Summary of M-CHAT-R/F Scoring
- 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. If parents have any concerns, they should consult their doctors.
- 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 higher, the child has screened positive. Action required: refer child for diagnostic evaluation and eligibility evaluation for early intervention. If score on Follow-Up is 0-1, child has screened negative. No further action required unless surveillance indicates risk for ASD. Child should be rescreened at future well-child visits.
- HIGH-RISK: Total Score is 8-20; It is acceptable to bypass the Follow-Up and refer immediately for diagnostic evaluation and eligibility evaluation for early intervention.
© 2009 Diana Robins, Deborah Fein, & Marianne Barton
Source: Diana Robins, Deborah Fein, & Marianne Barton. “Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F)” 2009. Retrieved from: https://www.m-chat.org/_references/mchatdotorg.pdf
How reliable is the M-Chat-R/F?
- Based on a study comparing the validity of the M-CHAT-R/F against the original M-CHAT on a pool of just over 16,000 toddlers in Atlanta and Connecticut, the authors found that M-CHAT-R/F detected ASD at a higher rate compared to the M-CHAT with a reduced rate of kids needing follow up.
- The study showed children whose total score was ≥ 3 initially ≥ 2 on follow up, had a 47.5% risk of ASD diagnosis and 94.6% risk of any developmental delay (35.7% had other delays, 11,3% had developmental concerns but no formal diagnosis and only 5.4% were judged to be typical).
- Also worth noting is that children in the current study were diagnosed 2 years younger than the US national median age of diagnosis (roughly 2 yrs vs 4 yrs), thus increasing time for early intervention.
Source: Robins, D. L., Casagrande, K., Barton, M., Chen, C.A., Dumont-Mathieu, D., & Fein, D. (2013). “Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F)” Pediatrics. 2014 Jan; 133(1): 37–45. Retrieved from: http://pediatrics.aappublications.org/content/early/2013/12/18/peds.2013-1813
What are limitations?
- The most common concern raised is that parents could be biased in their reporting. Further as this is a level 1 screening (done by user) it may not be as accurate as a level 2 screening (with a clinician).