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Adapting an Autism Screening Tool for Use in the DeKalb County Refugee Pediatric Clinic

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Abstract

Background

Minimal literature exists regarding Autism Spectrum Disorder (ASD) among refugee children in the United States. Reliable ASD screening tools, such as the M-CHAT-R/F, have yet to be culturally adapted and translated into some languages spoken in the homes of these children.

Methods

Pediatric refugee patients (n = 13) of caregivers of Bhutanese (Nepali-speaking) descent were screened using a newly translated Nepali M-CHAT-R/F. The M-CHAT-R/F was adapted based on feedback from Bhutanese caregivers and interpreter expertise. Qualitative interviews regarding caregiver awareness of ASD were conducted.

Results

Caregivers understood the majority of M-CHAT-R/F items (91%). Four items required revision. Interviews revealed minimal awareness among Bhutanese caregivers regarding ASD or child development.

Discussion

The M-CHAT-R/F was adapted into Nepali using a combination of translation protocols, and is publicly available for clinical use. Future validation studies are needed which will aid in clinical screening for and epidemiologic research of ASD in this population.

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Notes

  1. Note that “concerning responses” refer to M-CHAT-R/F responses that suggest risk for ASD.

  2. Caregiver responses that were determined to reflect ‘equivocal’ understanding were coded as ‘without understanding.’

  3. Question 1: If you point to something across the room, does your child look at it? Question 5: Does your child make unusual finger movements near his or her eyes? (For example, does your child wiggle his or her fingers close to his or her eyes?)

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Acknowledgements

There are many people who made this project possible. Our team of Nepali translators and interpreters, including Chandrama Sharma, Deo Sharma, and Pingala Sharma were instrumental in accomplishing this project. Their dedication extended far beyond the clinic walls, as they worked with us in the community setting as well as the clinic. Natalie Hill, Program Associate at DeKalb County Board of Health, contacted and scheduled patients. This project was made possible by funding from the Global Health Institute and Emory University’s Boozer-Noether scholarship.

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Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    C. McClure, S. Reines, P. S. Suchdev & A. B. Goodman

  2. The Southeast Permanente Medical Group, Atlanta, GA, USA

    S. Reines

  3. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    P. S. Suchdev

  4. DeKalb County Board of Health, Decatur, GA, USA

    A. Oladele

  5. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA

    A. B. Goodman

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  1. C. McClure
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  2. S. Reines
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Correspondence to C. McClure.

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All authors declare that they have no conflict of interest.

Ethical Approval

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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McClure, C., Reines, S., Suchdev, P.S. et al. Adapting an Autism Screening Tool for Use in the DeKalb County Refugee Pediatric Clinic. J Immigrant Minority Health 20, 360–369 (2018). https://doi.org/10.1007/s10903-017-0553-0

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