This commentary highlights the limitations of many existing population-based studies examining the utility of the Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) in screening for autism. We expound on three major factors: (a) the limited number of screen-negative children who undergo diagnostic evaluations, (b) the substantial number of children who screen positive and were subsequently lost to follow-up (i.e. without further diagnostic evaluations), and (c) the sizeable number of children who did not complete the full two-stage screening process as intended. Each of these factors can lead to erroneous estimates of the psychometric properties, specifically, the sensitivity, specificity, and negative predictive value. Hence, we emphasize the need for future studies to increase the number of children who screen negative and receive a diagnostic evaluation and ensure that these children are selected at random without a higher likelihood for the presence of autism. It is also imperative that concrete steps are taken to minimize the number of screen-positive children who are lost to follow-up both within and after the screening process. Both of these will play a major role in ensuring more robust results from empirical research that can guide the clinical implementation of the M-CHAT-R/F.

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评论：盘点并前进——需要考虑自闭症筛查研究中失访对后续行动的影响

这篇评论强调了许多现有的基于人群的研究的局限性，这些研究检验了幼儿自闭症改良清单，修订/随访（M-CHAT-R/F）在自闭症筛查中的效用。我们阐述了三个主要因素：(a) 接受诊断评估的筛查阴性儿童数量有限，(b) 筛查呈阳性但随后失访的儿童数量相当大（即没有进一步的诊断评估）， (c) 大量儿童没有按预期完成完整的两阶段筛查过程。这些因素中的每一个都可能导致对心理测量特性的错误估计，特别是敏感性、特异性和阴性预测值。因此，我们强调未来的研究需要增加筛查呈阴性并接受诊断评估的儿童数量，并确保这些儿童是随机选择的，而不存在较高的自闭症可能性。还必须采取具体措施，尽量减少筛查过程中和筛查后失访的筛查呈阳性儿童的数量。这两者都将在确保实证研究获得更可靠的结果方面发挥重要作用，从而指导 M-CHAT-R/F 的临床实施。