Someone, maybe a daycare educator, maybe a search result, mentioned "the M-CHAT". You want to know what it is, whether you can do it yourself, and what the number means if it comes back high. Here it is, without the jargon.
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 questionnaire filled in by parents, created by Diana Robins, Deborah Fein and Marianne Barton and published in 2009. official
- Stage one is a 20-item yes/no checklist about everyday behaviours: things like whether your child looks where you point, responds to their name, and shows you things they find interesting.
- Stage two is a short follow-up interview a clinician uses for children in the middle range, to clarify the answers before deciding on a referral.
It was validated at the 18 and 24 month well-child visits, on more than 16,000 toddlers. strong It takes about five minutes and is scored in under two.
The questionnaire itself is copyrighted, so we do not reproduce the questions here. You can download it free from the official site, including a French-Canadian version adapted by Quebec clinicians. Parents and clinicians may use it freely; only companies that build it into software, and websites that redistribute it, need a licence. official
What the score means
The authors publish a simple scoring rule. Three ranges: official
| Total score | The authors' label | What they recommend |
|---|---|---|
| 0–2 | Low likelihood | No follow-up needed. If the child is under 24 months, screen again after their second birthday. |
| 3–7 | Moderate likelihood | Do the follow-up interview. If two or more items are still flagged afterward, refer for a diagnostic evaluation and for early intervention. |
| 8–20 | High likelihood | Skip the follow-up interview and refer immediately for a diagnostic evaluation and early intervention. |
Three items are scored in reverse (a "yes" is the concerning answer). If you download the official form, the scoring sheet handles that for you; do not try to score it from memory.
A positive result is a referral, not a diagnosis
This is the sentence to hold onto. The M-CHAT-R/F is built to maximize sensitivity: to catch as many autistic children as possible. The price of that is a lot of false positives, and the authors say so plainly in the tool's own instructions. strong
In the validation study, among children who screened positive and stayed positive after the follow-up interview, just under half were diagnosed autistic. Almost all of the rest had some other developmental delay. strong So a high score tells you two useful things at once:
- Your child should be seen by someone qualified to assess development.
- Whatever the outcome, most children in this group benefit from support, and the assessment is how you reach it.
It does not tell you your child is autistic. Please do not spend the waiting period as if it did.
A negative result does not rule autism out
The tool misses some children. It is weaker for subtle presentations, for children who are sociable but struggle in other ways, and for girls, who are diagnosed later on average. The study that validated it also found that many children who were later identified had not been flagged at their first visit. strong
If your score is low but your gut is not, you have not been overruled. Parental concern is itself a recognized signal, and a "wait and see" reply is the most common reason families lose time. That is covered on What to say to your doctor.
How to bring it to your doctor in Quebec
Quebec's public route runs through the CLSC and your family doctor or pediatrician. Both are fine starting points, and you can use both at once.
- Fill it in at home first. Answer for how your child usually behaves, not their best day. Write the total on the front.
- Bring the printed form and the score to the appointment. A number on paper is harder to wave away than a worry in words.
- Ask for two things: a referral for a developmental assessment, and a note in the file that you raised the concern today.
- Call your CLSC and ask about Agir tôt. It takes children under 7 without a diagnosis, free and voluntary, and it can start while you wait for the assessment. official If you do not know your CLSC, 811 (option 1 for health, option 2 for psychosocial) is free, 24 hours a day, and will direct you. official
- Ask for a hearing test. Several items on the checklist overlap with hearing differences, and it is easy to rule out.
The Fédération québécoise de l'autisme notes that in Quebec, physicians and psychologists can conclude an autism diagnosis, often working with a multidisciplinary team. Autisme Montréal reports the public evaluation wait on the island at roughly 6 to 24 months, and private evaluations at about $1,600–$4,200, not covered by RAMQ. Those figures move; confirm on the official pages before acting. official The decision between the two routes is its own page: Public or private assessment in Quebec.
What the screen cannot do
- It cannot replace an assessment, and it cannot be used to give a diagnosis.
- It cannot tell you about ADHD, language delay or global developmental delay, which overlap heavily with autism at this age. See the overlap page.
- It cannot be scored from a subset of questions. The authors are explicit that partial versions lose their accuracy.
Used for what it is, a free five-minute checklist that turns a vague worry into a clear next step, it is one of the most useful things a worried parent can do this week.
This week
- Download the official M-CHAT-R/F (French-Canadian or English) from mchatscreen.com and fill it in tonight, answering for a typical day.
- Whatever the score, if you are still concerned, book your family doctor or call your CLSC and say "I'd like a referral documented today."
- Ask about Agir tôt on the same call. It does not require a diagnosis.
Sources
- M-CHAT-R/F official site — Robins, Fein and Barton, accessed 2026
- Scoring the M-CHAT-R/F — mchatscreen.com, accessed 2026
- M-CHAT-R/F translations, including French-Canadian — mchatscreen.com, accessed 2026
- Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) — Robins et al., Pediatrics, 2014
- Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months — Pierce et al., JAMA Pediatrics, 2019
- Agir tôt program — Gouvernement du Québec, accessed 2026
- Info-Santé 811 and Info-Social 811 — Gouvernement du Québec, accessed 2026
- Diagnostic et premières démarches — Fédération québécoise de l'autisme, accessed 2026 (French)
- How to get a diagnosis — Autisme Montréal, accessed 2026