How to Recognize Early Signs of Autism in Toddlers Using MCHAT

There’s a lot of confusion about toddlers and their development. Many parents worry about their toddlers in terms of their language development, their imitation, and their tantrums. They are concerned that their child might have autism. But they’re hoping for the best and, in many ways, putting their head in the sand while hoping that everything will just work itself out. Professionals may even be confused if a child with delays also has autism. 

Today I want to talk about the M-CHAT, the Modified Checklist for Autism in Toddlers. So if you are thinking “What are the early signs of autism?” this can help see if a child is exhibiting them and needs further assessments.  Learn about the red flags you should pay attention to, get out of denial and jump into action. 

Early signs of autism and the M-CHAT screening

Table of Contents

How did I get involved with autism?

I fell into the autism world in 1999 when my first-born son Lucas was diagnosed with autism one day before his third birthday. But I actually fell into the autism world a year and a half earlier when my husband, who’s a physician, first mentioned the possibility that Lucas might have autism. 

I was really freaked out. I had just had my second son Spencer, and I was stressed. I had no idea that my husband was thinking anything about Lucas’ delays. Lucas had some skills, then he lost some skills. 

I didn’t want to hear the word autism, and I pretty much told him that. I just hoped that things would work themselves out.

But they didn’t…

After Lucas was diagnosed with moderate-to-severe autism right before he turned three, I started looking at the early signs of autism. I was really angry at my pediatrician for not knowing about the signs and therefore not being able to alert me that something was wrong, and at the speech therapist, who was falsely reassuring me. I was angry at myself for not looking into this sooner. 

As a mom having my first son, I didn’t really know anything about early childhood development. I didn’t know that that was my role, to worry about a child’s development.

The reality about autism in numbers

The rate of autism used to be, when Lucas got diagnosed two decades ago, 1 in 500. Now, it is thought to be 1 in 59, or even as high as 1 in 44, as some studies show. So, the rate of autism is higher, and the waiting lists for evaluations and therapy are longer. 

More people are not only in denial, but they’re having to wait and worry while they are waiting. They’re trying not to panic, but at the same time, their children are not getting the kind of therapy they need to make real gains. 

What is an MCHAT screening?

The M-CHAT, which stands for the Modified Checklist of Autism in Toddlers, is valid for kids ages 16 to 30 months of age. It is a screener  you can print out off the internet at mchatscreen.com. It is simply a list of 20 questions to help determine if your child is showing early signs of autism. I recommend that everyone with a child of this age, whether they have language delays or not, take this screener! It will help identify if a child needs furthur assessment. 

Currently, the creators of this helpful tool recommend you use the new and revised version – the M-CHAT-R/F. They improved the first document in two directions: 
 
  • Reduce the false positive rate
  • Detect more ASD cases than the original M-CHAT, especially when used during regular pediatric visits
 

MCHAT Screening and Pediatricians

Some pediatricians do the M-CHAT, but testing for autism isn’t a mandatory practice. The pediatrician that cared for my sons incorporated the M-CHAT after Lucas got his diagnosis. And, after I went on a mission to educate physicians in my local and state area.

So, hopefully, the doctors will do the M-CHAT at the 18-month well-visit, as well as at the 24-month well-visit. They have the parents fill out this screening tool in the waiting room. Once scored, the pediatrician can see if the child should be referred onto a psychologist or developmental pediatrician for furthur assessment. If your doctor does not offer this screener, ask for it!

Once early signs are identified and the process of assessment is started, there will likely still be a wait. Reading books, like my newest book Turn Autism Around, can help you with strategies to help while you wait. 

What is an MCHAT screening?

Some of the things on the MCHAT screening are simply yes and no questions. It says in the directions that if your child rarely does things to mark it as a no. 

The kids should be, for example, pointing a lot both to request items, and to show you interesting things.  I know I recently did a video blog on the importance of pointing so you might want to check that out. 

There are a few of these 20 questions that deal with pointing, like: 

  • Does your child point with his index finger to show you things? 
  • Does your child bring you things to show you? 
  • If you point across the room to a stuffed animal or the TV, or Grandma, say, “Look, Johnny!” does the child’s attention go in that general direction? 
  • One of the questions is, does your child pretend or make-believe? As pretend play is usually very delayed in kids with autism.

As you can see, early signs of autism is so much more than just a speech or language delay. I go over the remaining ten signs I often see in this 
podcast
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What questions are included in the MCHAT?

The MCHAT screening also asks about other early signs of autism-like moving their fingers in front of their face near the eyes. It also includes questions like: 

  • If you smile at your child, does he smile back? Does he have eye contact with you? 
  • If you just turn your head and look at something, will the child then follow your look to see what you’re looking at? 
  • Does your child understand when you tell him or her to do something, like ‘go and get your shoes?’

The MCHAT for autism covers walking, too. Studies show that kids with autism can often have physical delays like walking late
 
  • Do they enjoy movement activities? 
  • Are they hypersensitive to noises?

In the M-CHAT-R/F screening

The new version of the MCHAT screening tool, the M-CHAT-R/F, includes a follow-up interview. The goal is to reduce the false positive rate (the number of children who score MCHAT as being at risk but are never diagnosed with ASD). 

Even with the additional interview part, parents and practitioners should know there is still a high rate of kids who will score at risk but would not be diagnosed with autism spectrum disorder. However, it is better to identify kids who may be at risk earlier to get them help than to wait and see. 

