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

Aug 26, 2026

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Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) is a two-stage parent-report screening tool designed to assess risk for Autism Spectrum Disorder (ASD). It aims to maximize sensitivity to detect as many potential cases as possible, with follow-up questions used to clarify at-risk responses. Scoring is completed in under two minutes, followed by guidance for low-, medium-, and high-risk outcomes, including referral for diagnostic evaluation and early intervention eligibility when indicated.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Instructions for Use

Scoring Algorithm

M-CHAT-R/F Questions

Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F)TM Diana L. Robins, Ph. D. Deborah Fein, Ph. D. Marianne Barton, Ph. D. Acknowledgement: We thank the M-CHAT Study Group in Spain for developing the flow chart format used in this document. For more information, please [see](see www.mchatscreen.com)[ ](see www.mchatscreen.com)[www.mchatscreen.com](see www.mchatscreen.com) or contact Diana Robins [at DianaLRobins@gmail.com](at DianaLRobins@gmail.com) © 2009 Diana Robins, Deborah Fein, & Marianne Barton Permissions for Use of the M-CHAT-R/FTM The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD) . The M-CHAT-R/F is available for free download for clinical, research, and educational purposes. Download of [the M-CHAT-R/F and related material is authorized from](the M-CHAT-R/F and related material is authorized from www.mchatscreen.com)[ ](the M-CHAT-R/F and related material is authorized from www.mchatscreen.com)[www.mchatscreen.com](the M-CHAT-R/F and related material is authorized from www.mchatscreen.com). The M-CHAT-R/F is a copyrighted instrument, and use of the M-CHAT-R/F must follow these guidelines: (1) Reprints/reproductions of the M-CHAT-R must include the copyright at the bottom (􀂤 2009 Robins, Fein, & Barton) . No modifications can be made to items, instructions, or item order without permission from the authors. (2) The M-CHAT-R must be used in its entirety. Evidence indicates that any subsets of items do not demonstrate adequate psychometric properties. (3) Parties interested in reproducing the M-CHAT-R/F in print (e.g. , a book or journal article) or electronically for use by others (e.g. , as part of digital medical record or other software packages) must contact Diana Robins to request permission ([DianaLRobins@gmail.com](DianaLRobins@gmail.com)) . (4) If you are part of a medical practice, and you want to incorporate the first stage M-CHAT-R questions into your own practice’s electronic medical record (EMR), you are welcome to do so. However, if you ever want to distribute your EMR page outside of your practice, please contact Diana Robins to request a licensing agreement. Instructions for Use The M-CHAT-R can be administered and scored as part of a well-child care visit , and also can be used by specialists or other professionals to assess risk for ASD. The primary goal of the M-CHAT-R is to maximize sensitivity, meaning to detect as many cases of ASD as possible. Therefore, there is a high false positive rate, meaning that not all children who score at risk will be diagnosed with ASD. To address this, we have developed the Follow-Up questions (M-CHAT-R/F) . Users should be aware that even with the Follow-Up, a significant number of the children who screen positive on the M-CHAT-R will not be diagnosed with ASD; however, these children are at high risk for other developmental disorders or delays, and therefore, evaluation is warranted for any child who screens positive. The M-CHAT-R can be scored in less than two minutes. Scoring instructions can be downloaded from [http://www.mchatscreen.com](http://www.mchatscreen.com. Associated)[. Associated](http://www.mchatscreen.com. Associated) documents will be available for download as well. Scoring Algorithm For all items except 2, 5, and 12, the response “NO” indicates ASD risk; for items 2, 5, and 12, “YES”indicates ASD risk. The following algorithm maximizes psychometric properties of the M-CHAT-R: LOW-RISK: Total Score is 0-2; if child is younger than 24 months, screen again after second birthday. No further action required unless surveillance indicates risk for ASD. MEDIUM-RISK: Total Score is 3-7; Administer the Follow-Up (second stage of M-CHAT-R/F) to get additional information about at-risk responses. If M-CHAT-R/F score remains at 2 or highe

FAQs

What is the purpose of the M-CHAT-R/F screening tool?

The M-CHAT-R/F is a two-stage parent-report tool used to screen for risk of Autism Spectrum Disorder (ASD). Its primary goal is to maximize sensitivity to detect as many cases as possible.

How is the M-CHAT-R/F scored, and what do the risk ranges mean?

Responses are scored using an algorithm where most items use “NO” as low risk and items 2, 5, and 12 use “YES” as indicating risk. Total scores define low-, medium-, and high-risk groups, guiding whether follow-up is needed and whether referral is recommended.

What happens if a child screens positive on the M-CHAT-R/F?

A positive screen means the child is at high risk and should receive evaluation. Even when follow-up is used, not all children who screen positive will be diagnosed with ASD, but developmental disorders or delays are possible, so evaluation is warranted.

Aug 26, 2026

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