The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders

Robins, Diana L.; Fein, Deborah; Barton, Marianne L.; Green, James A.

doi:10.1023/a:1010738829569

Cited by 1,563Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

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The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders

Robins, Diana L., Fein, Deborah, Barton, Marianne L., Green, James A.·2001·Journal of Autism and Developmental Disorders

DOI 10.1023/a:1010738829569

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Abstract

Autism, a severe disorder of development, is difficult to detect in very young children. However, children who receive early intervention have improved long-term prognoses. The Modified Checklist for Autism in Toddlers (M-CHAT), consisting of 23 yes/no items, was used to screen 1,293 children. Of the 58 children given a diagnostic/developmental evaluation, 39 were diagnosed with a disorder on the autism spectrum. Six items pertaining to social relatedness and communication were found to have the best discriminability between children diagnosed with and without autism/PDD. Cutoff scores were created for the best items and the total checklist. Results indicate that the M-CHAT is a promising instrument for the early detection of autism.

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Autism diagnosis was verified by age-appropriate screening (M-CHAT or SCQ) followed by ADOS evaluation conducted by a research-reliable assessor.
“To verify ASD, students were screened for autism with the Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, Barton, & Green, 2001) or the Social Communication Questionnaire (SCQ; Berument, Rutter, Lord, Pickles, & Bailey, 1999), depending on age. Students were then evaluated using the Autism Diagnostic Observation Schedule (Lord et al., 2000) to verify diagnosis by an evaluator with”
From Too Stressed to Teach? Teaching Quality, Student Engagement, and IEP Outcomes (2017) · cites this paper as Robins, Fein, Barton, & Green, 2001
The M-CHAT has been validated in two large validation studies.
“The M–CHAT has been validated in two large validation studies.”
From Effects of a Brief Early Start Denver Model (ESDM)–Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial (2012) · cites this paper as [30]

