If you point at something across the room, does your child look at it? (For Example , if you point at a toy or an animal, does your child look at the toy or animal?)
Answer 1
Yes
No
Have you ever wondered if your child might be deaf?
Answer 2
Yes
No
Does your child play pretend or make-believe? (For Example , pretend to drink from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?)
Answer 3
Yes
No
Does your child like climbing on things? (For Example , furniture, playground equipment, or stairs)
Answer 4
Yes
No
Does your child make unusual finger movements near his or her eyes? (For Example , does your child wiggle his or her fingers close to his or her eyes?)
Answer 5
Yes
No
Does your child point with one finger to ask for something or to get help? (For Example , pointing to a snack or toy that is out of reach)
Answer 6
Yes
No
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 in the road)
Answer 7
Yes
No
Is your child interested in other children? (For Example , does your child watch other children, smile at them, or go to them?)
Answer 8
Yes
No
Does your child show you things by bringing them to you or holding them up for you to see — not to get help, but just to share? (For Example , showing you a flower, a stuffed animal, or a toy truck)
Answer 9
Yes
No
Does your child respond when you call his or her name? (For Example , does he or she look up, talk or babble, or stop what he or she is doing when you call his or her name?)
Answer 10
Yes
No
When you smile at your child, does he or she smile back at you?
Answer 11
Yes
No
Does your child get upset by everyday noises? (For Example , does your child scream or cry to noise such as a vacuum cleaner or loud music?)
Answer 12
Yes
No
Does your child walk?
Answer 13
Yes
No
Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?
Answer 14
Yes
No
Does your child try to copy what you do? (For Example , wave bye-bye, clap, or make a funny noise when you do)
Answer 15
Yes
No
If you turn your head to look at something, does your child look around to see what you are looking at?
Answer 16
Yes
No
Does your child try to get you to watch him or her? (For Example , does your child look at you for praise, or say “look” or “watch me”?)
Answer 17
Yes
No
Does your child understand when you tell him or her to do something? (For Example , if you don't point, can your child understand “put the book on the chair” or “bring me the blanket”?)
Answer 18
Yes
No
If something new happens, does your child look at your face to see how you feel about it? (For Example , if he or she hears a strange or funny noise, or sees a new toy, will he or she look at your face?)
Answer 19
Yes
No
Does your child like movement activities? (For Example , being swung or bounced on your knee)
Answer 20
Yes
No
Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
Checklist Answers
If you point at something across the room, does your child look at it? (For Example , if you point at a toy or an animal, does your child look at the toy or animal?)
Your answer
Have you ever wondered if your child might be deaf?
Your answer
Does your child play pretend or make-believe? (For Example , pretend to drink from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?)
Your answer
Does your child like climbing on things? (For Example , furniture, playground equipment, or stairs)
Your answer
Does your child make unusual finger movements near his or her eyes? (For Example , does your child wiggle his or her fingers close to his or her eyes?)
Your answer
Does your child point with one finger to ask for something or to get help? (For Example , pointing to a snack or toy that is out of reach)
Your answer
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 in the road)
Your answer
Is your child interested in other children? (For Example , does your child watch other children, smile at them, or go to them?)
Your answer
Does your child show you things by bringing them to you or holding them up for you to see — not to get help, but just to share? (For Example , showing you a flower, a stuffed animal, or a toy truck)
Your answer
Does your child respond when you call his or her name? (For Example , does he or she look up, talk or babble, or stop what he or she is doing when you call his or her name?)
Your answer
When you smile at your child, does he or she smile back at you?
Your answer
Does your child get upset by everyday noises? (For Example , does your child scream or cry to noise such as a vacuum cleaner or loud music?)
Your answer
Does your child walk?
Your answer
Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?
Your answer
Does your child try to copy what you do? (For Example , wave bye-bye, clap, or make a funny noise when you do)
Your answer
If you turn your head to look at something, does your child look around to see what you are looking at?
Your answer
Does your child try to get you to watch him or her? (For Example , does your childlook at you for praise, or say “look” or “watch me”?)
Your answer
Does your child understand when you tell him or her to do something? (For Example , if you don't point, can your child understand “put the book on the chair” or “bring me the blanket”?)
Your answer
If something new happens, does your child look at your face to see how you feel about it? (For Example , if he or she hears a strange or funny noise, or sees a new toy, will he or she look at your face?)
Your answer
Does your child like movement activities? (For Example , being swung or bounced on your knee)
Your answer
Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
M-CHAT-R risk score:
The score indicates low risk , but if your child is younger than 24 months, or you have other concerns you should talk to your doctor about rescreening.
Have questions? Contact our Autism Response Team at 888-AUTISM2 (288-4762) or help@autismspeaks.org .
This questionnaire is designed to screen for autism, not other developmental issues. It is important to discuss any concerns about your child’s development with his or her doctor.
Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
M-CHAT-R risk score:
The score indicates medium risk . This means you should to take your child to his or her doctor for a follow-up screening. You can also seek early intervention services for your child.
Our First Concern to Action Tool Kit will help you learn how to begin early intervention services.
Have questions? Contact our Autism Response Team at 888-AUTISM2 (288-4762) or help@autismspeaks.org .
This questionnaire is designed to screen for autism, not other developmental issues. It is important to discuss any concerns about your child’s development with his or her doctor.
Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
M-CHAT-R risk score:
Score indicates high risk . This means you should to take your child to his or her doctor for a full evaluation. You should also begin early intervention services for your child.
Our First Concern to Action Tool Kit will help you learn how to begin early intervention services.
Have questions? Contact our Autism Response Team at 888-AUTISM2 (288-4762) or help@autismspeaks.org .
This questionnaire is designed to screen for autism, not other developmental issues. It is important to discuss any concerns about your child’s development with his or her doctor.
Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
Message to Health Care Providers:
Dear Health Care Provider,
The parent or caregiver of one of your patients has concerns about their child's development. He or she has taken the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), which is freely available online. The M-CHAT-R is a screening tool that has been endorsed by the American Academy of Pediatrics to be administered at 18 and 24 months.
The M-CHAT-R is a screening tool, and because no screening tool is perfect, research recommends that the original 20 questions include a Follow-Up Interview. This interview will improve the specificity of the screen, and also provides an opportunity for you to discuss the parent or caregiver's specific concerns. Administering the M-CHAT-R Follow-Up Interview may also reduce unnecessary referrals.
A guide to administering the Follow-Up Interview is found here: http://www.autismspeaks.org/sites/default/files/2018-09/m-chatinterview.pdf
More information about the M-CHAT-R can be found at: http://www.mchatscreen.com
Thank you for your time with this patient and his/her family. For more information please visit: http://www.autismspeaks.org/first-concern-action .
Autism Speaks
