Development and validation of an early screening tool for young children with autism spectrum disorders: the checklist for Chinese toddlers with autism
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.