M-CHAT Questionnaire - Autism Screening Assessment

Assessment Information

Purpose: The M-CHAT is a validated screening tool to assess risk for Autism Spectrum Disorder (ASD) in toddlers aged 16-30 months.

Scoring: Children who fail 3 or more items total OR 2 or more critical items should be referred for diagnostic evaluation by a specialist trained in ASD assessment.

Note: This screening has a high false positive rate. Not all children who fail will be diagnosed with ASD, but evaluation is warranted for any child who fails the screening.

Evaluator & Child Information

Evaluator Name:

Evaluator Role:

Child's Name:

Child's Date of Birth:

Assessment Date:

Parent/Guardian Name:

M-CHAT Assessment Questions

Please answer each question based on how your child usually is. If the behavior is rare (seen once or twice), answer "No".

Assessment Results

Total Items Failed

Critical Items Failed

The M-CHAT is a copyrighted instrument. For more information, visit www.mchatscreen.com or www.firstsigns.org

For permission to reproduce the M-CHAT in print or electronically, contact Diana Robins at drobins@gsu.edu

M-CHAT™ Questionnaire

Assessment Information

Evaluator & Child Information

M-CHAT Assessment Questions

Assessment Results