Diana L Robins Ph D Deborah Fein Ph D Marianne Barton

Diana L Robins Ph D Deborah Fein Ph D Marianne Barton-Free PDF

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Permissions for Use of the M CHAT R FTM, The Modified Checklist for Autism in Toddlers Revised with Follow Up M CHAT R F Robins Fein. Barton 2009 is a 2 stage parent report screening tool to assess risk for Autism Spectrum Disorder. ASD The M CHAT R F is available for free download for clinical research and educational purposes. Download of the M CHAT R F and related material is authorized from www mchatscreen com. The M CHAT R F is a copyrighted instrument and use of the M CHAT R F must follow these guidelines. 1 Reprints reproductions of the M CHAT R must include the copyright at the bottom 2009. Robins Fein Barton No modifications can be made to items instructions or item order without. permission from the authors, 2 The M CHAT R must be used in its entirety Evidence indicates that any subsets of items do not. demonstrate adequate psychometric properties, 3 Parties interested in reproducing the M CHAT R F in print e g a book or journal article or. electronically for use by others e g as part of digital medical record or other software packages. must contact Diana Robins to request permission mchatscreen2009 gmail com. 4 If you are part of a medical practice and you want to incorporate the first stage M CHAT R. questions into your own practice s electronic medical record EMR you are welcome to do so. However if you ever want to distribute your EMR page outside of your practice please contact. Diana Robins to request a licensing agreement,Instructions for Use. The M CHAT R can be administered and scored as part of a well child care visit and also can be used. by specialists or other professionals to assess risk for ASD The primary goal of the M CHAT R is to. maximize sensitivity meaning to detect as many cases of ASD as possible Therefore there is a high. false positive rate meaning that not all children who score at risk will be diagnosed with ASD To. address this we have developed the Follow Up questions M CHAT R F Users should be aware that. even with the Follow Up a significant number of the children who screen positive on the M CHAT R will. not be diagnosed with ASD however these children are at high risk for other developmental disorders or. delays and therefore evaluation is warranted for any child who screens positive The M CHAT R can. be scored in less than two minutes Scoring instructions can be downloaded from. http www mchatscreen com Associated documents will be available for download as well. Scoring Algorithm, For all items except 2 5 and 12 the response NO indicates ASD risk for items 2 5 and 12 YES.
indicates ASD risk The following algorithm maximizes psychometric properties of the M CHAT R. LOW RISK Total Score is 0 2 if child is younger than 24 months screen again after second. birthday No further action required unless surveillance indicates risk for ASD. MEDIUM RISK Total Score is 3 7 Administer the Follow Up second stage of M CHAT R F to get. additional information about at risk responses If M CHAT R F score remains at 2 or. higher the child has screened positive Action required refer child for diagnostic. evaluation and eligibility evaluation for early intervention If score on Follow Up is 0 1. child has screened negative No further action required unless surveillance indicates risk. for ASD Child should be rescreened at future well child visits. HIGH RISK Total Score is 8 20 It is acceptable to bypass the Follow Up and refer immediately for. diagnostic evaluation and eligibility evaluation for early intervention. 2009 Diana Robins Deborah Fein Marianne Barton,M CHAT RTM. Please answer these questions about your child Keep in mind how your child usually behaves If you have seen. your child do the behavior a few times but he or she does not usually do it then please answer no Please circle. yes or no for every question Thank you very much, 1 If you point at something across the room does your child look at it Yes No. FOR EXAMPLE if you point at a toy or an animal does your child look at the toy or animal. 2 Have you ever wondered if your child might be deaf Yes No. 3 Does your child play pretend or make believe FOR EXAMPLE pretend to drink Yes No. from an empty cup pretend to talk on a phone or pretend to feed a doll or stuffed animal. 4 Does your child like climbing on things FOR EXAMPLE furniture playground Yes No. equipment or stairs, 5 Does your child make unusual finger movements near his or her eyes Yes No. FOR EXAMPLE does your child wiggle his or her fingers close to his or her eyes. 6 Does your child point with one finger to ask for something or to get help Yes No. FOR EXAMPLE pointing to a snack or toy that is out of reach. 7 Does your child point with one finger to show you something interesting Yes No. FOR EXAMPLE pointing to an airplane in the sky or a big truck in the road. 8 Is your child interested in other children FOR EXAMPLE does your child watch Yes No. other children smile at them or go to them, 9 Does your child show you things by bringing them to you or holding them up for you to Yes No. see not to get help but just to share FOR EXAMPLE showing you a flower a stuffed. animal or a toy truck, 10 Does your child respond when you call his or her name FOR EXAMPLE does he or she Yes No.
