What does a positive M-CHAT-R/F result mean?

It means a follow-up interview or an evaluation may be recommended under the authors' instructions. It does not confirm autism. The follow-up interview is part of the scoring steps when they call for it.

Can my child still be autistic if the M-CHAT-R/F was negative?

Yes. A negative result does not rule out every possibility. If your concerns continue, discuss them with a professional.

Where do I get the M-CHAT-R/F in French for Quebec?

Check the official translations page, which lists a French-Canadian version, and read the current terms of use. Do not assume that every form of redistribution is allowed.

M-CHAT-R/F explained: what the toddler autism screen means

You may have heard of "the M-CHAT" from a daycare educator, a health professional or an online search. This guide explains what the questionnaire is, what its results mean and how to discuss them with your doctor or CLSC.

What the M-CHAT-R/F is

The M-CHAT-R/F stands for Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. It is a two-stage screening tool created by Diana Robins, Deborah Fein and Marianne Barton and published in 2009. ¹

Stage one is 20 questions about everyday behaviours, which the parent answers yes or no.
Stage two is a follow-up interview a professional uses to clarify some answers before deciding on a referral.

The validation study cited here involved more than 16,000 children seen at 18 and 24 months. ⁴ Allow about five minutes to answer and under two minutes to score; these times are approximate.

The questionnaire is copyrighted. Download the official version and read the current terms of use, especially before any copying, adapting or embedding in a website. A French-Canadian version is among the translations offered. ^{1, 3} This guide does not reproduce any of the questionnaire's items.

What the score means

Here are the ranges and instructions the authors publish. Always follow the current official version. ²

Total score	Range	Next step the authors indicate
0–2	Low likelihood	No follow-up interview under the scoring steps; screen again after the second birthday if the child is under 24 months. Ongoing concerns are still worth discussing.
3–7	Moderate likelihood	Follow-up interview; if two or more items are still flagged, referral for a diagnostic evaluation and early intervention.
8–20	High likelihood	Referral for a diagnostic evaluation and early intervention without waiting for the follow-up interview.

Three items are scored in reverse. Use the official instructions; do not score it from memory or from only some of the questions. This table is not a clinical calculator.

A positive result is not a diagnosis

The tool aims to flag as many children as possible who may need an evaluation. As a result, it also gives positive results for children who will not be diagnosed autistic. ⁴

In the validation study, just under half of the children whose result stayed positive after the follow-up interview received that diagnosis; many of the others had other developmental difficulties. ⁴ That is a reason for an appropriate evaluation. The presence of difficulties does not, on its own, show that a particular intervention will help.

A negative result does not rule autism out

Some children are not identified at a first evaluation. The diagnostic-stability study cited here is separate from the M-CHAT-R/F validation and does not directly measure all of its false negatives. ⁵ Keep discussing ongoing concerns with a professional. See What to say to your doctor.

Discussing it in Quebec

Ask whether the questionnaire suits your child. If it does, follow the official instructions and describe how your child usually behaves.
Bring the form and the results to the appointment. Ask how they are interpreted and what follow-up is needed.
Ask for a developmental assessment, and ask that your concerns be noted in your child's file.
Contact your CLSC about Agir tôt, which is for children under 7, requires no diagnosis, and is free and voluntary. ⁶
If you do not know which CLSC to contact, 811 (option 1 for Info-Santé, option 2 for Info-Social) is free, available 24 hours a day, and can direct you. ⁷
Discuss whether a hearing evaluation is relevant. Do not draw your own conclusions about the cause of the behaviours you see.

In Quebec, physicians and psychologists can conclude an autism diagnosis, according to the organizations cited. Autisme Montréal reports a public evaluation wait of about 6 to 24 months on the island of Montreal, and private evaluations at about $1,600–$4,200. These estimates change and are not guarantees; confirm them before acting. ^{8, 9} See Public or private assessment in Quebec.

What the screen cannot do

It does not replace an assessment, it cannot be used to give a diagnosis, it does not on its own describe ADHD or a language disorder, and it should not be reduced to a few items. See the overlap page.

This week

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Look at the official version and ask whether it suits your child.
If your concerns continue, book an appointment, whatever the result.
Ask your CLSC about Agir tôt and how your request will be followed up.