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Modified Checklist for Autism in Toddlers (M-CHAT)


The Modified Checklist for Autism in Toddlers (M-CHAT) is a screening questionnaire specific for Autism Spectrum Disorder (ASD). It is one of the measures the American Academy of Pediatrics recommends be used for all children at either their 18- or 24-month well-child exam. In addition to the M-CHAT, there is a Follow-Up Interview to the M-CHAT, which is to be used to further explore answers to M-CHAT questions which are indicative of ASD. The Follow-Up Interview was created because of the high rate of false positives in the M-CHAT. Recently the M-CHAT has been revised. The latest version is called the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F).

The Infant Toddler Checklist (ITC) is a parent questionnaire. It is a sub-part of the Communication and Symbolic Behavior Scales. The ITC identifies children between the ages of 6 to 24 months of age who have any type of communication delay, including Autism Spectrum Disorder (ASD). It is available freely on the internet and is used in both research and clinical settings.

Name Modified Checklist for Autism in Toddlers (M-CHAT) and M-CHAT Follow-Up Interview>
Reference Robins, Fein & Barton, 1999; the M-CHAT is freely available on the internet.
Summary The M-CHAT is an ASD-specific screening questionnaire for toddlers. It has been found to accurately identify children on the autism spectrum before they are of concern to parents or professionals. However, the questionnaire yields a very high rate of false positives. Thus, the authors highly recommend also using the published M-CHAT phone follow-up interview to reduce unnecessary referrals. The M-CHAT is one of the measures specified by the American Academy of Pediatrics in its recommendation that all children be screened for ASD at the 18- and/or 24- month well child exam. Many pediatric practices have begun to incorporate either the full M-CHAT questionnaire or the 6 critical items into their well-child exams, sometimes via the Electronic Medical Record. This has not yet been well studied. The M-CHAT authors continue to study and refine this measure. They have compiled well over 4,000 M-CHATs from hundreds of pediatricians. The M-CHAT has been translated into more than 40 languages and has been widely adopted in research on early signs of ASD.
Age Range 16-30 months
Format Parent questionnaire (23 items in a yes/no format; takes approximately 10 minutes). In the case of a screen positive score, the authors recommend a follow-up interview before determining whether a referral is necessary (takes approximately 20 minutes).
Who Can Rate Parents and caregivers complete the questionnaire.
Who Can Interpret Scores Any child care professional can access and score the M-CHAT questionnaire. The follow-up phone interview is available freely on the internet and provides very specific follow-up questions and decision trees.
Results Yielded Total score: a score of 3 suggests the need for the followup interview. Six “critical items' score: a score of 2 suggests the need for the followup interview.
Author’s Suggested Uses Children who screen positive at both the questionnaire and phone follow-up should be referred for an ASD diagnostic evaluation.
Author Cautions The M-CHAT questionnaire (without the follow-up interview) yields a very high number of false positives.
Item Development Items were developed based on the CHAT (the first toddler autism screening instrument) and the literature of early signs of ASD.
Development Research Development of the measure was first described in Robins et al., 2001. However, more recent work has described various aspects of its utility with larger sample sizes (Kleinman et al., 2008). The authors of the M-CHAT have found that the M-CHAT can identify children on the autism spectrum before they are of concern to parents or professionals (Robins 2008), and that in general it performs well at both 18- and 24-months but with some increased predictive ability at 24 months (Pandey et al., 2008).

Additional Resources

The Center for Autism Research and The Children's Hospital of Philadelphia do not endorse or recommend any specific person or organization or form of treatment. The information included within the CAR Autism Roadmap™ and CAR Resource Directory™ should not be considered medical advice and should serve only as a guide to resources publicly and privately available. Choosing a treatment, course of action, and/or a resource is a personal decision, which should take into account each individual's and family's particular circumstances.