The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders
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.”
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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 · see citing works
Barbaro, J., & Dissanayake, C. (2009) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181ba0f9f · Cited by 257 · see citing works
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 · see citing works
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 · see citing works
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 · see citing works
Self-citationPromoting 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 · see citing works
Screening for autism spectrum disorders in primary care settings
Robins, D. L. (2008) · Autism · doi:10.1177/1362361308094502 · Cited by 239 · see citing works
Self-citationRogers, S. J., Estes, A., Lord, C., Munson, J., Rocha, M., Winter, J., Greenson, J., Colombi, C., Dawson, G., Vismara, L. A., et al. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.01.004 · Cited by 233 · see citing works
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 · see citing works
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 · see citing works
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 · see citing works
Hadders‐Algra, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10040861 · Cited by 243 · see citing works
GPs’ confidence in caring for their patients on the autism spectrum: an online self-report study
Unigwe, S., Buckley, C., Crane, L., Kenny, L., Remington, A., & Pellicano, E. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x690449 · Cited by 226 · see citing works
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 · see citing works
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 226 · see citing works
“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…”
BackgroundEarly 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 223 · see citing works
“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.”
Yirmiya, N., & Charman, T. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02214.x · Cited by 224 · see citing works
Screening Accuracy of Level 2 Autism Spectrum Disorder Rating Scales
Norris, M., & Lecavalier, L. (2010) · Autism · doi:10.1177/1362361309348071 · Cited by 222 · see citing works
Diagnostic tests for autism spectrum disorder (ASD) in preschool children
Randall, M., Egberts, K. J., Samtani, A., Scholten, R. J. P. M., Hooft, L., Livingstone, N., Sterling-Levis, K., Woolfenden, S. R., & Williams, K. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009044.pub2 · Cited by 221 · see citing works
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 217 · see citing works
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 · see citing works
“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.”
BackgroundResultPatten, 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 · see citing works
“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.”
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 216 · see citing works
Moh, T. A., & Magiati, I. (2011) · Research in Autism · doi:10.1016/j.rasd.2011.05.011 · Cited by 214 · see citing works
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 · see citing works
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 210 · see citing works
“symptom development (Robins et al., 2001).”
BackgroundResultThe 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 209 · see citing works
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 · see citing works
“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).”
MethodAllen, 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 · see citing works
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 · see citing works
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 201 · see citing works
“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.”
MethodAgreement 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 197 · see citing works
Self-citationScreening 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 193 · see citing works
Matson, J. L., Wilkins, J. W., & González, M. L. (2007) · Research in Autism · doi:10.1016/j.rasd.2007.03.002 · Cited by 190 · see citing works
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 · see citing works
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 · see citing works
Conversational gestures in autism spectrum disorders: Asynchrony but not decreased frequency
de Marchena, A. B., & Eigsti, I. (2010) · Autism Research · doi:10.1002/aur.159 · Cited by 190 · see citing works
Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2012) · Early Childhood Research Quarterly · doi:10.1016/j.ecresq.2012.06.006 · Cited by 189 · see citing works
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 · see citing works
Charman, T., & Gotham, K. (2013) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2012.00664.x · Cited by 185 · see citing works
“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).”
BackgroundMethodInfluentialKuban, 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 · see citing works
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 184 · see citing works
Snow, A. V., & Lecavalier, L. (2008) · Autism · doi:10.1177/1362361308097116 · Cited by 182 · see citing works
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 · see citing works
- Authors
- Robins, D. L., Fein, D., Barton, M. L., & Green, J. A.
- Affiliations
- University of Connecticut (US)
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2001-04
- Volume
- 31
- Issue
- 2
- Pages
- 131-144
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- 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
- 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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