Children Classified as Medium-Risk by the M-CHAT-R at Age Two Years Have an Increased Likelihood of Subtle but Widespread Developmental Challenges at Preschool Entry: Results From the French National Birth Cohort ELFE
AI Summary
Children classified medium-risk by M-CHAT-R at age 2 showed higher rates of developmental delay and lower cognitive and language scores by 3.5 years.
Adjusted analyses: medium-risk children had a 2.2 relative risk of developmental delay and up to 0.4 SD lower cognitive-language performance.
Despite deficits, most medium-risk children attended school and had school experiences similar to low-risk peers; enhanced neurodevelopmental care and support recommended.
J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07402-4. Online ahead of print.
ABSTRACT
BACKGROUND: The Modified Checklist for Autism in Toddlers – Revised (M-CHAT-R) is widely used for screening children at age 2 for autism spectrum disorders (ASD), but it also identifies children at risk for broader developmental challenges. We aimed to examine whether M-CHAT-R risk status at age 2 is associated with cognitive, behavioral, adaptive, and school-related outcomes at ages 3 to 4.
METHODS: We used data from the French national birth Cohort ELFE, including children assessed with the M-CHAT-R at age 2. Children were classified as low or medium risk. Outcomes at ages 3-4 included general cognitive development (Child Development Inventory), non-verbal reasoning (Picture Similarities test), family and daily activities, school engagement and performance, attention regulation (teacher-rated ADHD symptoms), specific neurodevelopmental care and school-based assistance. Multivariate analyses used modified Poisson regression for binary outcomes and linear regression for continuous outcomes, adjusted for sociodemographic, child-related, and school-related factors.
FINDINGS: 9,223 children were classified as low-risk and 1,248 children as medium-risk. Medium-risk children were more often boys and from socioeconomically disadvantaged families. At 3.5 years, medium-risk children had increased likelihood of developmental delay (16.6% vs. 6.1%, RR 2.2 after adjustment) and lower cognitive and language scores (up to -0.4 SD). Despite these differences, most children attended school, and their school life was similar to that of low-risk peers.
INTERPRETATION: Children classified as medium-risk by the M-CHAT-R at age 2 have an increased likelihood of subtle but widespread developmental challenges at school entry. Strategies to improve access to neurodevelopmental care and school support could enhance outcomes for this group.
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