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In 2015, the US Preventive Services Task Force questioned the benefits of universal screening, indicating insufficient evidence supports this practice (Mc Pheeters, Weitlauf, Vehorn, Taylor, Sathe, Krishnaswami, … However, the AAP and researchers in the field of ASD screening, diagnosis, and treatment have responded to this conclusion, asserting that evidence is sufficient to recommend universal autism screening, to reduce the age of detection and promote more equitable access to intervention (AAP, 2016; Robins et al, 2016; Zwaigenbaum et al., 2015; Coury, D. A number of validated measures are available to screen for ASD risk in children 18 months of age and older, including the Modified Checklist for Autism in Toddlers (M-CHAT; Chlebowski, Robins, Barton, & Fein, 2013; Robins, Fein, Barton, & Green, 2001) and the Infant Toddler Checklist (ITC; Johnson and Meyers, 2007; Zweigenbaum, Bryson, Lord, Rogers, Carter, Carver, … A recently validated, revised version of the M-CHAT, the M-CHAT-Revised with Follow up (M-CHAT-R/F) has demonstrated strong psychometric properties, with estimates of sensitivity and specificity of .854 and 0.993 in a low-risk, population-based sample (Robins et al., 2014).

For the purposes of this paper, the term M-CHAT-R-A will be used when referring to the screening and M-CHAT-R/F-A when referring to screening plus follow up.

It is now well documented that ASD can be reliably diagnosed in children aged 18-24 months (Kleinman, Ventola, Pandey, Verbalis, Barton, Hodgson …

& Fein, 2008) and even earlier (Zweigenbaum, Bryson, Brian, Smith, Roberts, Szatmari, Roncadin, Garon, & Vaillancourt, 2015), and that early identification and intervention are associated with more positive outcomes (Anderson, Liang, & Lord, 2014; Johnson & Myers, 2007; Orinstein et al, 2014; Robins and Dumont-Mathieu 2006; Rogers, 1996).

Its predecessor, the M-CHAT, however, has been translated into at least 69 languages and has been found to have clinical utility in a number of international validation studies (Canal-Bedia, García-Primo, Martín-Cilleros, Santos-Borbujo, Guisuraga-Fernández, Herráez-García et al., 2010; Inada, Tomonori Koyama, Inokuchi, Kuroda, & Kamio, 2010; Kara, Mukaddes, Altinkaya, Guntepe, Gokcay, & Ozmen, 2014; Koh, Lim, Chan, Lin, Lim, Choo, & Magiati, 2014; Perera, Wijewardena, & Aluthwelage, 2009; Seif Eldin, Habib, Noufal, Farrag, Bazaid, Al-Sharbati, et al., 2008).

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The American Academy of Pediatrics (AAP) recommends using an ASD-specific screener at 18- and 24-month well-child care (WCC) visits to screen for ASD symptoms (Johnson & Myers, 2007; Robins, Casagrande, Barton, Chen, Dumont-Mathieu, & Fein, 2014).In addition, in this study, diagnostic confirmation occurred years after the screener was completed.Given that symptom presentation may change over time, social and communication demands increase with age, and parent awareness of symptoms also likely change over time, the sensitivity of the parent-report screener at 18-months can be expected to be higher when diagnostic confirmation occurs concurrently with screening.The Modified Checklist for Autism in Toddlers Revised-Albanian screener (M-CHAT-R-A) was used to screen 2594 toddlers, aged 16-30 months, at well-child visits.Two hundred fifty-three (9.75 %) screened positive; follow up on failed items were conducted by phone with 127 (50 %); the remainder were lost to follow-up.