look up talk or babble or stop what he or she is doing when you call his or her name. 11 When you smile at your child does he or she smile back at you Yes No. 12 Does your child get upset by everyday noises FOR EXAMPLE does your Yes No. child scream or cry to noise such as a vacuum cleaner or loud music. 13 Does your child walk Yes No, 14 Does your child look you in the eye when you are talking to him or her playing with him Yes No. or her or dressing him or her, 15 Does your child try to copy what you do FOR EXAMPLE wave bye bye clap or Yes No. make a funny noise when you do, 16 If you turn your head to look at something does your child look around to see what you Yes No. are looking at, 17 Does your child try to get you to watch him or her FOR EXAMPLE does your child Yes No. look at you for praise or say look or watch me, 18 Does your child understand when you tell him or her to do something Yes No.
FOR EXAMPLE if you don t point can your child understand put the book. on the chair or bring me the blanket, 19 If something new happens does your child look at your face to see how you feel about it Yes No. FOR EXAMPLE if he or she hears a strange or funny noise or sees a new toy will. he or she look at your face, 20 Does your child like movement activities Yes No. FOR EXAMPLE being swung or bounced on your knee,2009 Diana Robins Deborah Fein Marianne Barton. M CHAT R Follow Up M CHAT R F TM,Permissions for Use. The Modified Checklist for Autism in Toddlers Revised with Follow Up M CHAT R F Robins Fein. Barton 2009 is designed to accompany the M CHAT R The M CHAT R F may be downloaded from. www mchatscreen com, The M CHAT R F is a copyrighted instrument and use of this instrument is limited by the authors and.
copyright holders The M CHAT R and M CHAT R F may be used for clinical research and educational. purposes Although we are making the tool available free of charge for these uses this is copyrighted. material and it is not open source Anyone interested in using the M CHAT R F in any commercial or. electronic products must contact Diana L Robins at mchatscreen2009 gmail com to request. permission,Instructions for Use, The M CHAT R F is designed to be used with the M CHAT R the M CHAT R is valid for screening. toddlers between 16 and 30 months of age to assess risk for autism spectrum disorder ASD Users. should be aware that even with the Follow Up a significant number of the children who fail the M CHAT. R will not be diagnosed with ASD however these children are at risk for other developmental disorders. or delays and therefore follow up is warranted for any child who screens positive. Once a parent has completed the M CHAT R score the instrument according to the instructions If the. child screens positive select the Follow Up items based on which items the child failed on the M CHAT. R only those items that were originally failed need to be administered for a complete interview. Each page of the interview corresponds to one item from the M CHAT R Follow the flowchart format. asking questions until a PASS or FAIL is scored Please note that parents may report maybe in. response to questions during the interview When a parent reports maybe ask whether most often the. answer is yes or no and continue the interview according to that response In places where there is. room to report an other response the interviewer must use his her judgment to determine whether it is. a passing response or not, Score the responses to each item on the M CHAT R F Scoring Sheet which contains the same items as. the M CHAT R but Yes No has been replaced by Pass Fail The interview is considered to be a screen. positive if the child fails any two items on the Follow Up If a child screens positive on the M CHAT R F. it is strongly recommended that the child is referred for early intervention and diagnostic testing as soon. as possible Please note that if the healthcare provider or parent has concerns about ASDs children. should be referred for evaluation regardless of the score on the M CHAT R or M CHAT R F. 2009 Diana Robins Deborah Fein Marianne Barton,M CHAT R Follow UpTM Scoring Sheet. Please note Yes No has been replaced with Pass Fail. 1 If you point at something across the room does your child look at it Pass Fail. FOR EXAMPLE if you point at a toy or an animal does your child look at the toy or animal. 