Large-scale use of the modified checklist for autism in low-risk toddlers

Pediatrics. 2013 Apr;131(4):e1121-7. doi: 10.1542/peds.2012-1525. Epub 2013 Mar 25.


Objective: 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.

Methods: The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18,989 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: 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.

Conclusions: This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.

Publication types

  • Clinical Trial

MeSH terms

  • Autistic Disorder / diagnosis*
  • Checklist*
  • Child Development Disorders, Pervasive / diagnosis
  • Child Health Services
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Mass Screening / methods*
  • Predictive Value of Tests
  • Primary Health Care
  • Risk