How to Recognize Early Signs of Autism in Toddlers Using MCHAT

There’s a lot of confusion with toddlers. Many parents are worried about their toddler in terms of their language development, their imitation, their tantrums, and they are concerned that their child might have autism. But they’re hoping for the best and, in a lot of ways, putting their head in the sand and hoping that everything just works itself out. Today I want to talk about the M-CHAT, the Modified Checklist for Autism in Toddlers. This is a free tool that you can use to see what the early signs of autism and red flags are so you can get out of denial and into action.

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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.

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 the signs and not telling me, 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 development and I didn’t know that that was my role, to worry about a child’s development.

The rate of autism used to be, when Lucas was diagnosed two decades ago, 1 in 500. It is now thought to be 1 in 59 or even as low as 1 in 29 some studies are showing. So the rate of autism is higher and the waiting lists for evaluations are longer. More people are not only in denial, but they’re having to wait and worry while they wait. 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. In rare cases, one of the parents has autism too.

An autism screening questionnaire that may be able to help

The M-CHAT, which stands for the Modified Checklist of Autism in Toddlers, is valid for kids ages 16 months to 30 months of age and it is something you can print out off the internet at It is simply a list of 20 questions to help determine if your child is showing early signs of autism. Some pediatricians do the M-CHAT. The pediatrician that cared for my sons incorporated the M-CHAT after Lucas’ diagnosis and after I went on a mission to educate physicians in my local and state area.

So they will do the M-CHAT at the 18-month well-visit as well as the 24-month well-visit. They have parents fill out this screening tool in the waiting room and they can see if anything looks suspicious. If there are red flags for autism they can then get them to an evaluation, hopefully as soon as possible.

What early signs of autism does the M-CHAT ask about?

Some of the things on the M-CHAT are simply yes and no, and it says in the directions that if your child rarely does things to mark it as a no. They should be, for example, pointing a lot. I know I recently did a video blog on the importance of pointing so you may want to check that out. There are a few of these 20 questions that deal with pointing. 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 to the TV or to 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? Which, pretend play is usually very delayed in kids with autism.

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It also asks about unusual early signs of autism like moving their fingers in front of their face near the eyes. It also talks about 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 get your shoes?

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.

It also talks about walking, which studies are now showing that kids with autism can often have physical delays like walking late. Do they enjoy movement activities? Are they hypersensitive to noises? So I do think that if parents download this M-CHAT at it’ll give you more information if your child is showing early signs of autism.

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. Those three things are to know the milestones for ages 4 months up to the age of 5, 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, and start to sing songs. This is all in regular developmental milestones.

Step number 2 in my free ebook is if you do see delays get help. Make a sick appointment with your pediatrician because there’s often no well-visit between the ages of two and three and a lot of people are worrying and waiting for that next well-visit which could be a couple of months away. Make an appointment and speak to your child’s pediatrician. Also, speak to your daycare providers to see what they think about your child’s delays.

Step number 3 is to learn about ABA. Applied Behavior Analysis is the most proven treatment for autism but it’s also great for kids with speech delays, ADHD, or even typical toddler tantrums. You can find out more about ABA by attending a free online workshop at

I hope you enjoyed this short video blog about recognizing early signs of autism through the MCHAT. 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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