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Sullivan, M., Finelli, J., Marvin, A., Garrett-Mayer, E., Bauman, M., & Landa, R. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0335-3 · Cited by 280
Diagnosis of autism spectrum disorders in the first 3 years of life
Landa, R. J. (2008) · Nature Clinical Practice Neurology · doi:10.1038/ncpneuro0731 · Cited by 273
Infants and Toddlers With Autism Spectrum Disorder: Early Identification and Early Intervention
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Diagnostic Stability in Very Young Children with Autism Spectrum Disorders
Kleinman, J. M., Ventola, P. E., Pandey, J., Verbalis, A. D., Barton, M., Hodgson, S., Green, J., Dumont-Mathieu, T., Robins, D. L., & Fein, D. (2008) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-007-0427-8 · Cited by 272
Self-citation
Feasibility and Effectiveness of Very Early Intervention for Infants At-Risk for Autism Spectrum Disorder: A Systematic Review
Bradshaw, J. L., Steiner, A. M., Gengoux, G. W., & Koegel, L. K. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2235-2 · Cited by 272
“These assessments included systematic behavioral observation (Drew et al. 2002; Koegel et al. 2013), Autism Diagnostic Observation Schedule—Toddler Module (ADOS-T, Lord et al. 2012; Rogers et al. 2012), Autism Diagnostic Interview—Revised (ADI-R) and Toddler Autism Diagnostic Interview (Dawson et al. 2010; Drew et al.…”
BackgroundMethod
The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence
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Behavioral profiles of affected and unaffected siblings of children with autism: Contribution of measures of mother–infant interaction and nonverbal communication
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Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships
Elder, J. H., Kreider, C. M., Brasher, S. N., & Ansell, M. (2017) · Psychology Research and Behavior Management · doi:10.2147/prbm.s117499 · Cited by 307
Large-Scale Use of the Modified Checklist for Autism in Low-Risk Toddlers
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Self-citation
Accuracy of autism screening in a large pediatric network
Guthrie, W., Wallis, K., Bennett, A., Brooks, E., Dudley, J., Gerdes, M., Pandey, J., Levy, S. E., Schultz, R. T., & Miller, J. S. (2019) · Pediatrics · doi:10.1542/peds.2018-3963 · Cited by 252
The Q-CHAT (Quantitative CHecklist for Autism in Toddlers): a normally distributed quantitative measure of autistic traits at 18–24 months of age: preliminary report
Allison, C., Baron-Cohen, S., Wheelwright, S., Charman, T., Richler, J., Pasco, G., & Brayne, C. (2008) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-007-0509-7 · Cited by 327
Autism Spectrum Disorders in Infancy and Toddlerhood: A Review of the Evidence on Early Signs, Early Identification Tools, and Early Diagnosis
Barbaro, J., & Dissanayake, C. (2009) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181ba0f9f · Cited by 257
Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-Up Approach
Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., & Gallagher, N. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.02.036 · Cited by 256
Prospective Longitudinal Studies of Infant Siblings of Children With Autism: Lessons Learned and Future Directions
Szatmári, P., Chawarska, K., Dawson, G., Georgiades, S., Landa, R. J., Lord, C., Messinger, D. S., Thurm, A. E., & Halladay, A. K. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.12.014 · Cited by 250
Breif Report: Sensory Abnormalities as Distinguishing Symptoms of Autism Spectrum Disorders in Young Children
Wiggins, L. D., Robins, D. L., Bakeman, R., & Adamson, L. B. (2009) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-009-0711-x · Cited by 248
Self-citation
Promoting Joint Attention in Toddlers with Autism: A Parent-Mediated Developmental Model
Schertz, H. H., & Odom, S. L. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0290-z · Cited by 242
Screening for autism spectrum disorders in primary care settings
Robins, D. L. (2008) · Autism · doi:10.1177/1362361308094502 · Cited by 239
Self-citation
A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual
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Autism spectrum disorder: advances in evidence-based practice
Anagnostou, E. A., Zwaigenbaum, L., Szatmári, P., Fombonne, E. J., Fernandez, B. A., Woodbury‐Smith, M., Brian, J. A., Bryson, S. E., Smith, I. M., Drmic, I., et al. (2014) · Canadian Medical Association Journal · doi:10.1503/cmaj.121756 · Cited by 234
Screening for Autism Spectrum Disorders in Children With Down Syndrome: Population Prevalence and Screening Test Characteristics
DiGuiseppi, C., Hepburn, S., Davis, J. M., Fidler, D. J., Hartway, S., Lee, N. R., Miller, L., Ruttenber, M., & Robinson, C. (2010) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181d5aa6d · Cited by 233
Effectiveness of Developmental Screening in an Urban Setting
Guevara, J. P., Gerdes, M., Localio, R. A., Huang, Y.-S. V., Pinto‐Martin, J. A., Minkovitz, C. S., Hsu, D., Kyriakou, L., Baglivo, S. J., Kavanagh, J. E., et al. (2012) · PEDIATRICS · doi:10.1542/peds.2012-0765 · Cited by 231
Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities
Hadders‐Algra, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10040861 · Cited by 243
GPs’ confidence in caring for their patients on the autism spectrum: an online self-report study
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Screening for autistic spectrum in children aged 14 to 15 months. I: the development of the Early Screening of Autistic Traits Questionnaire (ESAT)
Swinkels, S. H. N., Dietz, C., van Daalen, E., Kerkhof, I. H. G. M., van Engeland, H., & Buitelaar, J. K. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0115-0 · Cited by 226
Use of Artificial Intelligence to Shorten the Behavioral Diagnosis of Autism
Wall, D. P., Dally, R. L., Luyster, R., Jung, J.-Y., & DeLuca, T. F. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043855 · Cited by 241
“Significant attention has been paid to the design of abbreviated screening examinations that are meant to foster more rapid diagnosis, including the Autism Screening Questionnaire (ASQ, designed to discriminate between PDD and non-PDD diagnoses [12]), the Social Communication Questionnaire (SCQ) [13], and the Modified…”
Background
Early diagnosis of autism and impact on prognosis: a narrative review
Fernell, E., Eriksson, �., & Gillberg, C. (2013) · Clinical Epidemiology · doi:10.2147/clep.s41714 · Cited by 250
“The CHAT (Checklist for Autism in Toddlers) was developed by Baron-Cohen et al 57 and was later extended to the Modified CHAT or M-CHAT.”
The prodrome of autism: early behavioral and biological signs, regression, peri‐ and post‐natal development and genetics
Yirmiya, N., & Charman, T. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02214.x · Cited by 233
Screening Accuracy of Level 2 Autism Spectrum Disorder Rating Scales
Norris, M., & Lecavalier, L. (2010) · Autism · doi:10.1177/1362361309348071 · Cited by 237
Diagnostic tests for autism spectrum disorder (ASD) in preschool children
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A Parent-Report Instrument for Identifying One-Year-Olds at Risk for an Eventual Diagnosis of Autism: The First Year Inventory
