An Investigation into Referrals Placed Following Positive Screening With the Modified Checklist for Autism in Toddlers, Revised With Follow-up

OBJECTIVE: The objective of this study was to examine referral practices after positive autism spectrum disorder screening with the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F) for potential variability based on demographic factors focusing on language and patient-reported need for interpretation. METHODS: This was a retrospective cohort study. The study population consisted of 776 patients (mean age 25 months) with a positive M-CHAT-R/F (367 high risk, 409 moderate risk). Data collected included self-reported race, ethnicity, preferred language, interpreter need, screening results, and referrals placed at the time of screening. Patients with a prior autism spectrum disorder diagnosis were excluded. Data were analyzed using Pearson's χ2 test of independence and logistic regression to determine if demographic factors, focusing on preferred language and need for an interpreter, were associated with placement of recommended referrals. RESULTS: Among children with a positive M-CHAT-R/F screen, 69% were referred to developmental behavioral pediatrics, 76% to behavioral health, 83% for early intervention, 93% for speech therapy, and 91% for audiology. In unadjusted stratified analysis, no significant differences were found in rates of referral to recommended services in relation to race, language spoken, or interpreter need. After a logistic regression analysis, no factors were predictive of higher or lower rates of referral to any service studied. CONCLUSION: We found no disparities in referrals after a positive M-CHAT-R/F in relation to preferred language or interpreter need. Further research could examine what factors can help prevent disparities in referral placement to recommended services.