The M-CHAT Screener for Autism Risk

The M-CHAT is a free autism screener that parents fill out about their toddler, at home or during a pediatrician’s appointment. The current version is the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R). It asks 20 yes-or-no questions about everyday behaviors, such as pointing, pretend play, and responding to their name. Your answers show whether your child has a low, moderate, or high likelihood of autism. It is a screening tool, not an autism diagnosis.

Each answer that points to a higher likelihood of autism counts as 1 point, for a total between 0 and 20. For most questions, “no” earns the point. For questions 2, 5, and 12, “yes” does. A total of 0 to 2 is low likelihood. A total of 3 to 7 is moderate, and a short follow-up interview comes next. A total of 8 to 20 is high, and the official guidance is to refer your child for a diagnostic evaluation and an early intervention eligibility evaluation. Your pediatrician can make that referral, or you can request a diagnostic evaluation from a provider like Soar yourself.

The follow-up is the second stage of the screener, called the M-CHAT-R/F (Revised, with Follow-Up). It is used when the first score falls between 3 and 7. A provider, often your pediatrician, asks more detailed questions about only the items your child scored on. If 2 or more items still point to a higher likelihood, the screen is indicating positive and a diagnostic evaluation is recommended. If the follow-up score is 0 or 1, the screen is leaning negative.

The M-CHAT-R is designed for toddlers 16 to 30 months old. Its official guidance adds that it can be used up to 48 months, since studies have used it with children that age. The American Academy of Pediatrics (AAP) recommends autism screening for all children at their 18- and 24-month well-child visits, and M-CHAT screening is one of the screening tools the Centers for Disease Control and Prevention (CDC) lists for it. If your child is younger than 24 months and scores low (0 to 2), consult their pediatrician and consider screening again after their second birthday.

It is a screening tool, not a diagnostic autism test. A screener shows whether a closer look is a good idea. A diagnosis comes from a full evaluation by trained specialists. Soar offers diagnostic evaluations in Arizona, Colorado, and Maryland, where a licensed psychologist leads an intake conversation, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3). CHOP-Soar centers in Pennsylvania do not offer diagnostic evaluations at this time.

The M-CHAT-R is a general screener, so it is not built to be highly specific, and it can flag some children who do not have autism. Its authors note that many children who screen positive are not diagnosed with autism, but they may have other developmental delays. The goal of a screener is to start a conversation with a provider, to determine if a formal evaluation is needed. If your child scores low and you still have concerns, trust your instincts and talk with your pediatrician.

A positive autism screening means your child should have a closer look. It does not mean your child has autism. Share the result with your pediatrician, who can talk through next steps. You can also reach out to our care team directly, and no referral is needed to talk with us. You are already doing the right thing by looking into it.

The M-CHAT-R autism questionnaire has 20 yes-or-no questions about how your child usually behaves. They ask whether your child looks when you point, points to show you things, plays pretend, responds to their name, smiles back, copies what you do, and shows interest in other children. If you have seen a behavior only a few times, the instructions say to answer “no.”