Modified Checklist for Autism in Toddlers (M-CHAT)
This is the html version of the file http://www.firstsigns.org/downloads/m-chat.PDF

  • Please fill out the following about how your child usually is.

  • Please try to answer every question.
  • If the behavior is rare (e.g., you've seen it once or twice),
    please answer as if the child does not do it.

Child's name:______________________

Filled out by: ______________________

Date of birth: ______________________

Relationship to child: ________________

Today's date: ______________________

  
     
1. Does your child enjoy being swung, bounced on your knee, etc.?   Yes   No
2. Does your child take an interest in other children?   Yes   No
3. Does your child like climbing on things, such as up stairs?   Yes   No

4. Does your child enjoy playing peek-a-boo/hide-and-seek?

  Yes   No

5. Does your child ever pretend, for example, to talk on the phone or take care of dolls,
    or pretend other things?

  Yes   No
6. Does your child ever use his/her index finger to point to ask for something?   Yes   No
7. Does your child ever use his/her index finger to point to indicate interest in something?   Yes   No
8. Can your child play properly with small toys (e.g., cars or bricks) without just
    mouthing, fiddling, or dropping them?		   Yes   No
9. Does your child ever bring objects over to you (parent) to show you something?   Yes   No
10. Does your child look you in the eye for more than a second or two?   Yes   No

11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)

  Yes   No
 12. Does your child smile in response to your face or your smile?   Yes   No
13. Does your child imitate you? (e.g., you make a face -- will your child imitate it?)   Yes   No
14. Does your child respond to his/her name when you call?   Yes   No
15. If you point at a toy across the room, does your child look at it?   Yes   No

16. Does your child walk?

  Yes   No
17. Does your child look at things you are looking at?   Yes   No

18. Does your child make unusual finger movements near his/her face?

  Yes   No
19. Does your child try to attract your attention to his/her own activity?   Yes   No
20. Have you ever wondered if your child is deaf?   Yes   No

21. Does your child understand what people say?

  Yes   No

22. Does your child sometimes stare at thing or wander with no purpose?

  Yes   No

23. Does your child look at your face to check your reaction when faced with
     something unfamiliar?

  Yes   No

©1999 Diana Robins, Deborah Fein, & Marianne Barton
http://www.dbpeds.org/media/mchat.pdf