Systematic Review of Translation and Cultural Adaptations of Autism Spectrum Disorder's Screening Tool: The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) [version 1; peer review: awaiting peer review]

In recent years, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), a screening tool for autism spectrum disorder (ASD), has been translated into various languages and made accessible for the assessment of children globally. This study aims to systematically review and identify the available translations of the M-CHAT-R that have been adapted for use in different cultures, to evaluate the translation and cultural adaptation process, to report on the methodologies and psychometric properties of the adaptations of the M-CHAT-R and to critically discuss the implications for clinical practice and future research. An electronic search was performed through four main databases, EBSCOhost, Google Scholar, PubMed and Elsevier, to identify eligible articles. The PRISMA guidelines were employed as the primary search strategy and reporting system, while the COSMIN checklist was used to evaluate the selected studies' psychometric properties and cultural validity. Thirteen studies were included in this systematic review. The evaluation of screening accuracy properties for all studies showed that the M-CHAT-R translations achieved reasonable to good screening accuracy and further highlighted that sensitivity and specificity values, which are not dependent on the prevalence rate, are more appropriate measures than other psychometric properties to reflect the validity of the M-CHAT-R. The review of methodologies and results showed that the M-CHAT-R might be equally effective as the original tool in screening children aged up to 48 months, but future research is required to obtain more normative data. The large discrepancies among sample sizes and differences in population settings with ambiguous translations and adaptations highlighted the need for a more in-depth adaptation process for future cross-cultural validation studies.