Reznick, J. S., Baranek, G. T., Reavis, S., Watson, L. R., & Crais, E. R. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0303-y · Cited by 221
Can Parents’ Concerns Predict Autism Spectrum Disorder? A Prospective Study of High-Risk Siblings From 6 to 36 Months of Age
Sacrey, L.-A. R., Zwaigenbaum, L., Bryson, S. E., Brian, J. A., Smith, I. M., Roberts, W., Szatmári, P., Roncadin, C., Garon, N., Novak, C., et al. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.03.014 · Cited by 216
“Historically, parents’ descriptions helped inform the development of early detection and screening strategies (e.g., Robins et al.32), but have received less attention with the shift to direct observation in prospective studies of high-risk infants.”
BackgroundResult
Vocal Patterns in Infants with Autism Spectrum Disorder: Canonical Babbling Status and Vocalization Frequency
Patten, E., Belardi, K., Baranek, G. T., Watson, L. R., Labban, J. D., & Oller, D. K. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2047-4 · Cited by 217
“Still, the most widely used autism screening tool for young children, the Modified Checklist for Autism Toddlers (MCHAT: Robins et al. 2001) is recommended for ages 16–30 months.”
Autism Spectrum Disorders and Symptoms in Children with Molecularly Confirmed 22q11.2 Deletion Syndrome
Fine, S. E., Weissman, A., Gerdes, M., Pinto‐Martin, J. A., Zackai, E. H., McDonald‐McGinn, D. M., & Emanuel, B. S. (2005) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-005-5036-9 · Cited by 221
Factors associated with parental stress and satisfaction during the process of diagnosis of children with Autism Spectrum Disorders
Moh, T. A., & Magiati, I. (2011) · Research in Autism · doi:10.1016/j.rasd.2011.05.011 · Cited by 244
How early do parent concerns predict later autism diagnosis?
Ozonoff, S., Young, G. S., Steinfeld, M. B., Hill, M. M., Cook, I., Hutman, T., Macari, S., Rogers, S. J., & Sigman, M. (2009) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181ba0fcf · Cited by 210
Family Nurture Intervention in the Neonatal Intensive Care Unit improves social‐relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial
Welch, M. G., Firestein, M. R., Austin, J., Hane, A. A., Stark, R. I., Hofer, M. A., Garland, M., Glickstein, S. B., Brunelli, S. A., Ludwig, R. J., et al. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12405 · Cited by 217
“symptom development (Robins et al., 2001).”
BackgroundResult
The CAST (Childhood Asperger Syndrome Test)
Williams, J. G., Gullon-Scott, F., Stott, C., Allison, C. L., Bolton, P., Baron‐Cohen, S., & Brayne, C. (2004) · Autism · doi:10.1177/1362361305049029 · Cited by 215
Injury to the Premature Cerebellum: Outcome is Related to Remote Cortical Development
Limperopoulos, C., Chilingaryan, G., Sullivan, N. R., Guizard, N., Robertson, R. L., & du Plessis, A. J. (2012) · Cerebral Cortex · doi:10.1093/cercor/bhs354 · Cited by 201
“The “Modified Checklist for Autism in Toddlers” (M-CHAT) was used to screen all children’s behaviors for early signs of autism by parental report (Robins et al. 2001).”
Method
Validity of the Social Communication Questionnaire in Assessing Risk of Autism in Preschool Children with Developmental Problems
Allen, C. W., Silove, N., Williams, K., & Hutchins, P. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0279-7 · Cited by 200
Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial
Rogers, S. J., Estes, A. M., Vismara, L. A., MUNSON, J. A., Zierhut, C., Greenson, J., Dawson, G., Rocha, M., Sugar, C. A., Şentürk, D., et al. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3740-5 · Cited by 207
Goal Attainment Scaling as an Outcome Measure in Randomized Controlled Trials of Psychosocial Interventions in Autism
Ruble, L. A., McGrew, J. H., & Toland, M. D. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1446-7 · Cited by 205
“Child participants received one of two screeners—the Modified Checklist for Autism in Toddlers (M-CHAT; Robins et al. 2001) for children under 4 years old, and the Social Communication Questionnaire (SCQ; Rutter et al. 2004) for those 4 or older.”
Method
Agreement Among Four Diagnostic Instruments for Autism Spectrum Disorders in Toddlers
Ventola, P. E., Kleinman, J. M., Pandey, J., Barton, M. L., Allen, S. T., Green, J., Robins, D. L., & FEIN, D. A. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0128-8 · Cited by 203
Self-citation
Screening and surveillance for autism and pervasive developmental disorders
Baird, G., Charman, T., Cox, A., Baron‐Cohen, S., Swettenham, J., Wheelwright, S. J., & Drew, A. (2001) · Archives of Disease in Childhood · doi:10.1136/adc.84.6.468 · Cited by 194
Early identification and diagnosis in autism spectrum disorders in young children and infants: How early is too early?
Matson, J. L., Wilkins, J. W., & González, M. L. (2007) · Research in Autism · doi:10.1016/j.rasd.2007.03.002 · Cited by 204
Autistic Spectrum Disorders in Velo-cardio Facial Syndrome (22q11.2 Deletion)
Antshel, K. M., Aneja, A., Strunge, L., Peebles, J., Fremont, W. P., Stallone, K., AbdulSabur, N., Higgins, A. M., Shprintzen, R. J., & Kates, W. R. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0308-6 · Cited by 183
Reliability and item content of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): Parts 1–3
Matson, J. L., Wilkins, J. W., Sevin, J. A., Knight, C., Boisjoli, J. A., & Sharp, B. (2008) · Research in Autism · doi:10.1016/j.rasd.2008.08.001 · Cited by 191
Conversational gestures in autism spectrum disorders: Asynchrony but not decreased frequency
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Effects of Joint Attention Mediated Learning for toddlers with autism spectrum disorders: An initial randomized controlled study
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The First Year Inventory: Retrospective Parent Responses to a Questionnaire Designed to Identify One-Year-Olds at Risk for Autism
Watson, L. R., Baranek, G. T., Crais, E. R., Reznick, J. S., Dykstra, J. R., & Perryman, T. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0334-4 · Cited by 181
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“In their initial report, Robins et al. (2001) had tested 1122 unselected children (initially at 18 months, but subsequently at 24 months of age) and 171 children referred for early intervention services (considered to be at high risk of having an ASD or other developmental disability).”
BackgroundMethodInfluential
Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns
Kuban, K., O’Shea, T. M., Allred, E. N., Tager-Flusberg, H. B., Goldstein, D. J., & Leviton, A. (2009) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2008.10.011 · Cited by 184
The importance of physician knowledge of autism spectrum disorder: results of a parent survey
Rhoades, R. A., Scarpa, A., & Salley, B. J. (2007) · BMC Pediatrics · doi:10.1186/1471-2431-7-37 · Cited by 202
Sensitivity and specificity of the Modified Checklist for Autism in Toddlers and the Social Communication Questionnaire in preschoolers suspected of having pervasive developmental disorders
Snow, A. V., & Lecavalier, L. (2008) · Autism · doi:10.1177/1362361308097116 · Cited by 182
Language Disorders: Autism and Other Pervasive Developmental Disorders
Tager-Flusberg, H., & Caronna, E. (2007) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2007.02.011 · Cited by 181

