Validation of two parent-reported autism spectrum disorders screening tools M-CHAT-R and SCQ in Bamako, Mali

Abstract

Background:Early screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention.ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized thattheir use in Mali may require a prior validation.Objective:To validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social com-munication questionnaire (SCQ) in the Malian sociocultural context for ASD screening.Study design:We administered M-CHAT-R and SCQ in 947 toddlers aged 16–30 months old at the district andcommunity health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated forcultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined forboth M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-Rand SCQ for ASD screening in Bamako.Results:We found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have foundfour out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context.Discussion:M-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train adescent number of Malian physicians in chief and pediatricians at the district hospitals across the country tointegrate the early ASD screening into the national health system.Conclusion:M-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali.