CHAT Checklist

The Checklist for Autism in Toddlers (CHAT) is a short questionnaire that is filled out at the 18 month developmental check-up. It aims to identify children who are at risk for social/communication disorders.

The CHAT consists of two sections: the first nine items are questions asked to the parents and the last five items are observations made by the primary health care worker. The key items look at behaviours which, if absent at 18 months, put a child at risk for a social-communication disorder. These behaviours are (a) joint attention, including pointing to show and gaze-monitoring (eg looking to where a parent is pointing), and (b) pretend play (eg pretending to pour tea from a toy teapot).

The CHAT is very easy to score. There are five key items:

• A5 (pretend play)
• A7 (protodeclarative pointing)
• Bii (following a point)
• Biii (pretending)
• Biv (producing a point).

If a child fails all five key items, they have a high risk of an autism diagnoses. Children who fail items A7 and Biv have a medium risk of an autism diagnoses.

Any child who fails the CHAT should be re-screened approximately one month later. As with any screening instrument, a second CHAT is advisable so that those children who are just slightly delayed, are given time to catch up. Any child who fails the CHAT for a second time, should be referred for further assessmenth since the CHAT is not a diagnostic tool.

If a child passes the CHAT during the first administration, no further action needs to be taken. Passing the CHAT, however, does not guarantee that a child will not go on to develop a social/communication problem of some form and if parents are worried they should seek referral.

Click here for the CHAT Screening Tool.