Use of Machine Learning to Investigate the Quantitative Checklist for Autism in Toddlers (Q-CHAT) towards Early Autism Screening

• Main Authors: Gennaro Tartarisco, Giovanni Cicceri, Davide Di Pietro, Elisa Leonardi, Stefania Aiello, Flavia Marino, Flavia Chiarotti, Antonella Gagliano, Giuseppe Maurizio Arduino, Fabio Apicella, Filippo Muratori, Dario Bruneo, Carrie Allison, Simon Baron Cohen, David Vagni, Giovanni Pioggia, Liliana Ruta
• Format: Article
• Language: English
• Published: MDPI AG 2021-03-01
• Series: Diagnostics
• Subjects: Q-CHAT; early screening; machine learning; autism
• Online Access: https://www.mdpi.com/2075-4418/11/3/574

In the past two decades, several screening instruments were developed to detect toddlers who may be autistic both in clinical and unselected samples. Among others, the Quantitative CHecklist for Autism in Toddlers (Q-CHAT) is a quantitative and normally distributed measure of autistic traits that demonstrates good psychometric properties in different settings and cultures. Recently, machine learning (ML) has been applied to behavioral science to improve the classification performance of autism screening and diagnostic tools, but mainly in children, adolescents, and adults. In this study, we used ML to investigate the accuracy and reliability of the Q-CHAT in discriminating young autistic children from those without. Five different ML algorithms (random forest (RF), naïve Bayes (NB), support vector machine (SVM), logistic regression (LR), and K-nearest neighbors (KNN)) were applied to investigate the complete set of Q-CHAT items. Our results showed that ML achieved an overall accuracy of 90%, and the SVM was the most effective, being able to classify autism with 95% accuracy. Furthermore, using the SVM–recursive feature elimination (RFE) approach, we selected a subset of 14 items ensuring 91% accuracy, while 83% accuracy was obtained from the 3 best discriminating items in common to ours and the previously reported Q-CHAT-10. This evidence confirms the high performance and cross-cultural validity of the Q-CHAT, and supports the application of ML to create shorter and faster versions of the instrument, maintaining high classification accuracy, to be used as a quick, easy, and high-performance tool in primary-care settings.