Modified Checklist for Autism in Toddlers (M-CHAT)

Assessment Rating:
A
A – Psychometrics Well-Demonstrated
See entire scale
Developer(s):

Diana Robins, PhD, Deborah Fein, PhD, & Marianne Barton, PhD

Description / Purpose:

The M-CHAT screens for risk for autism spectrum disorder

The M-CHAT is a two-stage screening tool. It is designed to be completed by parents of children 16-30 months old. The initial screening consists of 23 yes/no questions about the child’s usual behavior. Children who fail 3 or more items total or 2 or more critical items (particularly if these scores remain elevated after the M-CHAT Follow-up Interview) should be referred for diagnostic evaluation by a specialist trained to evaluate ASD in very young children.

Note: A revised version of the M-CHAT has been released. The developers strongly recommend that users switch to the new version, also known as M-CHAT-R/F. The revised tool reduces the false positive rate and detects more ASD cases than the original M-CHAT when used during routine pediatric check-ups.

Target Population: 16-30 months

Time to Administer: 5 minutes for first stage, 5-10 minutes for Follow-Up

Completed By: Parent/guardian

Modalities Available: Pen and paper and computerized. web-based screening is currently undergoing validation, but commercial electronic tools are available (e.g., www.m-chat.org) *Please note that m-chat.org is a licensee and pays fees to use the M-CHAT; paper download available free from www.mchatscreen.com

Scoring Information: The website, www.mchatscreen.com, offers several scoring options; it can be hand scored in less than one minute, scoring overlay and excel scoring program are available for download

Languages Available: English

Training Requirements for Intended Users: No training needed

Availability: Paper/PDF downloads are free and available at www.mchatscreen.com Entities who wish to incorporate M-CHAT into electronic tools must have license agreement – see website

Contact Information

Website: www.mchatscreen.com
Name: Diana L. Robbins, PhD
Email:

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of "A – Psychometrics Well-Demonstrated" based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.

Show relevant research...

Robins, D., Fein, D., Barton, M., Green, J. (2001). The modified-checklist for autism in toddlers (M-CHAT): An initial investigation in the early detection of autism and Pervasive Developmental Disorders. Journal of Autism and Developmental Disorders, 31(2), 131-144

Sample:

Participants — 1,293

Race/Ethnicity — Not Specified

Summary:

The purpose of the current study was to validate the M-CHAT, a 23-item parent-report checklist, examining children’s developmental milestones. Reliability was determined using Cronbach’s alpha for the 22-item checklist as well as for the subset of 6 items found to be the best discriminators of children diagnosed with autism spectrum disorders. Internal reliability was found to be adequate for both the entire checklist and for the critical items (a = .85 and a = .83, respectively). Based on the DFA classification, the M-CHAT has a sensitivity of .87, specificity of .99, positive redictive power of .80, and negative predictive power of .99.

Robins, D. L. (2008). Screening for autism spectrum disorders in primary care settings. Autism: The International Journal of Science and Practice, 12 (5), 537-556.

Sample:

Participants — 4,797

Race/Ethnicity — Not Specified

Summary:

The current study used the Modified Checklist for Autism in Toddlers (M–CHAT) and the M–CHAT Follow-Up Interview to screen children during toddler checkups. 466 screened positive on the M–CHAT; of the 362 who completed the follow-up interview, 61 continued to show risk for autism spectrum disorders (ASDs). A total of 41 children have been evaluated; 21 children have been diagnosed with ASD, 17 were classified with non-ASD delays, and three were typically developing. The PPV of M–CHAT plus interview was .57. It is notable that only four of the 21 cases of ASD were flagged by their pediatrician. Results indicate that the M–CHAT is effective in identifying ASD in primary care settings.

Pandey, J., Verbalis, A., Robins, D.L., Boorstein, H., Klin, A., Babitz, T., Chawarska, K., Volkmar, F., Green, J., Barton, M., & Fein, D. (2008). Screening for autism in older and younger toddlers. Autism: The International Journal of Science and Practice, 12 (5), 513-535. PMID: 18805945

Sample:

Participants — 6,776 (4592, 16–23 months, and 2184, 24–30 months)

Race/Ethnicity — Not Specified

Summary:

The purpose of the current study was to utilize the Modified Checklist for Autism in Toddlers (M–CHAT) to screen younger (16–23 months) versus older (24–30 months) high- and low-risk toddlers to explore two questions in children with Autism. First, is the false-positive rate significantly different for groups stratified by age and risk: older/high-risk versus younger/high-risk samples and older/low-risk versus younger/low-risk samples? Second, of the children who screen positive and then meet criteria for ASD on evaluation, does the clinical picture differ for the younger versus older and high-risk versus low-risk groups of children. Results indicate comparisons of PPP for ASD between age groups show that it is lowest for the younger/low-risk toddlers (0.28), those below the age of 24 months screened routinely at a well-child visit; their PPP was significantly lower than the older/low-risk toddlers (0.61). For children already identified to be at some developmental risk, PPP (0.79 for younger children and 0.74 for older children) did not differ by age.

