1 Modified Checklist for Autism in Toddlers (M-CHAT) Follow-Up Interview **May be used for research or clinical purposes, but please do not cite or distribute** Acknowledgement: We thank Joaquin Fuentes, M.D. for his work in developing the flow chart format used in this interview. The M-CHAT Follow-Up Interview can be downloaded free of charge from For more information, please contact Diana Robins or Deborah Fein Robins, Fein, & Barton, 1999
2 Instructions for the M-CHAT Follow-Up Interview Select items based on M-CHAT scores. Administer only those items for which the parent indicated behavior that demonstrates risk for autism spectrum disorders (ASDs), and/or those which the healthcare provider has concerns may not have been answered accurately. Score interview items in the same manner as the M-CHAT. If an item is failed, it indicates risk for ASDs. Failure of two critical items (items 2, 7, 9, 13, 14, 15) or any three total warrants referral to a specialist. Please note that failing the follow-up interview does not diagnose ASDs; it indicates increased risk for ASDs. Please note that if the healthcare provider has concerns about ASDs, children should be referred to a specialist regardless of the score on the M-CHAT or M-CHAT follow-up interview. Please use the following M-CHAT page to record the scores after the interview is completed.
3 M-CHAT Please score the interview items on this page. Critical items are marked in BOLD and reverse score items, meaning those for which a score of indicates risk for autism (11, 18, 20, 22) are noted by the word REVERSE. 1. Does your child enjoy being swung, bounced on your knee, etc.? 2. Does your child take an interest in other children? 3. Does your child like climbing on things, such as up stairs? 4. Does your child enjoy playing peek-a-boo/hide-and-seek? 5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things? 6. Does your child ever use his/her index finger to point, to ask for something? 7. Does your child ever use his/her index finger to point, to indicate interest in something? 8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them? 9. Does your child ever bring objects over to you (parent) to show you something? 10. Does your child look you in the eye for more than a second or two? 11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) (REVERSE) 12. Does your child smile in response to your face or your smile? 13. Does your child imitate you? (e.g., you make a face-will your child imitate it?) 14. Does your child respond to his/her name when you call? 15. If you point at a toy across the room, does your child look at it? 16. Does your child walk? 17. Does your child look at things you are looking at? 18. Does your child make unusual finger movements near his/her face? (REVERSE) 19. Does your child try to attract your attention to his/her own activity? 20. Have you ever wondered if your child is deaf? (REVERSE) 21. Does your child understand what people say? 22. Does your child sometimes stare at nothing or wander with no purpose? (REVERSE) 23. Does your child look at your face to check your reaction when faced with something unfamiliar? Critical Score: 1999 Diana Robins, Deborah Fein, & Marianne Barton Total Score:
4 1. You reported that does not enjoy being swung, bounced on your knee, etc. Then s/he does enjoy being bounced or swung? When you swing or bounce him/her, how does s/he react? Laughs or smiles Talks or babbles Requests more by holding out his/her arms Other (Describe): If NO to all If YES to any specific examples If other is clearly a positive response
5 2. You reported that does not take an interest in other children. (Critical) Then your child does take an interest in other children? Is he/she interested in children who are not his/her brother or sister? When you are at the playground or supermarket, does your child usually respond to the presence of another child? How does your child respond? (Ask all) Plays with the other child Talks to the other child Aggressive behavior Vocalizes Looks at the other child Smiles at the other child NO to all If yes to any: Does s/he (fill in responses given here- e.g. plays, talks, smiles, looks, or vocalizes) more than half of the time?
