The M-CHAT-R/F is a 20-question yes-or-no checklist that a parent fills in to screen their toddler for autism, from 16 to 30 months. The total counts the at-risk answers, from 0 to 20, and a medium score is checked with a short Follow-Up interview. See what each risk level means and when to refer, then record the result with the free template. The official form is free from the authors’ site.
M-CHAT-R/F result template
FreeM-CHAT-R/F RESULT Date: [Date] Child: [Name or ID, date of birth] Age in months: [Age on the day of screening; valid from 16 to 30 months] Visit: [18-month visit, 24-month visit, rescreen, or a concern raised by the family or clinician] Screened by: [Name, credentials] SCREEN Completed by: [Parent or caregiver and relationship; on paper, on a tablet, online, or read aloud] Language: [Language of the form; official translation or interpreter used] Total: [0 to 20, the number of at-risk answers] Risk level: [Low 0 to 2, medium 3 to 7, or high 8 to 20] At-risk questions: [Question numbers answered at risk] FOLLOW-UP INTERVIEW Done: [Yes, with whom, in person or by phone, and the date; or not needed because the total was low or high] Follow-Up score: [Number of questions still at risk after the interview; 2 or more is positive] In the parent's words: [Short examples of what the child does at home] RESULT Screen: [Negative or positive] Other concerns: [Family worries, lost words or skills, red flags seen today, hearing history; or none] Decision: [Routine rescreen, closer watch at each visit, or refer] REFERRALS Diagnostic evaluation: [Service and date sent, or not needed] Early intervention: [Program and date sent, or not needed] Audiology: [Hearing test and date booked, or not needed] Speech-language: [Speech-language pathology and date sent, or not needed] Results shared with: [Who receives the screening results, with the family's agreement] EXPLAINED TO THE FAMILY What the result means: [A screen, not a diagnosis; what happens next] Their questions: [What the family asked, and the answers given] Written information: [Handout or link, and its language; or none] NEXT STEPS Rescreen: [Date or visit, such as the 24-month visit; or not needed] Referral check: [Who confirms the referrals arrived, and by when] Return sooner if: [Lost words or skills, new worries from the family] Signed: [Name, credentials, date]
Use it for
A parent or caregiver answers 20 yes-or-no questions about how their child usually behaves, on the official form, in a few minutes before or during the visit.
Avoid: Rewording or shortening the questions, or making your own version. The authors don’t allow changes, and the cutoffs hold only for the form as published.
Count the at-risk answers for a total from 0 to 20. The total sets the risk level and the next step.
Avoid: Counting every “no” as at risk. For three of the questions, “yes” is the at-risk answer.
For a total of 3 to 7, a clinician or trained staff member asks the official Follow-Up questions about each at-risk answer, at the visit or by phone soon after.
Avoid: Referring every medium score without the Follow-Up, or calling it negative without one. The Follow-Up sorts out the children who need an evaluation from those who don’t.
A positive screen means two referrals on the same day: a diagnostic evaluation and early intervention.
Avoid: “Watch and wait” after a positive screen. The authors advise referring right away, and evaluation waits are often long.
A low total, or a Follow-Up score of 0 or 1, is a negative screen today. It isn’t a guarantee.
Avoid: Letting one negative screen close the question. Some signs of autism appear later, which is why the screen is repeated.
Each one follows the recording template. Use them to judge how much to write.
Family medicine clinic, 24-month well visit, with her father and a phone interpreter
24-month-old girl, born at term. Completed by her father on paper in the waiting room, using the official Arabic translation. Total 5, medium risk.
Done at the same visit with her father, through the interpreter. Of the 5 at-risk answers, 2 passed once he gave examples and 3 still failed. Follow-Up score 3: positive screen. In his words: “She pulls me to the fridge when she wants milk, but she never points at things to show me. She lines up her blocks and screams if her brother moves one.”
Positive screen. About 10 single words, no word combinations yet. No loss of words or skills. In clinic: fleeting eye contact, didn’t look where I pointed, turned to her name on the second call. Passed the newborn hearing screen; no hearing test since. Decision: refer.
Sent today, with her father’s agreement to share the results: developmental pediatrics for an autism diagnostic evaluation; early intervention for an assessment now, not after the evaluation; audiology for a full hearing test; speech-language pathology through early intervention.
