Author ORCID Identifier

Date of Award

Spring 5-4-2020

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Brian Barger

Second Advisor

Teresa Pigott


This study is a systematic review and meta-analysis of published Modified Checklist for Autism in Toddlers (M-CHAT) screening studies. The purpose of this study was to determine if the quality of clinical reference outcomes across M-CHAT screening studies relates to reported diagnostic accuracy metrics. PRISMA guidelines were implemented and 3631 records were collected from 3 main databases: EBSCO, Web of Science, and PROQUEST. 22 studies with 24 sample sets then had their psychometric data directly reported and were ranked using an adaptation framework for ranking the quality of clinical reference standard categories. The data was analyzed using a random effects bivariate Reitsma model and meta-regression. The relationship was explored between clinical reference standard criteria and the diagnostic accuracy measures of Sensitivity, Specificity and the Diagnostic Odds Ratio. The results indicate that there is not a linear relationship between increases in reference standard quality and decreases in diagnostic accuracy metrics, but clinical reference standard categories may have an impact on reported accuracy. In the future, researchers should consider the quality reference standards when conducting diagnostic accuracy studies of autism screening tools.

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