The M-CHAT-R, which stands for Modified Checklist for Autism in Toddlers, Revised with Follow-Up, is a screening tool for parents to assess their child’s risk for Autism Spectrum Disorder (ASD). This unique diagnostic tool was developed by Diana Robins, Ph.D., who offers free resources and information downloads on the official M-CHAT-R website.

How-to Guide

The M-CHAT-R tool may be administered as part of a child wellness visit with a health care provider, or it may be used by other professionals, such as a school psychologist or counselor. The ultimate goal of the M-CHAT-R is to accurately detect as many cases of Autism Spectrum Disorder as possible in a timely manner. The statistical interpretation of the M-CHAT-R comes with a high false positive rate, so many children who score at risk will not be diagnosed with ASD. In order to address any concerns or red flags, there is the associated Follow-Up Questions tool, which is called the M-CHAT-R/F. Even after this is completed, a certain number of the children who test positive on the M-CHAT-R exam will not be diagnosed with ASD. Still, parents, educators and professionals can use the results to continue monitoring the children who are at high right for developmental disorders. The M-CHAT-R contains a list of standard questions that can be scored in under two minutes.

The Scoring Algorithm

Most questions that result in a negative response indicate potential risk for Autism Spectrum Disorder. There is a set algorithm that maximizes the psychometric scoring of the M-CHAT-R. Low-risk children will score between zero to two. Children younger than two years old should repeat the test after their next birthday. Unless observations indicate risk, no further action is required. Medium-risk children who score between three to seven points must complete the second stage of M-CHAT-R/F, which is the Follow-Up questionnaire. If the following score is high, then the child should be referred to a professional for eligibility evaluations for early intervention programs. However, a score of zero to one on the Follow-Up indicates a negative chance of risk. These children should be re-screened at future wellness checks with their health care provider. High risk children will score between eight to 20 points on the test, which means they may bypass the Follow-Up questionnaire and immediately receive a diagnostic evaluation for an early intervention program.

Sample Questions

Questions may ask as if children look at things that are pointed at across the room, such as a stuffed animal, and if children exhibit deaf-like behaviors, such as failing to listen or respond to verbal stimuli. For example, many children with Autism Spectrum Disorder have trouble understand and following directions. One question asks if the child enjoys playing pretend games, such as make-believe games of eating, talking on the phone and driving a car. Children who struggle to express their imagination may have Autism Spectrum Disorder. There are questions that ask if the child likes to climb on this, if they make unusual finger movements and if their child points with a finger to ask for something. Non-verbal children with Autism Spectrum Disorder may struggle to physically communicate their needs and desires to parents. One question asks if the child likes to play with other children and if they smile and interact with their peers.

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The M-CHAT-R is an important diagnostic tool for doctors, therapists, counselors and psychologists to pre-diagnose children with Autism Spectrum Disorder. Those who want to pursue a career working with children with special needs should consider becoming a psychologist.