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National Health And Morbidity Survey 2016 : Maternal And Child Health (MCH) Volume II : Findings

6.2. Autism

Contributors : Mohamad Aznuddin Abdul Razak, Mohd Kamal Ariff Abd Ghani, Ahmad Nadzri Jai, Aminah Bee Mohd Kassim,
Sangita Dharshini Terumalay, Mohd Ridzuan Janudin, Noran Hashim, Norazizah Ibrahim Wong, Tahir Aris

6.2.1. Introduction

Autism is a complex neurodevelopmental and behavioral disorder that includes impairment in social
interaction, developmental and communication skills. Studies in the Western Pacific Region report
varying prevalence rates ranging from 2.8 to 94 per 10,000.1 Only one available study in South East
Asia, namely Indonesia estimates the rate at 11.7/10000. 1

Currently, there is no epidemiological data to describe prevalence of autism in Malaysia. In 2005, a
small scale feasibility study on the use of M-CHAT involving 4,767 toddlers in 5 districts, showed an
M-CHAT failure rate of 0.6% with an autism prevalence rate of 16 per 10,000. 2,3 A study screening
Egyptian toddlers for ASD using M-CHAT (validated Arabic version) showed failure of MCHAT in
23.8%4,5. Following the study, MOH carried out routine screening for autism for toddlers at 18 and
36 months of age using M-CHAT. M-CHAT is a validated screening tool used in early detection of ASD
in toddlers between age 18-36 months and is highly recommended by the American Academy of
Pediatrics. 4,5

This study was carried out to determine the prevalence of children aged 18 – 36 months old at risk
of autism in Malaysia among children who had not been screened for autism using the M-CHAT
questionnaire. Parents of selected children were asked whether the M-CHAT was performed for their
children previously. Verification was done by reviewing child health records.

6.2.2. Findings

A total of 5,846 children aged 18-36 months were included in the study, of which 1,308 children were
selected to complete the MCHAT as it had not been done previously. A total of 51 children failed the
MCHAT during the study. Overall, prevalence of failed M-CHAT is 1.6%, including those who those
who were told to have failed M-CHAT previously. Although there was slightly higher prevalence among
male toddlers (1.8%) as compared to female toddlers (1.4%), the difference is not statistically
significant. There was no significant finding within all sociodemographic variables.

Out of 8,271 children under 5 years with child health records, 1,730 (20.9%) of them (1,064 children
aged 18-35 months and 666 aged 36-59 months) had never been screened for autism using the M-
CHAT. M-CHAT was also performed for children more than 36 months as they never had any formal
screening prior to the study. From this study, we also discovered that 22 parents of children who
failed MCHAT screening reported that their children were not referred for further management (Table
6.2.2.1).

1. Mayada Elsabbagh, Gauri Divan, Yun-Joo Koh, Young Shin Kim, Shuaib Kauchali, Carlos Marcín et al. (2012), Global Prevalence of Autism and Other
Pervasive Developmental Disorders, Autism Res. 5(3): 160–179.
2. Family Health Development Division, Ministry of Health Malaysia (2006), Prosiding Mesyuarat Membincangkan Hasil Kajian Saringan dan Pengendalian
Masalah Autisme. Kuala Lumpur.
3. Ministry of Health Malaysia, (2014), Clinical Practice Guideline: Management of Autism Spectrum Disorder in Children & Adolescents, Malaysia, Putrajaya,
Malaysia Health Technology Assessment Section.
4. F.E. Mohamed, E.A. Zaky , A. Youssef , R. Elhossiny , S. Zahra , R. Khalaf et al, (2016), Screening of Egyptian toddlers for autism spectrum disorder using
an Arabic validated version of M-CHAT; report of a community-based study (Stage I), European Psychiatry 34; 43–48
5. Johnson CP, Myers SM. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007;120:1183–215. http://dx.doi.org/
10.1542/peds.2007-2361.