Modified Checklist for Autism in Toddlers-Revised (MCHAT-R): The Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) stands as a crucial tool in the realm of early childhood development and neurodevelopmental screening. Developed as an updated version of the original MCHAT, this assessment is designed to identify potential signs of Autism Spectrum Disorder (ASD) in toddlers between the ages of 16 and 30 months. Autism, a complex neurodevelopmental condition, manifests itself in a spectrum of behaviors and challenges, making early detection and intervention paramount for optimal outcomes.

The MCHAT-R serves as a valuable resource for healthcare professionals, educators, and parents alike, offering a structured approach to observing and evaluating a child’s social communication skills and behaviors. As a screening instrument, it aids in the early identification of potential red flags associated with ASD, allowing for timely intervention and support. This introduction aims to provide insight into the significance of the MCHAT-R, its purpose, and the role it plays in fostering early intervention strategies that can positively impact a child’s developmental trajectory.

Instruction for Use of MCHAT Questionnaire

The M-CHAT-R/F is meant to accompany the M-CHAT-R, a screening tool valid for assessing the risk of autism spectrum disorder (ASD) in toddlers aged 16 to 30 months. It’s important to note that, even with the Follow-Up, a significant number of children who do not pass the M-CHAT-R may not be diagnosed with ASD. Nevertheless, these children may be at risk for other developmental disorders or delays, warranting follow-up for any child who screens positive.

After a parent completes the M-CHAT-R, the instrument should be scored following the provided instructions. If the child screens positive, the Follow-Up items should be selected based on the items failed in the M-CHAT-R. Only the originally failed items need to be administered for a comprehensive interview, with each page corresponding to an item from the M-CHAT-R. The interview follows a flowchart format, posing questions until a PASS or FAIL is determined.

It’s important to recognize that parents might respond with “maybe” during the interview. In such cases, inquire whether the predominant response is “yes” or “no” and proceed accordingly. In instances where an “other” response can be provided, the interviewer must exercise judgment to ascertain whether it constitutes a passing response.

Record the responses on the M-CHAT-R/F Scoring Sheet, which mirrors the M-CHAT-R items but uses Pass/Fail instead of Yes/No. A screen is considered positive if the child fails any two items during the Follow-Up. If a child screens positive on the M-CHAT-R/F, prompt referral for early intervention and diagnostic testing is strongly recommended. It’s crucial to emphasize that if healthcare providers or parents have concerns about ASD, children should be referred for evaluation irrespective of the M-CHAT-R or M-CHAT-R/F score.

Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) Questionnaire

The Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R) is a valuable screening tool designed to identify early signs of Autism Spectrum Disorder (ASD) in toddlers. Developed for ease of use, the M-CHAT-R is suitable for administration during routine well-child care visits and can also be employed by specialists or other professionals to assess the risk of ASD. The primary objective of the M-CHAT-R is to achieve maximum sensitivity, ensuring the detection of as many potential cases of ASD as possible.

It is crucial to note that the emphasis on sensitivity leads to a higher false positive rate, implying that not all children identified as at risk will ultimately receive a diagnosis of ASD. To address this inherent limitation, the Follow-Up questions (M-CHAT-R/F) have been incorporated into the assessment process. While these additional questions help refine the screening results, users should be mindful that a significant number of children who initially screen positive may not be diagnosed with ASD. Nevertheless, these children are at an elevated risk for other developmental disorders or delays, necessitating further evaluation for any child who screens positive.

One notable advantage of the M-CHAT-R is its efficiency, allowing for quick and straightforward scoring in less than two minutes. For comprehensive guidance on scoring, users can access scoring instructions on the official website https://www.mchatscreen.com. Additionally, associated documents are available for download, offering a comprehensive resource for professionals and caregivers alike. In utilizing the M-CHAT-R, stakeholders contribute to the early identification and intervention for children at risk of developmental challenges, fostering optimal outcomes for their future well-being.

Modified Checklist for Autism in Toddlers (MCHAT) Scoring

Scoring Algorithm for Modified Checklist for Autism in Toddlers-Revised (MCHAT-R)

1. Item Responses (except 2, 5, and 12):
   • “NO” indicates Autism Spectrum Disorder (ASD) risk.
2. Specific Items (2, 5, and 12):
   • “YES” indicates ASD risk.
3. Low-Risk: Total Score 0-2:
   • If the child is younger than 24 months, screen again after the second birthday.
   • No further action required unless surveillance suggests ASD risk.
4. Medium-Risk: Total Score 3-7:
   • Administer the Follow-Up (second stage of M-CHAT-R/F) to gather additional information.
   • If M-CHAT-R/F score remains at 2 or higher, the child has screened positive.
   • Action required: Refer the child for diagnostic evaluation and eligibility evaluation for early intervention.
   • If the score on Follow-Up is 0-1, the child has screened negative.
   • No further action required unless surveillance indicates risk for ASD. Rescreen at future well-child visits.
5. High-Risk: Total Score 8-20:
   • It is acceptable to bypass the Follow-Up and refer immediately for diagnostic evaluation and eligibility evaluation for early intervention.

Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) Questions

Please be aware that Yes/No options have been replaced with Pass/Fail.

1. When you point at something across the room, does your child look at it?
   (For instance, when you point at a toy or an animal, does your child look at the toy or animal?)

   • Pass: The child looks at the pointed object.
   • Fail: The child does not look at the pointed object.

