What is the difference between the Modified Checklist for Autism in Toddlers (MCHAT) and the Modified Checklist for Autism in Toddlers - Revised (MCHAT-R)?

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Last updated: May 23, 2025 • View editorial policy

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From the Guidelines

The M-CHAT-R is the preferred screening tool for autism spectrum disorder in young children due to its improved sensitivity, specificity, and simplified scoring system compared to the original M-CHAT. The M-CHAT (Modified Checklist for Autism in Toddlers) and M-CHAT-R (Revised) are both screening tools for autism spectrum disorder in young children, but they differ in several important ways.

  • The M-CHAT-R features a reduction from 23 to 20 questions and revised scoring criteria to improve accuracy, as seen in studies evaluating the effectiveness of the M-CHAT in low-risk samples 1.
  • The M-CHAT-R has better sensitivity and specificity, meaning it more accurately identifies children who may have autism while reducing false positives.
  • The revised version also includes a follow-up interview (M-CHAT-R/F) for children who screen positive, which helps to further clarify results and reduce unnecessary referrals.
  • The scoring system is simplified in the M-CHAT-R, with clearer risk categories: low risk, medium risk, and high risk, making it more efficient and accurate for screening toddlers between 16-30 months of age.
  • According to a study published in Pediatrics, the PPV of the M-CHAT for ASD was 0.54, and for any developmental disorder, it was 0.98, highlighting the importance of early screening and follow-up evaluations 1.
  • These improvements make the M-CHAT-R more efficient and accurate for screening toddlers, which is why it has largely replaced the original M-CHAT in clinical practice.

From the Research

Difference between MCHAT and MCHAT-R

  • The Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F) are two screening tools used for autism spectrum disorder (ASD) in toddlers 2.
  • The M-CHAT-R/F is an updated version of the original M-CHAT, with a follow-up component to improve the accuracy of screening results 3.
  • Studies have shown that the M-CHAT-R/F has high sensitivity and specificity for detecting ASD, with a pooled sensitivity of 0.83 and a pooled specificity of 0.94 2.
  • The M-CHAT-R/F has been validated as a screening tool for early detection of ASD in children, with a high positive predictive value (PPV) of 57.7% 4.
  • The main difference between the M-CHAT and M-CHAT-R/F is the addition of a follow-up component in the M-CHAT-R/F, which helps to reduce false positives and improve the accuracy of screening results 3.

Key Features of MCHAT and MCHAT-R

  • The M-CHAT is a 23-item questionnaire that assesses the presence of autistic symptoms in toddlers 2.
  • The M-CHAT-R/F is a revised version of the M-CHAT, with a follow-up component that includes additional questions to clarify the presence of autistic symptoms 3.
  • Both the M-CHAT and M-CHAT-R/F are designed to be used in clinical settings, such as pediatrician's offices or early intervention programs 2, 3.

Comparison of MCHAT and MCHAT-R

  • Studies have compared the psychometric properties of the M-CHAT and M-CHAT-R/F, with results showing that the M-CHAT-R/F has higher sensitivity and specificity than the original M-CHAT 2, 4.
  • The M-CHAT-R/F has been shown to be more effective in detecting ASD in high-risk populations, such as children with a family history of autism 4.
  • However, the M-CHAT-R/F may have lower specificity in low-risk populations, such as children without a family history of autism 4.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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