2 Have you ever wondered if your child might be deaf Pass Fail. 3 Does your child play pretend or make believe Pass Fail. FOR EXAMPLE pretend to drink from an empty cup pretend to talk on a phone. or pretend to feed a doll or stuffed animal, 4 Does your child like climbing on things Pass Fail. FOR EXAMPLE furniture playground equipment or stairs. 5 Does your child make unusual finger movements near his or her eyes Pass Fail. FOR EXAMPLE does your child wiggle his or her fingers close to his or her eyes. 6 Does your child point with one finger to ask for something or to get help Pass Fail. FOR EXAMPLE pointing to a snack or toy that is out of reach. 7 Does your child point with one finger to show you something interesting Pass Fail. FOR EXAMPLE pointing to an airplane in the sky or a big truck in the road. 8 Is your child interested in other children Pass Fail. FOR EXAMPLE does your child watch other children smile at them or go to them. 9 Does your child show you things by bringing them to you or holding them up Pass Fail. for you to see not to get help but just to share, FOR EXAMPLE showing you a flower a stuffed animal or a toy truck.
10 Does your child respond when you call his or her name Pass Fail. FOR EXAMPLE does he or she look up talk or babble or stop what he or she is doing. when you call his or her name, 11 When you smile at your child does he or she smile back at you Pass Fail. 12 Does your child get upset by everyday noises Pass Fail. FOR EXAMPLE a vacuum cleaner or loud music,13 Does your child walk Pass Fail. 14 Does your child look you in the eye when you are talking to him or her playing with him Pass Fail. or her or dressing him or her, 15 Does your child try to copy what you do Pass Fail. FOR EXAMPLE wave bye bye clap or make a funny noise when you do. 16 If you turn your head to look at something does your child look around to see what Pass Fail. you are looking at, 17 Does your child try to get you to watch him or her Pass Fail. FOR EXAMPLE does your child look at you for praise or say look or watch me. 18 Does your child understand when you tell him or her to do something Pass Fail. FOR EXAMPLE if you don t point can your child understand put the book on the chair. or bring me the blanket, 19 If something new happens does your child look at your face to see how you feel about it Pass Fail.
FOR EXAMPLE if he or she hears a strange or funny noise or sees a new toy will he or. she look at your face, 20 Does your child like movement activities Pass Fail. FOR EXAMPLE being swung or bounced on your knee,Total Score. 2009 Diana Robins Deborah Fein Marianne Barton, 1 If you point at something across the room does look at it. Please give me an example of how he she If you point at something what does. will respond if you point at something If your child typically do. parent does not give a PASS example below,ask each individually. Does he she,PASS examples Does he she,FAIL examples.
Look at object Yes No,Point to object Yes No Ignores you Yes No. Look and comment on object Yes No Look around room randomly Yes No. Look if you point and say Look at your finger Yes No. look Yes No,Yes only to Yes only to,PASS Yes to both PASS FAIL. example s and FAIL examples example s,PASS Which one does FAIL. he she do most,Most often is Most often is,PASS example FAIL example. 2009 Diana Robins Deborah Fein Marianne Barton, 2 You reported that you have wondered if you child is deaf What led you to wonder that.
Does he she,often ignore sounds Yes No,often ignore people Yes No. No to both Yes to either,ALSO ASK FOR Has your child s hearing been tested. ALL CHILDREN, What were the results of the hearing test choose one. Hearing in normal range,Hearing below normal,Results inconclusive or not definitive. 3 Parties interested in reproducing the M CHAT R F in print e g a book or journal article or electronically for use by others e g as part of digital medical record or other software packages must contact Diana Robins to request permission mchatscreen2009 gmail com 4 If you are part of a medical practice and you want to incorporate the first stage M CHAT R questions into your

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