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Abstract
The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (MCHAT-R/F) is one of the most widely used early screening tools for autism spectrum disorder (ASD); however, it was developed within a Western framework that may not align with the cultural norms, values, and experiences of all families. This study utilized cognitive interviewing techniques grounded in a phenomenological approach, to explore how caregivers from diverse cultural and linguistic backgrounds cognitively process MCHAT-R/F items. Fourteen caregivers of children aged 16–48 months participated in semi-structured cognitive interviews using the MCHAT-R/F. Interviews were analyzed using a blended coding framework that drew from a four-stage cognitive model that examined participant comprehension, retrieval, judgement, and response along with dimensions of cultural relevance. Analysis revealed notable variation in caregiver cognitive processing, particularly in the retrieval and response domains. Findings also highlighted notably increased difficulties for participants that were identified as bicultural on an acculturation measuring, indicating greater interpretation difficulties when navigating both their culture of origin and dominant Western culture. Items that assessed subtle or low-frequency behaviors (e.g., unusual finger movements, social referencing), child response to social bids and joint attention (e.g., following a point, responding to name or directions), and behaviors with culturally variable salience (e.g., upset by noise, emotional referencing) elicited the greatest number of interpretation errors.These results underscore the need for more culturally responsive adaptations of existing autism screeners and reinforce the value of cognitive interviewing as a tool for examining cross-cultural differences. Clinicians and researchers should be aware of how sociocultural frameworks influence item interpretation and avoid misattributing response variability to parental inaccuracy or disengagement.