Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F)

Pediatrics. 2014 Jan;133(1):37-45. doi: 10.1542/peds.2013-1813. Epub 2013 Dec 23.


Objective: 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.

Methods: Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated.

Results: 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; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). 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 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.

Conclusions: The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.

Keywords: autism; screening; toddlers.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Algorithms
  • Checklist
  • Child Development Disorders, Pervasive / diagnosis*
  • Child, Preschool
  • Decision Support Techniques
  • Developmental Disabilities / diagnosis
  • Early Diagnosis
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Psychological Tests*
  • ROC Curve
  • Reproducibility of Results