childhood Screener for Autism Spectrum Disorders (2004). The Canadian Journal of Occupational Therapy 2008; 75(2).
13.  Eaves RC, Williams Jr TO. Exploratory and confirmatory factor analyses of the pervasive developmental disorders rating scale for young children with autistic disorder. J Genet Psychol 2006; 167(1): 65-92.
14.  Eaves RC, Campbell HA, Chambers D. Criterion‐Related and construct validity of the pervasive developmental disorders rating scale and the autism behavior checklist. Psychology in the Schools. 2000; 37(4): 311-21.
15.  Eaves RC, Williams Jr TO, Woods-Groves S, Fall A-M. Reliability and validity of the pervasive developmental disorders rating scale and the gilliam autism rating scale. Education and Training in Developmental Disabilities 2006: 300-9.
16.  Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling. 2002; 9(2): 233-55.
17.  Tsai J-M, Lu L, Jeng S-F, Cheong P-L, Gau SS-F, Huang Y-H, et al. Validation of the modified checklist for autism in toddlers, revised with follow-up in Taiwanese toddlers. Res Dev Disabil 2019; 85: 205-16.
18.  Srisinghasongkram P, Pruksananonda C, Chonchaiya W. Two-step screening of the modified checklist for autism in toddlers in Thai children with language delay and typically developing children. J Autism Dev Disord 2016; 46(10): 3317-29.
19.  Samadi SA, McConkey R. Screening for autism in Iranian preschoolers: Contrasting M-CHAT and a scale developed in Iran. J Autism Dev Disord 2015; 45(9): 2908-16.
20.  Magán-Maganto M, Canal-Bedia R, Hernández-Fabián A, Bejarano-Martín Á, Fernández-Álvarez CJ, Martínez-Velarte M, et al. Spanish cultural validation of the modified checklist for autism in toddlers, revised. J J Autism Dev Disord 2020; 50(7): 2412-23.
21.  Jonsdottir SL, Saemundsen E, Jonsson BG, Rafnsson V. Validation of the modified checklist for autism in toddlers, revised with follow-up in a population sample of 30-month-old children in Iceland: a prospective approach. J Autism Dev Disord 2022; 52(4): 1507-22.
22.  Yuen T, Penner M, Carter MT, Szatmari P, Ungar WJ. Assessing the accuracy of the Modified Checklist for Autism in Toddlers: a systematic review and meta‐analysis. Dev Med Child Neurol 2018; 60(11): 1093-100.
23.  Nukeshtayeva K, Lubchenko M, Omarkulov B, Delellis N. Validation non-English version of modified checklist for autism in toddlers-revised with follow-up. Clin Med Kaz 2021; 18(4): 4-11.
24.  Aishworiya R, Ma VK, Stewart S, Hagerman R, Feldman HM. Meta-analysis of the modified checklist for autism in toddlers, revised/follow-up for screening. Pediatrics 2023; 151(6): e2022059393.
25.  Robins DL, Casagrande K, Barton M, Chen C-MA, Dumont-Mathieu T, Fein D. Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics 2014; 133(1): 37-45.
26.  Carakovac M, Jovanovic J, Kalanj M, Rudic N, Aleksic–Hil O, Aleksic B, et al. Serbian language version of the modified checklist for autism in toddlers, revised, with follow-up: Cross-cultural adaptation and assessment of reliability. Sci Rep 2016; 6: 38222.
Journal of Isfahan Medical School
Volume 43, Issue 846
2nd Week, March
March and April 2026
Pages 1892-1901

  • Receive Date 04 October 2024
  • Accept Date 11 May 2026