The Modified - Checklist for Autism in Toddlers (M-CHAT): Early detection of autism spectrum disorders
Robins, D. L. (2002) · OpenCommons at University of Connecticut (University of Connecticut) · Cited by 5
Self-citation
ORIGINAL PAPER The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders
Klin, A., & FEIN, D. A. (2007)
Self-citation
Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in Detecting Autism and Other Developmental Disorders in Community Clinics
Toh, T., Tan, V. W.-Y., Lau, P. S.-T., & Kiyu, A. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3287-x · Cited by 41
The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders
Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H., Esser, E. L., Wilson, L. B., Rosenthal, M., Sutera, S., Verbalis, A. D., et al. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-007-0450-9 · Cited by 416
Self-citation
Screening for autism in young children: The Modified Checklist for Autism in Toddlers (M‐CHAT) and other measures
Dumont-Mathieu, T. M., & FEIN, D. A. (2005) · Mental Retardation and Developmental Disabilities Research Reviews · doi:10.1002/mrdd.20072 · Cited by 167
Self-citation

Authors: Robins, D. L., Fein, D., Barton, M. L., & Green, J. A.
Affiliations: University of Connecticut (US)
ORCID: Robins, Diana L.
Fein, Deborah
Barton, Marianne L.
Venue: Journal of Autism and Developmental Disorders
Publisher: Springer Science and Business Media LLC
Published: 2001-04
Volume: 31
Issue: 2
Pages: 131-144
ISSN: 0162-3257 (ISSN-L)
1573-3432
DOI: 10.1023/a:1010738829569
OpenAlex: W2127693561
Cited by: 1,563
References: 48
Citations by year: 2026: 36 · 2025: 50 · 2024: 71 · 2023: 51 · 2022: 68 · 2021: 89 · 2020: 82 · 2019: 74 · 2018: 75 · 2017: 67 · 2016: 73 · 2015: 88 · 2014: 116 · 2013: 104 · 2012: 117
FWCI: 6.29
Type: journal article
Language: en
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Journal of Autism and Developmental Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Education
University of Connecticut
National Institutes of Health
National Institute of Mental Health
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords: M-CHAT, autism spectrum disorder, pervasive developmental disorders, early detection, autism screening, toddlers, cut-off values, discriminability, social relatedness, communication
MeSH terms: Autistic Disorder, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Infant, Male, Mass Screening, Predictive Value of Tests, Psychiatric Status Rating Scales, Psychometrics, Sensitivity and Specificity, Reproducibility of Results

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The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders

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