6 3. You reported that does not like climbing on things, such as up stairs. Then s/he does like climbing on things? Then s/he does not like climbing on things? Does he/she enjoying climbing on.... stairs?... chairs?... furniture?... playground equipment? to any to all
7 4. You reported that does not enjoy playing peek-a-boo / hide and seek. Then your child does enjoy playing peek-a-boo or hideand-seek? YES NO Does your child like any games that involve a back and forth exchange with another person? Examples What does s/he do if you try to play a game like peek-a-boo or pat-a-cake (or example given) with him/her? Smiles/laughs Vocalizes pleasure Requests more verbally Requests more nonverbally Refuses to play Cries t interested in those games Leaves situation if parent initiates example(s) from above If yes to examples from both example(s) from above Pass response What is more typical? Fail response
8 5. You reported that does not ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things. Then your child does pretend play? Can you give me an example? Can you give me an example? Does he/she ever play make believe? If parent gives any examples listed, it is a pass. If no, ask examples individually Push a car on a pretend road Does he/ she put a toy pot on stove or stir imaginary food? Pretend to vacuum or mow lawn Feed self with a toy spoon or empty cup Pretend to be a robot, an airplane, a ballerina, or any other favorite character Put an action figure or doll into a toy car or truck Pretend to talk on the telephone Feed a doll with real or imaginary food? If parent gave any example listed: If parent did not give any example listed
9 6. You reported that does not use his/her pointer finger to point, to ask for something. Then your child does use his/her pointer finger in order to ask for something? If there is something your child wants that is out of reach, such as a cookie up on a counter, how does he/she get it? Points Reaches for the object with the whole hand Leads the parent to the object Tries to get the object for him/herself Asks for it If responds with any of the above: If you said Show me, would he/she point at it?
10 7. You reported that does not use his/her pointer finger to point, to indicate interest in something. (Critical) Then your child does use his/her pointer finger in order to point to indicate interest in something? If : Does your child ever want you to see something interesting such as......an airplane in the sky...a truck on the road...a bug on the ground...an animal in the yard How does your child draw your attention to it? Would he/she point with his/her pointer finger? Is this to indicate interest, not to get help?
11 8. You reported that does not play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them. Then your child does know how to play properly with small toys? Can you give me an example? How does he/she play with toys? Stacks blocks Does simple puzzles Plays with cars/ trucks Plays with a shape sorter Stacks rings on a stick Nests cups inside each other example(s) from above If yes to examples from both Puts toys in mouth Throws toys Doesn t play with toys Swallows pieces Lines toys up Carries one toy around the house Stares at toys If yes to any example from above Pass response What is more typical? Fail response
12 9. You reported that does not bring objects over to you (parent) to show you something. (Critical) Then your child does bring objects over to show you? Does your child sometimes bring you: A picture or toy just to show you? A drawing he/she has done? A flower he/she has picked? A bug he/she has found in the grass? If yes to any: Is this just to show you, not to get help?
13 10. You reported that does not look you in the eye for more than a second or two? Then your child does look you in the eyes for more than a second or two? Does s/he look you in the eyes when s/he needs something? When playing with you? During feeding? During diaper changes? When you are reading him/her a story? only to one to two or more to all Does your child look you in the eyes every day? On a day when you are together all day, does he/she look you in the eyes at least 5 times?
14 11. You reported that sometimes seems oversensitive to noise. Then your child does not seem oversensitive to noise?, he/she does not, he/she does If yes to two or more, continue: How does your child react to (list noise that child does not like)? Calmly covers ears Expresses displeasure verbally Screams Cries Covers ears while upset Does your child have a negative reaction to the sound of: (ask as needed)... A washing machine? Babies crying? Babies squealing or screeching? Vacuum cleaner? Sirens? Traffic? Doors slamming? Loud music? Telephone/doorbell ringing? isy places such as the supermarket or restaurant? Other (describe) : example(s) from above If yes to examples from both: What is more typical? example(s) from above one: Pass response Fail response
15 12. You reported that does not smile in response to your face or your smile. Then your child does smile in response to your face or your smile? Ask specifically about below examples if parent does not give any What makes smile? Smiles when parent smiles Smiles when parent enters the room Smiles when parent returns Always smiling Smiles at favorite toy or activity Smiles randomly or at nothing in particular example(s) from above If yes to examples from both: example(s) from above
16 13. You reported that does not usually imitate you. (Critical) Then your child does imitate you? Does your child copy you if you:... If yes to two or more Stick out your tongue? Make a funny sound? Wave good bye? Clap your hands? Put your fingers to your lips to signal Shhh? Blow a kiss? If yes to one or none
17 14. You reported that does not respond to his/her name when you call. (Critical) Then your child does respond to his/her name? If he/she is not doing anything particularly fun or absorbing, would he/she usually respond to his/her name being called? What does he/she do when you call his/her name? If parent does not spontaneously respond, ask below examples Looks up Talks or babbles Stops what he/she is doing response Seems to hear but ignores parent Parent needs to be in child s face Responds only if touched example(s) from above If yes to examples from both example(s) from above Pass response What is more typical? Fail response
18 15. You reported that if you point at a toy across the room, does not look at it. (Critical) Then your child does look at objects that you point to? If you point at something, what does your child typically do? example(s) from above Looks at object Points to it Looks and comments on object Looks if parent points and says look! If parent does not spontaneously respond, ask below examples If yes to examples from both Ignores parent Looks around room randomly Looks at parent s finger example(s) from above Pass response What is more typical? Fail response
19 16. You reported that your child does not walk. Then your child walks without holding on?
