Stories about ASD

A Screening Research Roadmap

ASD Roadmap

The CHAT+ Research Roadmap Pilot Study

Piloting the roadmap on 25 years of original research involving the CHecklist of Autism in Toddlers and its variants

June 20, 2019

One of the challenges of developing a research roadmap is identifying how best to test it. We sought to do just that, by using the roadmap to structure a systematic scoping review of all applied research conducted on the Checklist for Autism in Toddlers and its variants (CHAT+).  The CHAT+ family of instruments is well suited to this task because ASD screening is universally acknowledged to be a critical need, because the Modified Checklist for Autism in Toddlers (M-CHAT) is one of the most widely used screening instruments in the world, and because of our own familiarity with the instrument (Baron-Cohen et al, 2000; Doehring et al, 2001). The tremendous amount of research conducted over the past 25 years also made it likely that many if not all of the stages and phases of applied research would have been represented in this body of work. We presented the preliminary results of our review at the 2019 annual meeting of the International Society for Autism Research.  The principle findings are summarized below, while a more complete handout from the INSAR presentation (including other analyses) is available elsewhere.

In this study, we sought to evaluate the roadmap’s utility in capturing publication gaps and trends over time in the applied research conducted on the CHAT+. We utilized the stages and phases of applied research in the Roadmap, as defined elsewhere on this site.  We have subsequently integrated pivotal studies identified in the course of this review into our descriptions of the stages and phases of the Roadmap, to enrich the definitions offered there.

We conducted electronic database searches (MEDLINE, PSYCINFO) for all peer-reviewed publications describing original research involving the development, validation, or implementation of the CHAT+.  After reviewing abstracts to eliminate articles that were not relevant, we conducted full-text reviews to assign studies to a specific phase of applied research based on the primary objective.

We found over 90 relevant research studies involving the CHAT and its variants.  Most of these involved the M-CHAT. More than 80% of these studies were classified as clinical research studies based on the primary objective. Most of the remainder involved implementation research focused on assessing gaps and barriers to implementation, rather than demonstrating how to close these gaps or overcome these barriers. Only one published study focused primarily on demonstrating the regional impact of improvements in practice.

Trends over time in publications of clinical and implementation research involving the M-CHAT are consistent with the roadmap (see Figure 1).  More than a dozen clinical research studies were published before the first implementation research study emerged. Most phases emerged only after at least one study had been published in the previous phase. A bibliography categorizing references by stage of the research roadmap is available here.

Figure 1: Cumulative Studies over time across phases of applied research

Clinical Research     Implementation Research

Related Content

On this site

A Research Roadmap based on the CHAT+

Hover over phases for details


This review reveals the utility of the research roadmap in charting progress towards the demonstration of population impact. The relative lack of publications with a primary objective focused on implementation research may help to explain persistent gaps in timely and accurate identification, and suggests a need to shift research priorities. We have already used this roadmap to categorize $277 million of research funding allocated between 2008 and 2015 focused on improving ASD identification. Future work can help to paint a more complete picture of the research undertaken to date, by including secondary objectives involving applied research. Future work may also explore other differences in the research design and research team as a function of the phase of research, perhaps revealing challenges that help to explain the relative lack of implementation research.

The logo is adapted from Joaquim Alves Gaspar's drawing of Pedro Reinel's compass rose.


My Related Publications

Doehring, Peter, deKimpe, V., Tremblay, Peter, Baron-Cohen, S., Wheelwright, S., Cox, A., Baird, G., Swettenham, J., Drew, A., & Charman, T. (2001). The CHAT training kit and video.  Montreal, Canada, Hopital Rivieres-des-Prairies.

Baron-Cohen, S., Wheelwright, S., Cox, A., Baird, G., Charman, T., Swettenham, J., Drew, A., & Doehring, Peter (2000). Early identification of autism by the CHecklist for Autism in Toddlers (CHAT). Journal of the Royal Society of Medicine, 93, 521-525.