Screening Tools

Screening Tools for Autism

General developmental screens do not target key autism indicators and consequently may miss a subset of children who could benefit from early autism diagnosis and intervention. Thus, the American Academy of Pediatrics recommends autism-specific screening of all children at 18 and 24 months of age (and any time children present with delayed language/communication, regression in social /language skills, or when parents voice concerns regarding autism).

Autism screening instruments focus on the three criteria domains of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – communication impairment (verbal and non-verbal), social impairment (e.g., poor reciprocity and engagement), and behavioral atypicalities (e.g., stereotypic movements and restricted interests). 

The Modified Checklist for Autism in Toddlers (M-CHAT) (Robins, Fein, & Barton) is appropriate for children 16-30 months and is simple to use and available for download at no charge in numerous language translations.  The M-CHAT consists of 23 yes/no items completed with the caregiver, of which 9 critical items have the highest degree of autism discrimination.  Failure on ≥2 of these critical items or ≥3 total items indicates that a more extensive developmental evaluation should be completed by a specialist in autism diagnosis. An M-CHAT follow-up interview designed to reduce false positive rates, scoring templates, and electronic scoring are also free and publicly accessible through the primary author’s website or CDC Act Early.

The M-CHAT is not validated for babies and toddlers younger than 16 months.  However, red flags in even very young children may indicate the need for careful monitoring/referral. These include no response to name by 12 months, no babbling by 12 months, no gesturing (e.g., pointing or waving) by 12 months, no single words by 16 months, and no meaningful 2-word phrases by 24 months. The Infant-Toddler Checklist portion of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) (Wetherby & Prizant) is a norm-referenced communication screener for 6-24 month-olds that includes these key indicators and is widely utilized as both a developmental and autism screening instrument. It consists of 24 questions completed by the parent and scored by the provider and may be downloaded with scoring instructions free of charge from Brookes Publishing.

The two screening instruments described above are widely utilized because they are empirically supported, simple to administer and score, and available free of charge. In addition, there are a number of early screening instruments and rating scales that are available for purchase, including the Pervasive Developmental Disorders Screening Test -II (Siegel), the Childhood Autism Rating Scale-2 (Schopler, Van Bourgondien, Wellman & Love) and the Screening Tool for Autism in Toddlers and Young Children (Humberd, Stone, & Warren).  A number of screening tools for children ≥ 4-5 years and specifically for Asperger’s Disorder are also available for purchase , including the Social Communication Questionnaire (Rutter, Bailey, & Lord), Childhood Autism Rating Scale-2-HF (Schopler, Van Bourgondien, Wellman & Love), Autism Spectrum Screening Questionnaire(Ehlers, Gillberg, & Wing), Gilliam Autism Rating Scale-2 (Gilliam), Gilliam Asperger Disorder Scale (Gilliam), Asperger Syndrome Diagnostic Scale (Myles, Bock, & Simpson), Krug Asperger Disorder Index  (Krug & Arick) and Australian Scale for Asperger Syndrome (Garnett & Attwood).

Both the M-CHAT and the CSBS DP are easily accessible through the First Signs Autism Website.