What is the M-CHAT-R?

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.  Dr. Robins offers free resources and information downloads on the official M-CHAT-R website.

What are the Benefits of Using the M-CHAT-R?

The ultimate goal of the M-CHAT-R is to accurately detect as many cases of ASD as possible in a timely manner.  Early detection is crucial because it allows the child to receive early intervention services and support.  These services have been proven to improve outcomes for children on the spectrum.

The tool is also relatively quick to administer.  The straightforward questionnaire takes just a few minutes to complete.  It is also a cost-effective way to screen large numbers of children for autism risk.  It can be used by childcare centers or early intervention programs without causing financial burden.

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The tool also has cultural adaptability.  The M-CHAT-R has been translated into multiple languages and is adaptable to various cultural settings.  This means it is suitable for use in different populations around the globe.

The How-to Guide to M-CHAT-R

The M-CHAT-R tool may be administered as part of a child wellness visit with a health care provider.  It may also be used by other professionals, such as a school psychologist or counselor.  The statistical interpretation of the M-CHAT-R comes with a high false positive rate.  This is because the tool was developed to maximize sensitivity.  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.  This tool 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 risk for developmental disorders. The M-CHAT-R test 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 ASD. 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.  This means they may bypass the Follow-Up questionnaire and immediately receive a diagnostic evaluation for an early intervention program.

Sample Questions

The 20 questions on the M-CHAT-R all require a yes/no response.  The questions are designed to capture key indicators that would suggest a child is at risk for autism.  Some of the reasoning for the selected questions include:

-Social Communication Skills: Many children with autism have communication challenges.  The M-CHAT-R asks questions about the child’s communication skills to assess whether there are any delays.  If the child hears a strange or funny noise, do the react independently or look at the parent for cues?

-Joint Attention and Shared Interest:  Children with ASD may struggle to engage with others or share attention with other children.  These questions can help indicate any deficits in this area.

-Pretend Play: Since pretend play is a developmental milestone, children who do not engage in this behavior could have autism or another developmental disability.  These questions assess the child’s ability to engage in pretend activities such feeding a stuffed animal or driving a car.

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-Motor Skills and Play: There are questions that ask if the child likes to climb on things or if they make unusual finger movements.  These questions are designed to gauge the child’s physical development and interactions with objects.

-Eye Contact and Social Engagement:  Questions about eye contact and a child’s response to social cues help evaluate the child’s social engagement with others.  They can help identify potential difficulties in social interactions or social reciprocity.

-Communication with Pointing: Another asks if their child points with a finger to ask for something or makes strange or funny noises. Non-verbal children with Autism Spectrum Disorder may struggle to physically communicate their needs and desires to parents.

-Receptive Language Skills:  Questions related to understanding instructions help assess receptive language abilities and communication comprehension.

-Other Developmental Concerns:  Some questions are intended to capture red flags for other developmental issues such as a hearing impairment.  Questions may try and determine if children exhibit deaf-like behaviors, such as failing to listen or respond to verbal stimuli.

Related Resource: Top 10 Best Applied Behavior Analysis Online Programs

The M-CHAT-R is an important diagnostic tool for:

  • doctors
  • therapists
  • counselors
  • psychologists

The tool is used 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.