The M-CHAT-R: What It Is, How to Take It, and What Your Score Means

The short answer: The M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised, with Follow-Up) is a free, 20-question checklist that parents fill out about their toddler. It's designed for children 16 to 30 months old and takes about five minutes. It doesn't diagnose autism. It sorts children into low, moderate or high likelihood, so you and your pediatrician know whether a closer look makes sense. You can download the official version for free at mchatscreen.com.

If you're here because something about your toddler has you wondering, you're not overreacting. You're paying attention. A screener is one small, low-pressure way to put what you're noticing into words.

What is the M-CHAT-R?

The M-CHAT-R/F is one of the most widely used autism screeners for toddlers in the United States. It was developed by Diana Robins, Deborah Fein and Marianne Barton. The American Academy of Pediatrics recommends autism screening at the 18-month and 24-month well-child visits, and many pediatricians use the M-CHAT-R/F to do it.

It works in two stages:

• Stage 1, the checklist: 20 yes-or-no questions about things your child usually does, like how they share interest with you, respond to their name and play.
• Stage 2, the Follow-Up: if the checklist score lands in the middle range, a professional asks follow-up questions about the items that were flagged. This step is the "/F" in the name, and it helps sort out answers that were unclear or simply reflected a bad day.

How to take it

• Check the age. The M-CHAT-R/F is meant for children between 16 and 30 months.
• Download the official checklist. It's free at mchatscreen.com. Use the official version, since copies on other sites can be edited or out of date.
• Answer for what your child usually does, not what they did once or what they can do on a great day.
• Bring it to your pediatrician. Your child's doctor can score it with you, run the Follow-Up questions if needed and talk through next steps.

What your score means

The official scoring puts children into three ranges:

• 0 to 2: low likelihood. No follow-up is needed. If your child is younger than 24 months, the guidelines recommend screening again at 24 months. If you're still concerned, trust that and talk with your pediatrician anyway.
• 3 to 7: moderate likelihood. The next step is the Follow-Up questions about the flagged items. If two or more items are still flagged after the Follow-Up, the screen is considered positive.
• 8 to 20: high likelihood. The Follow-Up can be skipped.

For a positive screen, the official guidance recommends two things at once: a referral to early intervention and a referral for a diagnostic evaluation. You don't have to wait for one before starting the other.

What the M-CHAT-R can and can't tell you

• It's a screener, not a diagnosis. A positive screen means a closer look is worth it. Some children who screen positive aren't autistic, and many of them have another developmental difference, like a speech delay, that also benefits from support.
• A low score doesn't cancel your instincts. No screener catches every child. If you keep noticing something, ask for an evaluation anyway.
• It doesn't measure your parenting. Nothing on the checklist is a test of you.

What to do next, depending on your score

If you're in Illinois

• Early intervention: Illinois Early Intervention serves children under 3. Your pediatrician can refer you, or you can contact your local Child and Family Connections office yourself. Our guide to Early Intervention in Illinois walks through the steps.
• Evaluation: our Early Autism Testing team at our Naperville center evaluates young children without the long waits many families run into. Read what an early evaluation involves.

If you're in Texas

• Early intervention: in Texas, that's ECI, and any parent can refer their own child. Our guide to ECI in Texas walks through the steps.
• Evaluation: ask your pediatrician for a referral to a developmental pediatrician, psychologist or neuropsychologist who evaluates for autism.
• Paying for it: our Texas autism funding guide covers insurance, Medicaid and grants.

Common questions

Is the M-CHAT-R free?

Yes. The official checklist and scoring instructions are free to download at mchatscreen.com.

What age is the M-CHAT-R for?

It's designed for toddlers 16 to 30 months old. Pediatricians commonly use it at the 18-month and 24-month checkups.

Can the M-CHAT-R diagnose autism?

No. It screens for the likelihood of autism. Only a diagnostic evaluation by a qualified professional can diagnose autism.

My child scored low, but I'm still worried. What should I do?

Talk with your pediatrician and ask for an evaluation. Screeners miss some children, and you know your child best.

My child is older than 30 months. Is there a screener for them?

The M-CHAT-R/F isn't designed for older children. If you have concerns about a child over 30 months, skip the screener and ask your pediatrician about a developmental or autism evaluation.

Sources: M-CHAT-R/F scoring and use guidelines, mchatscreen.com (Robins, Fein and Barton); American Academy of Pediatrics recommendations on autism screening at 18 and 24 months.