2. Have you ever wondered if your child might be deaf?

   • Pass: No concerns about deafness.
   • Fail: There are concerns about potential deafness.

3. Does your child engage in pretend or make-believe play?
   (For example, pretending to drink from an empty cup, talking on a phone, or feeding a doll or stuffed animal.)

   • Pass: The child engages in pretend play.
   • Fail: The child does not engage in pretend play.

4. Does your child enjoy climbing on things?
   (For example, furniture, playground equipment, or stairs.)

   • Pass: The child enjoys climbing.
   • Fail: The child does not enjoy climbing.

5. Does your child exhibit unusual finger movements near their eyes?
   (For example, wiggling fingers close to the eyes.)

   • Pass: No unusual finger movements.
   • Fail: The child exhibits unusual finger movements.

6. Does your child point with one finger to ask for something or seek help?
   (For example, pointing to a snack or toy that is out of reach.)

   • Pass: The child points to communicate needs.
   • Fail: The child does not point to communicate needs.

7. Does your child point with one finger to show you something interesting?
   (For example, pointing to an airplane in the sky or a big truck on the road.)

   • Pass: The child points to share interesting things.
   • Fail: The child does not point to share interesting things.

8. Is your child interested in other children?
   (For example, watching, smiling, or approaching other children.)

   • Pass: The child shows interest in other children.
   • Fail: The child does not show interest in other children.

9. Does your child share things by bringing them to you or holding them up for you to see?
   (For example, showing you a flower, a stuffed animal, or a toy truck.)

   • Pass: The child shares items for enjoyment, not just seeking help.
   • Fail: The child does not share things.

10. Does your child respond when you call their name?
    (For example, looking up, talking, or babbling.)

    • Pass: The child responds when their name is called.
    • Fail: The child does not respond when their name is called.

11. When you smile at your child, do they smile back at you?

    • Pass: The child reciprocates with a smile.
    • Fail: The child does not reciprocate with a smile.

12. Does your child get upset by everyday noises?
    (For example, a vacuum cleaner or loud music.)

    • Pass: The child does not get upset by common noises.
    • Fail: The child gets upset by everyday noises.

13. Can your child walk?

    • Pass: The child can walk.
    • Fail: The child cannot walk.

14. Does your child make eye contact when you are talking, playing, or dressing them?

    • Pass: The child makes eye contact during interactions.
    • Fail: The child does not make eye contact during interactions.

15. Does your child attempt to imitate your actions?
    (For example, waving bye-bye, clapping, or making a funny noise.)

    • Pass: The child tries to copy your actions.
    • Fail: The child does not attempt to imitate your actions.

16. If you turn your head to look at something, does your child also look in that direction?

    • Pass: The child follows your gaze.
    • Fail: The child does not follow your gaze.

17. Does your child seek your attention by trying to get you to watch them?
    (For example, saying “look” or “watch me.”)

    • Pass: The child seeks your attention for praise.
    • Fail: The child does not seek your attention.

18. Does your child understand and comply when you instruct them to do something without pointing?
    (For example, “put the book on the chair” or “bring me the blanket.”)

    • Pass: The child understands and complies with instructions.
    • Fail: The child does not understand or comply with instructions without pointing.

19. When something new happens, does your child look at your face to gauge your reaction?
    (For example, a strange or funny noise, or seeing a new toy.)

    • Pass: The child looks at your face to understand your reaction.
    • Fail: The child does not look at your face in response to new stimuli.

20. Does your child enjoy movement activities, such as being swung or bounced on your knee?
    (For example, being swung or bounced on your knee)

    • Pass: The child enjoys movement activities.
    • Fail: The child does not enjoy movement activities.

FAQ about Modified Checklist for Autism in Toddlers-Revised (MCHAT-R)

1. What is the purpose of the MCHAT-R?

Answer: The MCHAT-R serves as a screening tool designed to identify potential signs of Autism Spectrum Disorder (ASD) in toddlers aged 16 to 30 months. It aids in the early detection of red flags associated with ASD, enabling timely intervention and support.

2. Who can use the M-CHAT-R and in what context?

Answer: The M-CHAT-R is suitable for use by healthcare professionals, educators, and parents. It can be administered during routine well-child care visits, contributing to the early identification of developmental challenges in toddlers.

3. What happens after a positive M-CHAT-R result?

Answer: If a child screens positive, the Follow-Up items should be administered based on the items failed in the M-CHAT-R. A positive screen on the Follow-Up warrants prompt referral for early intervention and diagnostic testing, regardless of the M-CHAT-R or M-CHAT-R/F score.

4. How is the MCHAT-R scored, and what do the scores indicate?

Answer: The scoring algorithm involves assigning points based on responses. Low, medium, and high-risk categories guide the next steps. For example, a high-risk score (8-20) may prompt an immediate referral for diagnostic evaluation and early intervention.

5. Can a child be at risk for ASD even if they do not pass the M-CHAT-R?

Answer: Yes, it’s important to note that not all children identified as at risk will receive a diagnosis of ASD. Even if a child does not pass the M-CHAT-R, they may be at risk for other developmental disorders or delays, emphasizing the need for further evaluation and surveillance.

References:

• Assessment in Speech Language Pathology A Resource Manual 5. Auflage, Kenneth G. Shipley, Julie G. McAfee [Buch]
• The American Academy of Pediatrics (AAP) in their guidelines on developmental surveillance and screening

You are reading about:

Modified Checklist for Autism in Toddlers-Revised (MCHAT-R)