Validating the Malaysian modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F): a cross-cultural adaptation

The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) is a two-stage parent-reported tool for screening autism spectrum disorder (ASD). Early detection of ASD is highly associated with improved social communication and reduced restricted and repetitive behaviors associated with ASD. However, there is limited availability of ASD screening tools in Malaysia and there are no relevant validation studies published. The process of modifying a screening instrument to align with the cultural and linguistic characteristics of the target population is a crucial component in establishing the instrument's validity.Therefore, this study translates and culturally adapts the M-CHAT-R/F into Malay and verifies its psychometric properties among the Malaysian population. 500 Malaysian toddlers aged between 18 and 48 months were recruited from different settings. The parents of the toddlers were asked to complete the Malaysian M-CHAT-R/F. The reliability of the screening tool was verified using Cronbach's alpha.By comparing the screening outcomes of the Malaysian M-CHAT-R/F and clinical evaluation results, the prevalence of ASD was determined as 6.6% in the sample. High values of sensitivity (96.6%) and specificity (93.2%) and a satisfactory positive predictive value (47.5%) supported the validity of the Malaysian M-CHAT-R/F. Furthermore, the receiver operating characteristic analysis yielded three as the optimal cut-off score of the Malaysian M-CHAT-R/F.These results suggest that the Malaysian M-CHAT-R/F is an effective screening tool reliable for use in clinical practice. Further investigation using a representative sample of the whole country is recommended given the high prevalence rate obtained in the current sample.