Checklist for Autism in Toddlers (CHAT)

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CHAT (Checklist for Autism in Toddlers)

CHAT is a simple screening tool provided to children after they have reached their eighteenth month of age, and it gives parents and specialists an indication of the likelihood that the child is exhibiting early signs of autism. The tool is a checklist of questions that a parent and primary health care worker are supposed to fill out, and pinpoints where a child is on a developmental scale. The test focuses on fourteen items that cover symptoms most commonly reported by the parents of children with autism.

Parents are asked to complete the first of the two sections, which includes nine items, and the specialist is supposed to complete the last five questions. The test is very simple for a parent to complete, and usually consists of “yes” and “no” answers. The test looks for behaviors that, if absent by the child’s 18^th month, should raise some concerns for the parent and specialist. These behaviors include joint attention (pointing to show something and child’s gazing ability) and pretend play (Example: pretending to cook breakfast or pretending to fly a plane).

The test gives simple scores, which match up with cutoff points that indicate whether or not there should be a concern. After a child fails the test once, they receive a re-screening one month later. After a child has failed twice, they should be referred to a clinic for an assessment for diagnosis. Below is an updated version of CHAT that is commonly used.

Section A - Ask Parent:

Yes or No?

____ 1) Does your child enjoy being swung, bounced on your knee, etc?

____ 2) Does your child take an interest in other children?

____ 3) Does your child like climbing on things, such as up stairs?

____ 4) Does your child enjoy playing peek-a-boo/hide-and-seek?

____ *5) Does your child ever pretend, for example, to make a cup of tea using a toy cup and teapot, or pretend other things?

____ 6) Does your child ever use his/her index finger to point, to ask for something?

____ *7) Does your child ever use his/her index finger to point, to indicate interest in something?

____ 8) Can your child play properly with small toys (e.g. cars or bricks) without just mouthing, fiddling, or dropping them?

____ 9) Does your child ever bring objects over to you, to show you something?

Section B - GP's observation

Yes or No?

____ i) During the appointment, has the child made eye contact with you?

____ *ii) Get child's attention, then point across the room at an interesting object and say "Oh look! There's a (name a toy)!" Watch child's face. Does the child look across to see what you are pointing at?

NOTE - To record yes on this item, ensure the child has not simply looked at your hand, but has actually looked at the object you are pointing at.

____ *iii) Get the child’s attention, then give child a miniature toy cup and teapot and say “Can you make a cup of tea?” Does the child pretend to pour out the tea, drink it, etc.?

NOTE - If you can elicit an example of pretending in some other game, score a yes on this item.

____ *iv) Say to the child “Where's the light?” or “Show me the light.” Does the child point with his/her index finger at the light?

NOTE - Repeat this with “Where's the teddy?” or some other unreachable object, if child does not understand the word “light.” To record yes on this item, the child must have looked up at your face around the time of pointing.

____ v) Can the child build a tower of bricks? (If so, how many?) (Number of bricks...)

* Indicates critical question most indicative of autistic characteristics

Sources:

[Reynolds, Tammi. Formal Screening Tools. <http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8782&cn=20>]

Checklist for Autism in Toddlers [http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=128&a=2226]

[British Journal of Psychiatry (1996), 168, pp. 158-163]
[British Journal of Psychiatry (1992), 161, pp. 839-843]

[Checklist for Autism in Toddlers (CHAT)]