Through the interpreter: the screen picks out children who need a full evaluation; it doesn’t diagnose autism. Support can start now, whatever the evaluation finds. He asked how long the evaluation takes: the local wait is about 4 months, so early intervention should start first. Arabic handout on early intervention given.
No rescreen; the evaluation answers the question. Care coordinator to confirm with early intervention by November 23 that the referral arrived. Follow-up visit once the hearing test is done, by mid-December. Come back sooner if she loses any words or skills.
Pediatric clinic, 18-month well visit, form completed online the day before
18-month-old boy. Completed in English by his mother through the patient portal the evening before the visit. Total 1, low risk.
Not needed for a total of 0 to 2.
Negative screen, and surveillance agrees. About 15 words. Points to show his mother the neighbor’s dog, brings books to be read, pretends to feed his stuffed bear, and waves bye-bye. In clinic: turned to his name straight away and followed my point to the fish tank. No loss of skills. No concerns from his mother or his daycare. His sister, now 5, had speech therapy for late talking and is on track. Decision: routine rescreen.
The screen is negative today. It’s repeated at 24 months because some early signs of autism show up later. His mother asked whether his sister’s late talking matters: worth keeping an eye on, and his language is on track for now.
Rescreen with the M-CHAT-R/F at the 24-month visit, booked for May 11. Come back sooner if he stops using words he had, stops turning to his name, or his mother is worried.
A total of 3 to 7 needs the Follow-Up before you decide. Many children with a medium total pass it and don’t need an evaluation; the ones who fail it do.
Evaluation waits can run for months. Send the early intervention referral the same day as the diagnostic one: children can get support for a delay without a diagnosis.
The cutoffs were set for toddlers from 16 to 30 months. For an older child, use a tool validated for their age, or refer when you’re concerned.
Homemade versions, shortened subsets, and the original 23-question M-CHAT score differently. Use the current official form and its official translations.
A positive screen means a closer look. About half of children who screen positive after the Follow-Up are diagnosed with autism, and most of the rest have another delay that needs support.
Vero Scribe records the M-CHAT-R/F result in your template from the visit, with the family’s consent, or from your dictation: the total, the Follow-Up score, the referrals, and what you explained. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Count the at-risk answers for a total from 0 to 20. For most of the 20 questions, “no” is the at-risk answer; for three of them, questions 2, 5, and 12, “yes” is. The authors’ free scoring overlay and spreadsheet do the count. A total of 0 to 2 is low likelihood, 3 to 7 is moderate likelihood, and 8 to 20 is high likelihood, the levels older materials call low, medium, and high risk.
Medium risk. Do the Follow-Up interview on the questions answered at risk. If 2 or more still fail, the screen is positive: refer for a diagnostic evaluation and to early intervention. If 0 or 1 fail, the screen is negative; keep watching at each visit, and screen again at 24 months if the child is under 2.
No. It means the child needs a diagnostic evaluation. In the 2014 study of more than 16,000 toddlers, 47.5% of children who screened positive after the Follow-Up were diagnosed with autism, and 94.6% had autism or another developmental delay or concern. That’s why every positive screen is referred, and why early intervention can start before any diagnosis.
It’s valid from 16 to 30 months. Many guidelines screen every child at the 18- and 24-month well visits; others screen when developmental surveillance or the family raises a concern. A child with a low score before age 2 is screened again at 24 months.
The original M-CHAT from 1999 had 23 questions and different scoring rules. The M-CHAT-R/F, revised in 2009, has 20 simpler questions, three risk levels, and the Follow-Up interview, which cuts the number of children referred who don’t need it. Use the revised version.
A parent or caregiver fills in the checklist; no training is needed for that. A clinician or trained staff member scores it and does the Follow-Up interview. Pediatricians, family doctors, nurse practitioners, and early intervention and therapy services all use it.
Yes, to download and use with your patients. The form, the Follow-Up, translations, and scoring aids are free from the authors’ site once you agree to their terms: keep the copyright notice, and don’t change the title, questions, or instructions. Posting it online or building it into software for others needs a license. The recording template on this page is free to copy or download.
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The whole screen: milestones by domain, ASQ-3 and M-CHAT-R/F scores, hearing, and the plan.
The full preventive visit, with development as one section.
Well visits, screening results, and family instructions, recorded for your review.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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