Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F)

Assessment Rating:
B – Psychometrics Demonstrated
See entire scale

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

Description / Purpose:

The M-CHAT-R/F screens for risk for autism spectrum disorder.

The M-CHAT-R/F 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 20 yes/no questions about the child’s usual behavior. Children who score in the low-risk range (0-2) need no referrals unless surveillance suggests risk for autism. Parents of children in the moderate risk range (3-7) should complete the relevant Follow-Up questions, and if the score on Follow-Up is 2 or higher, the child should be referred for diagnostic evaluation and early intervention. Children who score in the high risk range (8+) should be immediately referred for evaluation and intervention.

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., *Please note that is a licensee and pays fees to use the M-CHAT-R; paper download available free from

Scoring Information: The website,, offers several scoring options; M-CHAT-R/F 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 Entities who wish to incorporate M-CHAT into electronic tools must have license agreement – see website

Contact Information

Name: Diana L. Robbins, PhD

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of "B – Psychometrics Demonstrated" based on the published, peer-reviewed research available. The tool must have 1 published, peer-reviewed study that has established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.

Robins, D.L., Casagrande, K., Barton, M.L., Chen, C., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F). Pediatrics, 133 (1), 37-45.


Participants — 15,612 toddlers

Race/Ethnicity — Not Specified


This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low risk toddlers, and demonstrates improved utility compared with the original M-CHAT. The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was >3 initially and >2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD) and a 94.6% risk of any developmental delay or concern. Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R/F detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis.

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