So, if any child scores at risk, consulting a professional and looking for evaluation is the way to go. 

Pay attention to the early signs of autism

I remember when Spencer was a baby, he was probably six months old and Lucas had just turned two. We brought in a photographer to our house to try to take pictures. And the photographer gave Lucas a little film canister, an empty one, and said, “Can you throw this in the trash, buddy?” 

And Lucas just threw it on the floor and went about his business. I thought, “He doesn’t understand that.” but a child at the age of two should understand simple directions like throw this in the trash or go get your shoes.

What are global developmental delays?

Global developmental delay (GDD) is a term, used when children who don’t reach their developmental milestones in numerous areas within the expected timeframe. It’s a broad name, which refers to any delay in a child’s development between birth and the age of 18 years. 

GDD means more than simply falling behind in a developmental area. These delays must have lasted at least six months and are typically accompanied by a lack of communication skills. GDD impacts 1-3% of the population of children under 5 years old.

Among the most common signs for GDD are:

  • Delays in gross motor skills milestones (for sitting up, crawling, walking, etc.)
  • Limited reasoning or development of conceptual abilities
  • Poor social skills and judgment
  • Aggressive behavior as a coping technique
  • Communication issues


Early intervention proved to enhance the outcomes in treatable causes of GDD. Most importantly, each kid should be treated as an unique case, regardless of the cause, and their personal needs should always be taken into account while attempting to maintain a normal existence. 

Children with GDD can also have autism and may score as at risk on the MCHAT. This should be taken seriously and referred for more assessments even if they already have a GDD diagnosis. 

Other tools for detecting signs of early autism and diagnosisng autism

There are a few other tools that are used to detect the signs of early autism and used to diagnose autism but these must be completed by a professional:

The Autism Diagnostic Observation Schedule (ADOS)

The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured clinical interview used to evaluate children, adolescents, and adults for autism. The ADOS is just one part of a full comprehensive evaluation. 

It includes assesment of:

  • Social interaction
  • Communication
  • Play
  • Imaginative use of materials for individuals suspected of having ASD


The observational schedule includes four 30-minute modules and is usually administered by a psychologist, developmental pediatrician or neurologist. 

The Autism Diagnostic Interview-Revised (ADI-R)

The Autism Diagnostic Interview-Revised (ADI-R) is a structured parent interview used to evaluate children over 18 months, adolescents, and adults for autism. This tool focuses on evaluation in three main areas: 

  1. Reciprocal social interaction
  2. Communication and language
  3. Restricted and repetitive, stereotyped interests and behaviors.

The Childhood Autism Rating Scale (CARS)

The Childhood Autism Rating Scale (CARS) is a standardized measure of autism severity. 

The childhood autism rating scale (CARS; Schopler et al. 1980, 1988) is a behavioral rating scale used for assessing the presence and severity of symptoms of autism spectrum disorders.

National Library of Medicine

Other strategies for how to recognize autism in toddlers

I also wrote a short ebook several months ago, called Is it Autism, ADHD, or Typical Toddler Tantrums: Three Things You Can Do Today Instead of Worrying

It’s a free tool I’ve created for parents and professionals to recognize and address the early signs of autism in kids. My goal is to help you stop worrying or denying the indications, but take action and make a difference in your kid’s life.

If you are:

  • Concerned about your child
  • If their daycare teacher points out something might not be quite right 
  • They’re falling behind their peers
  • Display no interest in playing with other kids
  • They don’t fit in
  • They’re aggressive towards themselves or others

Don’t be in denial. The sooner you take action, the better chances you have to overcome bigger struggles before they even appear. Knowing how to help a child with developmental delay makes all the difference.

Step one: Testing for developmental milestone delays

The first of those three things is to know the milestones for ages 4 months up to the age of 5. There are a lot of things you should pay attention to.  
It’s important to know when your child is supposed to: 
  • Sit up
  • Crawl
  • Walk
  • Put two words together
  • Point to things
  • Pretend play
  • Imitate you without you telling them to
  • Start to answer WH questions
  • Start to sing songs


This is all in regular developmental milestones.

Knowing these will help you notice every cue and, if needed, act immediately.

Step two: How to help a child with developmental delays

Step number 2 in my free ebook is: if you do see any delays, get help. 

Make a sick appointment with your pediatrician because there’s often no well-visit between the ages of two and three. A lot of people are worrying and waiting for that next well-visit which could be a couple of months away. 

Don’t wait, act now. Make an appointment and speak to your child’s pediatrician. The sooner you apply for an evaluation, the quicker you’ll get it.

Also, speak to your daycare providers to see what they think about your child’s delays. They’ll be able to provide you with valuable insights.

Start making a difference for your child or client with autism or signs of autism through free training!
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Step three: Learn about Applied Behavior Analysis (ABA)

Step number 3 is to learn about ABA. Applied Behavior Analysis (ABA) is the most proven treatment for autism but it’s also great for kids with: 

  • Speech delays
  • ADHD
  • Even typical toddler tantrums. 

You can find out more about ABA by attending a free online workshop at 
marybarbera.com/toddlerworkshop.

These are the three pieces of advice I would give to anyone concerned about their child’s early development. The earlier you act, the better chance your child has to reach their fullest potential. 

Final words

I hope you enjoyed this short video blog about recognizing early signs of autism through the MCHAT. I am posting videos on YouTube regularly, so you might want to subscribe for more.

Leave me a comment, give me a thumbs-up, share this video with others who might benefit, and I’ll see you right here next week.

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