Kleinman, J.M., Robins, D.L., Ventola, P.E., Pandey, J., Boorstein, H.C., Esser, E.L., *Wilson, L.B., Rosenthal, M.A., Sutera, S., Verbalis, A.D., Marshia, G., Barton, M. Hodgson, S., Green, J., Dumont-Mathieu, T., Volkmar, F., Chawarska, K., Klin, A., & The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827-839

Sample:

Participants — 3,793

Race/Ethnicity — Not Specified

Summary:

The Modified Checklist for Autism in Toddlers (M-CHAT) was used to screen 3,793 children aged 16–30 months from low- and high-risk sources; screen positive cases were diagnostically evaluated. Rescreening was performed on 1,416 children aged 42–54 months. Time 1 Positive Predictive Value (PPV) was .36 for the initial screening and .74 for the screening plus follow-up telephone interview; values were similar for Time2 PPV. When separating referral sources, PPV was low for the low-risk sample but acceptable with the follow up telephone interview. Children with ASD from the low risk and high-risk samples were highly similar. Results indicate that the M-CHAT continues to be a promising instrument for the early detection of ASD.

Snow, A. V., & Lecavalier, L. (2008). Sensitivity and specificity of the modified checklist for autism in toddlers and the social communication questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism, 12(6), 627-644.

Sample:

Participants — 82

Race/Ethnicity — 87% Caucasian, 6% African-American, and 7% other

Summary:

This study assessed the psychometric properties of the Modified Checklist for Autism in Toddlers (M–CHAT) and the Social Communication Questionnaire (SCQ) in a sample of preschool children referred for possible pervasive developmental disorders (PDDs). The sample consisted of children between the ages of 18 and 70. M–CHAT scores were analyzed for children aged 18–48 months old and SCQ scores were analyzed for children aged 30–70 months old. Optimal sensitivity and specificity were achieved using the cutoff score of any three items on the M–CHAT and lowering the cutoff score of the SCQ. The diagnostic agreement of both instruments was also compared in an overlapping subsample of children aged 30–48 months. Overall, the M–CHAT and SCQ appear to more accurately classify children with PDDs who have lower intellectual and adaptive functioning.

Canal-Bedia, R., García-Primo, P., Martín-Cilleros, M. V., Santos-Borbujo, J., Guisuraga-Fernández, Z., Herráez-García, L., ... & Posada-de La Paz, M. (2011). Modified checklist for autism in toddlers: Cross-cultural adaptation and validation in Spain. Journal of autism and developmental disorders, 41(10), 1342-1351.

Sample:

Participants — 4,535

Race/Ethnicity — 100% Spanish

Summary:

This article discussed the Spanish version of the Modified Checklist for Autism in Toddlers (M-CHAT). This is the first study to validate the M-CHAT in Spain and outlines the three phases of the validation process: translation; cultural adaptation; validity and reliability analysis. Validity and reliability studies were carried out in two different geographical areas of Spain, where M-CHAT was administered to two different samples, namely: high- and low-risk children and low-risk children. The results obtained were similar to those yielded by the original M-CHAT studies. Differences were found in positive predictive value, due to the low ASD frequency observed in this study.

Inada, N., Koyama, T., Inokuchi, E., Kuroda, M., & Kamio, Y. (2011). Reliability and validity of the Japanese version of the modified checklist for autism in toddlers (M-CHAT). Research in Autism Spectrum Disorders, 5(1), 330-336.

Sample:

Participants — 1,187

Race/Ethnicity — 100% Japanese

Summary:

This study examined the reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT), completed by parents of children at 18–24 months of age. The reliability of the M-CHAT was investigated for children 4–20 months of age. The M-CHAT score (the number of failed items) was found to be significantly correlated among 24 mother–father pairs, representing good interrater reliability. The test–retest reliability was satisfactory, with 22 mothers providing almost equal M-CHAT scores on two different occasions. Significant correlations were observed between the M-CHAT score and the Childhood Autism Rating Scale-Tokyo version score in 25 two-year-old children, indicating good concurrent validity. The M-CHAT score was significantly higher in 20 children later diagnosed with ASD compared with reference children (n = 1167), revealing sufficient discriminant validity. A short version of the M-CHAT using 9 items was proposed and effectively differentiated children with ASD from reference children. The efficacy of the Japanese version of the MCHAT was demonstrated for first-level screening in the general population

Chlebowski, C., Robins, D.L., Barton, M.L., & Fein, D. (2013). Large-scale use of the Modified Checklist for Autism in low-risk toddlers. Pediatrics, 131 (4), e1121-1127.

Sample:

Participants — 18,989

Race/Ethnicity — Not Specified

Summary:

The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism specific screening instrument in a large, geographically diverse pediatrics-based sample. The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation. Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of >3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of >7.

Date Reviewed: February 2015 (Originally reviewed in February 2015)