M-CHAT-R scoring and likelihood levels
The M-CHAT-R is a 20-item parent-report autism screen for toddlers aged 16 to 30 months. Items use yes or no answers, with items 2, 5 and 12 reverse-scored, and the total runs from 0 to 20.
Totals fall into low, moderate and high likelihood bands. A practice must read the owner's permissions and ask the authors about its planned use before building the M-CHAT-R in Intake Pro.
Last updated
- Items 20 yes or no
- Score range 0 to 20
- Age range 16 to 30 months
- Bands Low/moderate/high likelihood
- Reversed items 2, 5 and 12
- Licence Read owner permissions
What is the M-CHAT-R and who developed it?
The Modified Checklist for Autism in Toddlers, Revised is a parent-report screen for children aged 16 to 30 months. Its authors are Diana L. Robins, Deborah Fein and Marianne Barton.
The M-CHAT-R has 20 yes or no items. The owner's instructions say it can be scored in less than two minutes and must be used in its entirety.
The second stage is the Follow-Up interview, called M-CHAT-R/F. The owner's scoring instructions explain which likelihood bands use that interview and when a screen is positive.
What do the 20 M-CHAT-R items cover?
The M-CHAT-R uses 20 parent-report items about a toddler. Its complete structure includes yes or no answers, one point for the scored answer and three reversed items.
- A parent answers 20 items about the toddler.
- Every item uses a yes or no response format.
- For most items, no is the answer that scores one point.
- Items 2, 5 and 12 are reversed, so yes scores the point on those three items.
- The owner requires the M-CHAT-R to be used in its entirety rather than as selected questions.
How is the M-CHAT-R scored?
M-CHAT-R scoring adds one point for the scored answer on each of 20 items, giving a total from 0 to 20. Reverse items 2, 5 and 12 before calculating the three likelihood bands and applying the owner's Follow-Up rules.
| Total | Likelihood band | Owner's screening rule |
|---|---|---|
| 0 to 2 | Low likelihood | No further action; rescreen at 24 months if the child is under 2 |
| 3 to 7 | Moderate likelihood | Give the Follow-Up interview on scored items; 2 or more still elevated afterward is a positive screen |
| 8 to 20 | High likelihood | Refer for evaluation without the Follow-Up |
A score is a screening result and not a diagnosis. The practice's clinical lead decides which cut point the practice uses and what staff do with a result.
Who owns the M-CHAT-R and what does its licence say?
The M-CHAT-R is copyright 2009 Robins, Fein and Barton. Its owner distinguishes a medical practice's own-office electronic health record use from distribution in software or posting on a website.
The owner's permissions page says a medical practice may put the M-CHAT-R into its own practice's electronic health record free of charge for use in its own office, provided it does not alter the name, instructions, items, item order or copyright notice.
A licence agreement is required to distribute it in software or to post it on a website. Read the owner's permissions page and ask the authors whether the planned Intake Pro use needs a licence before building or publishing the form.
How do you build the M-CHAT-R in Intake Pro?
Build the M-CHAT-R after confirming permission with the authors. Preserve the complete instrument, configure three reversed items and test scoring and Follow-Up handling.
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Get wording and ask about permission
Obtain the complete current M-CHAT-R from the owner. Read its permissions page and ask the authors whether the planned online use requires a licence agreement.
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Create the parent-response matrix
Add all 20 items in the form builder with the owner's order and yes or no choices. Require every item and retain the copyright notice.
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Set weights and reversed items
In scored assessments, make no the scored answer on most items and reverse items 2, 5 and 12 so yes scores their point.
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Configure totals and bands
Set the 0 to 20 total and three likelihood bands. Build the M-CHAT-R/F second stage from the owner's instructions.
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Complete clinical and arithmetic review
Have the clinical lead approve result handling. Test known answers by hand, especially the three reversed items and boundaries at 3 and 8.
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Publish the reviewed form
Publish only after wording, required items, total arithmetic, bands and review assignments pass staff testing. Later edits create a new version.
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Send to the parent
Place the parent form in an intake packet, send a private link by text or email, or provide it at the paired front-desk kiosk.
When does a practice send the M-CHAT-R and who reviews it?
The clinical lead sets the practice's M-CHAT-R schedule and assigns review of the total and any Follow-Up interview. Front-desk staff send the parent form according to that workflow.
The CDC's screening page says the American Academy of Pediatrics recommends autism-specific screening at 18 and 24 months. The low-likelihood rule includes rescreening at 24 months when the child is under 2.
Intake Pro retains the total with the signed response. It does not alert staff, interpret a score or provide clinical decision support. Assigned staff retrieve signed records and follow the clinical lead's result and Follow-Up procedure.
The Vanderbilt Assessment Scales guide covers an older age group. See pediatric intake forms for surrounding documents, patient form templates for permissions and intake forms for packet design.
Questions
Who completes the M-CHAT-R parent screen?
A parent completes the 20 yes or no items about a toddler aged 16 to 30 months. The owner says scoring can take less than two minutes and requires the screen to be used in its entirety.
Which M-CHAT-R items are reverse-scored?
Items 2, 5 and 12 are reverse-scored. Yes scores the point on those items, while no scores the point on most other items. Staff should test all three reversed items with known answers before publication.
When does the M-CHAT-R use its Follow-Up interview?
For a total of 3 to 7, the owner calls for the Follow-Up interview on scored items. A result of 2 or more still elevated afterward is a positive screen. Totals of 8 to 20 refer for evaluation without Follow-Up.
Can a practice post the M-CHAT-R online without asking the authors?
The practice should read the owner's permissions and ask the authors about its planned use. A licence agreement is required to distribute the M-CHAT-R in software or post it on a website, separate from the stated own-office EHR permission.