第十八屆 中文版嬰幼兒自閉症檢核表之跨文化應用及信度效度分析

中文版嬰幼兒自閉症檢核表之跨文化應用及信度效度分析

The Cultural Appropriateness, Reliability and Validity of the Chinese M-CHAT version as an Autism Screening Instrument for Toddlers in Taiwan

林鳳貞^1*

Feng-Chen Lin^1*

¹康寧大學嬰幼兒保育學系

¹Department of Early Childhood Care and Education, University of Kang-Ning

Background and Purpose：To date, an increasing number of children with autistic spectrum disorder (ASD) and lifelong developmental disabilities have impacted families in many ways around the world. However, there are some barriers to identifying children with ASD in Taiwan, including parental ignorance regarding early identification, lack of a systematic screening process, and lack of culturally validated screening instruments for autism. In the United States, the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool has been developed as a validated, systematic and cost-effective autism screening tool designed for young children 16-30 months of age. The purposes of this study were to examine the cultural appropriateness of the Chinese M-CHAT version as an autism screening instrument for toddlers in Taiwan, and to investigate the reliability and validity of the Chinese M-CHAT version for toddlers in Taiwan.

Methods: A cross-sectional survey was used to examine variables in different groups. Twenty settings, including registered nursery centers, were randomly selected from two special municipalities in north Taiwan. Three groups of participants participated in the study, including (a) a team of professionals who are experts in child development (n=18); (b) parents of typically developing children (n=100); and (c) parents of children identified with autism spectrum disorder (ASD, n=20). Quantitative analysis and evaluation of the rationales and comments on three instruments were used to investigate the cultural appropriateness, reliability, and validity of the Chinese M-CHAT.

Results: The Pearson’s correlation coefficients for each item between test and retest of the translated Chinese M-CHAT ranged from 0.72 to 0.97, which suggested high test-retest reliability of the translated Chinese M-CHAT. Internal consistency reliability calculated on each item by Cronbach's alpha coefficient was 0.78 for the whole scale, indicating satisfactory internal consistency. The mean content validity ratio (CVR) value of 0.94 showed high expert agreement on content validity. In addition, the qualitative evaluation of the expert professionals’ comments suggested that additional examples are required for some test items, and modifications for cultural appropriateness may help to obtain a higher degree of content validity.

Conclusion: As a result, the Chinese M-CHAT is a culturally appropriate child developmental screening instrument for young children in Taiwan and demonstrated satisfactory test-retest reliability, internal consistency, criterion validity, and content validity. However, some issues raised by parents and professionals regarding additional examples for some test items and modification for the meaning of words in specific items may be necessary to overcome cultural differences for parents in Taiwan.

Keywords: Autistic spectrum disorder (ASD), M-CHAT, culturally appropriateness, reliability and validity