Checklist for Autism in Toddlers (Chat)

Claudia BetancourtAngela BonnerBreona Smith

Common Level 1 Checklists for Autism in Children

These test are usually 5-15 minutes typically filled out by the parent and the pediatrician answers some

questions

Checklist for Autism in Toddlers (CHAT) CHAT - Denver Modifications Checklist for Autism in Toddlers-23 (China tested) Modified Checklist for Autism in Toddlers (M-CHAT) PDD Screening Test II, Primary Care Screener

CHAT Developed in England in 1992 by Dr. Simon Baron-

Cohen and colleagues

A screening instrument which identifies children at 18 months who are at risk of having social-communication disorders

A short questionnaire with 14 checklist items which is filled out by the parents and a primary health care worker at the 18 month developmental check-up

Administering CHAT It consists of two sections: the first nine items are questions asked

to the parents and the last five items are observations made by the primary health care worker

The key items look at behaviors which, if absent at 18 months, put a child at risk for a social-communication disorder

Includes 14 items measuring: (a) joint attention (pointing to show and gaze-monitoring, looking to

where a parent is pointing) (b) pretend play (pretending to pour tea from a teapot) (c) Imitation (copying actions or words)

Creating the Checklist Pediatricians generated a list of symptoms thought to be

present in very young children with autism

Items were created based on hypotheses in the literature, clinical instruments used to evaluate older children and their own clinical experience.

Some items were generated based on findings from home videos of children later found to have autism

Test Questions

Section A - Parents

1. Does your child enjoy being swung, bounced on your knee, etc?

2. Does your child take an interest in other children?

3. Does your child like climbing on things, such as upstairs?

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

5. Does your child ever PRETEND, for example, to make a cup of tea using a toy cup and teapot, or pretend other things?

6. Does your child ever use his/her index finger to point, to ASK for something?

7. Does your child ever use his/her index finger to point, to indicate INTEREST in something?

8. Can your child play properly with small toys (eg cars or bricks) without just mouthing, fiddling or dropping them?

9. Does your child ever bring objects over to you (parent) to SHOW you something?

Test QuestionsSection B – Observer

During the appointment, has the child made eye contact with you?

Get child's attention, then point across the room at an interesting object and say 'Oh look! There's a (name of toy!)' Watch child's face. Does the child look across to see what you are pointing at?

Get the child's attention, then give child a miniature toy cup and teapot and say 'Can you make a cup of tea? ' Does the child pretend to pour out tea, drink it, etc.?

Say to the child 'Where's the light?', or 'Show me the light'. Does the child point with his/her index finger at the light?

Can the child build a tower of bricks? (If so how many?)(Number of bricks:.............)

Modified Checklist for Autism in Toddlers (M-CHAT) Developed in 2001 by Robins, Fein, Barton and Green

Screens at 24 months instead of 18 months to catch regression between 18-24 months

14 new items were added to the 9 parent-report items from the original CHAT creating 23 parent-report items checklist

Broadens the design to identify greater range of children with pervasive developmental disorders (PDD) and eliminate the home health visitor observation

M-CHAT Additional Questions for Parents10. Does your child look you in the eye for more than a second or two? 11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)

(REVERSE) 12. Does your child smile in response to your face or your smile? 13. Does your child imitate you? (e.g., you make a face-will your child imitate it?)14. Does your child respond to his/her name when you call? 15. If you point at a toy across the room, does your child look at it? 16. Does your child walk? 17. Does your child look at things you are looking at? 18. Does your child make unusual finger movements near his/her face?

(REVERSE)19. Does your child try to attract your attention to his/her own activity? 20. Have you ever wondered if your child is deaf? (REVERSE)21. Does your child understand what people say? 22. Does your child sometimes stare at nothing or wander with no purpose?

(REVERSE) 23. Does your child look at your face to check your reaction when faced withsomething unfamiliar?

ScoringThere are five key items:

A5 (pretend play) A7 (protodeclarative pointing) Bii (following a point) Biii (pretending) Biv (producing a point)

If a child fails all five key items, they have a high risk of developing autism. Children who fail items A7 and Biv have a medium risk of

developing autism.

Scoring Six items pertaining to social relatedness and communication were

found to best identify between children diagnosed with and without autism

Cutoff scores were created for the best items and the total checklist

Critical items are marked in BOLD and reverse score items, meaning those for which a score of “Yes” indicates risk for autism (11, 18, 20, 22) are noted by the word REVERSE.

Results indicate that the M-CHAT is a promising instrument for the early detection of autism

M-CHAT Scoring A child fails the checklist when 2 or more critical

items (11, 18, 20, 22) are failed OR when any three items are failed.

Yes/No answers convert to pass/fail responses.

Rescreening Any child who fails the CHAT should be re-screened approximately

one month later

As with any screening instrument, a second CHAT is advisable so that those children who are just slightly delayed are given time to catch up

Any child who fails the CHAT for a second time should be referred to a specialist clinic for diagnosis since the CHAT is not a diagnostic tool

M-CHAT Follow-up Interview (addresses only the failed items) Failure of two critical items (items 2, 7, 9, 13, 14, 15) or any three total warrants referral to a specialist

Follow-Up

Pyschometrics Reliability

Validity

Usability

Advantages of CHAT There is no single known medical cause of social-communication

disorders, therefore it is very unlikely that there will be a medical test available in the near future

Regardless of the cause of these problems, the behavioral characteristics have been identified and this is what the CHAT is based on

In addition, CHAT is cheap (usually free), quick and easy to administer

More Advantages Given the pressures of the typical pediatrician’s office, such an

instrument must be objective, easy to administer, and brief

Physicians cannot always reliably identify a developmental delay based on a child’s behavior in one session in the doctor’s office

Particularly for very young children, a potentially serious communication and social delay may be confused with shyness in a typically developing youngster and behavior in the doctor’s office

Therefore, being able to administer the test in multiple settings increases the reliability of the test

Weaknesses The presentation of autism changes depending on the child’s age Must be sensitive to developmental concerns Potentially serious communication and social delay may be

confused with shyness in a typically developing child Behavior in the doctor’s office may not represent the child’s typical

behavior. This makes parent report essential to any screening instrument

Must distinguish between developmental delays and legitimate displays of autistic symptoms

Therefore, screening positive on the test does not diagnose autism;

it simply indicates an increased risk Yes/No answer format

Weaknesses The M-CHAT’s primary goal is to detect as many cases of Autism as

possible. Therefore, there is a high false positive rate, meaning that many children who score at risk for Autism will not be diagnosed with it

To address this, the authors developed a structured M-CHAT Follow-up Interview (addresses only the failed items)

References Iannelli, V., (2011). Autism Checklists for Toddlers. Retrieved from

http://pediatrics.about.com/od/autism/a/autism-checklists.htm

Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders. Journal Of Autism & Developmental Disorders, 31(2), 131.

The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children. (2001). Pediatrics, 107(5), 1221.

Questions?