20 17. You reported that does not look at things you are looking at. Then your child does look at things you are looking at? If parent does not spontaneously respond, ask below examples What does s/he do when you are looking at something? Looks at object you are looking at Points to object Looks around to see what you are looking at Ignores Looks at parent s face example(s) from above If yes to examples from both example(s) from above Pass response What is more typical? Fail response
21 18. You reported that makes unusual finger movements near his/her face. Then he/she does not make any unusual finger movements? Please describe these movements. If parent does not spontaneously respond, ask below examples Looks at hands Moves fingers when playing peek-a-boo Wiggles his/her fingers near his/her eyes Holds hands up close to eyes Holds hands off to the side of his/her eyes Flaps hands near face Other (describe) If yes to any fail response Does this happen more than twice a week?
22 19. You reported that does not try to attract your attention to his/her own activity. Then he/she does try to attract your attention to his/her own activity? o a Does he/she. Ask each item. Say Look! or Watch me! Bring a toy or activity to show you (parent) Look expectantly to get praise or comment Keep looking to see if you re (parent) is looking If yes to any or sometimes to two or more If yes to none or sometimes to one or fewer
23 20. Have you wondered if your child is deaf? Then you haven t wondered if he/she is deaf? What led you to wonder that? Did he/she frequently ignore sounds? Did he/she often ignore people? I have If no to second and third question If yes to either second or third question Ask all parents: Has your child s hearing been tested? If YES, what were the results? te results Hearing impaired Hearing in normal range If hearing is impaired > te: If parents report that they wondered about their child s hearing only as part of a routine checkup > te: Regardless of hearing test results, if child ignores sounds or people >
24 21. You reported that does not understand what people say? Then he/she does understand what people say? When the situation gives him/her a clue, can he/she follow a command? For example, when you are dressed to go out and you tell him/her to get his/her shoes say? If yes If no or sometimes If it is dinnertime and food is on the table, and you tell the child to sit down, will he/she come sit at the table? When the situation does not give any clues, can he/she follow a command (e.g., show me your shoe without any gestures)? Use other examples as needed: Bring me the book ; Bring me my keys.
25 22. You reported that sometimes stares at nothing or wanders with no purpose. Then your child does not stare at nothing or wander with no purpose? Can you give me some examples of this behavior? (If not stated above) Does your child often stare off into space? (If not stated above) Does he/she like to walk around the edges of the room instead of settling down with an activity? NOTE (Only if parent asks): these behaviors need to last for at least a couple of minutes. to either example to both examples Does he/she do this behavior (fill in behavior parent indicated) often- at least several times per week? Does he/she walk in circles (not in play to make self dizzy) often- at least several times per week? to either to both Does he/she do this only when tired?
26 23. You reported that does not usually look at your face to check your reaction when faced with something unfamiliar and a little scary. Then he/she does look at your face to check your reaction when faced with something scary? If your child hears an unfamiliar or scary noise, will he/she look at you before deciding how to respond? Does your child look at you when someone new approaches? What does your child do when faced with something unfamiliar and a little scary? Sometimes or probably looks at parent s reaction Probably does not look at parent s reaction
Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) TM Acknowledgement: We thank Joaquin Fuentes, M.D. for his work in developing the flow chart format used in this document.
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