How to Fill Out the M-CHAT-R/F: Scoring and Follow-Up Interview

To fill out the M-CHAT-R/F, download the free one-page form from mchatscreen.com (or ask your pediatrician’s office for a copy), write your child’s name, date of birth, and today’s date at the top, and answer all 20 yes-or-no questions based on how your toddler usually behaves.¹ Hand it to your child’s doctor for scoring. The whole thing takes about five minutes.

Before You Start

The form is designed for toddlers between 16 and 30 months old.² Most children are screened twice during routine well-child checkups, once at 18 months and again at 24 months.³

The M-CHAT-R/F is free for clinical, research, and educational use. No licensing fee, no registration. You can print it from mchatscreen.com or complete the paper copy your pediatrician’s office hands out at check-in.¹ The form has been officially translated into more than 35 languages, including Arabic, Chinese (Mandarin and Cantonese), French, Hindi, Korean, Japanese, and Spanish. The full list with downloadable PDFs lives on the translations page at mchatscreen.com.⁴

Fill it out somewhere quiet if you can. The results depend on how carefully you think about your child’s typical behavior, and a loud waiting room is not the best place for that.

Answering the 20 Questions

At the top of the form, write your child’s name, date of birth, and today’s date. The provider uses those to confirm your child falls in the 16-to-30-month window.

Then work through the 20 questions. Each is a yes-or-no about something your child does in daily life. Answer based on the pattern you see week to week, not a single good day or bad day. If you’re torn between yes and no, go with what happens most of the time.

The questions focus on social engagement, communication, and how your child responds to people and surroundings. A sample of what you’ll be asked:

If you point at something across the room, does your child look at it?
Does your child play pretend or make-believe?
Does your child respond when you call his or her name?
Does your child look you in the eye when you are talking, playing, or dressing him or her?
When you smile at your child, does he or she smile back?
Does your child point with one finger to show you something interesting?
Does your child bring things to you or hold them up for you to see, not to get help but just to share?

Answer every question. Leaving blanks throws off the scoring. If a question confuses you, flag it for the pediatrician rather than guessing, because the follow-up stage is built to re-examine any item where your initial answer may not reflect what your child actually does.

How Your Answers Get Scored

Your pediatrician or a staff member scores the form, but it helps to know what they’re doing with your answers. Each question is worth either zero points (low likelihood of autism) or one point (elevated likelihood). For most questions, “yes” scores zero and “no” scores one. Three questions, items 2, 5, and 12, are reverse-scored, so “yes” is the elevated-likelihood answer. Those three ask about behaviors that would be concerning if present, such as unusual finger movements near the eyes or wondering whether the child might be deaf.⁵

The total falls into one of three tiers:⁵

Score 0 to 2: low likelihood. No follow-up needed. If your child is younger than 24 months, the provider will rescreen at the next well-child visit.
Score 3 to 7: moderate likelihood. The provider moves to the follow-up interview, re-examining only the items your child failed.
Score 8 to 20: high likelihood. The provider skips the follow-up interview and refers your child directly for a diagnostic evaluation and early intervention services.

A score of 3 does not mean your child has autism. It means the screening picked up enough signals that a closer look is worthwhile. That closer look is the follow-up interview.

The Follow-Up Interview

The follow-up interview is the second stage of the M-CHAT-R/F, and it exists to filter out false positives. A parent might answer “no” because the question was confusing, or because the child does the behavior but the parent read the question differently. The interview digs into each failed item with a structured set of branching questions.

Only items your child failed on the initial screen get revisited; you will not redo all 20. The interviewer, usually the pediatrician or a nurse, asks for specific examples of how your child handles the behavior at home. If you say “maybe,” they ask whether the answer is more often yes or no, and proceed from there. Each item ends up scored pass or fail based on your more detailed answers.⁵

If your child fails two or more items on the follow-up, the overall screen is positive and the provider will recommend a formal diagnostic evaluation and early intervention referral. If zero or one items remain failed, the screen is negative, and the provider will keep monitoring at future visits.

The two-stage design matters. In the original validation study, children who screened positive after both stages had a 47.5% chance of receiving an autism diagnosis and a 94.6% chance of having some developmental delay or concern worth attention.⁶ Even when the screen catches something other than autism, it is almost always catching something worth knowing about.

What Happens After a Positive Screen

A positive screen is a signal to get a comprehensive developmental evaluation from a specialist, not a diagnosis in itself. Developmental-behavioral pediatricians, child neuropsychologists, and child psychologists all conduct these evaluations. Your pediatrician’s referral depends on what’s available locally and the specific concerns on the form.

You do not have to wait for that specialist appointment to start services. Under Part C of the Individuals with Disabilities Education Act, children under age 3 who have or are at risk of developmental delays can receive early intervention through their state’s program, and a formal autism diagnosis is not required to qualify.⁷ A positive M-CHAT-R/F screen combined with a documented developmental concern is enough to request an eligibility evaluation. Ask your pediatrician for a referral to your state’s Part C program, or search for your state’s coordinator through the ECTA Center directory at ectacenter.org. The diagnostic evaluation and the early intervention process can run at the same time.

If Your Child Scores Low but Something Still Feels Off

A passing score is not a guarantee of typical development. The validation study behind the M-CHAT-R/F states that if a physician has concerns about a child, the physician should follow clinical judgment regardless of the screening result.⁶ The same goes for you. If your child lost a skill they previously had, avoids eye contact more than other toddlers, or seems unusually unresponsive, raise it with the pediatrician even if the score came back low. No screening tool catches every case, and the results are only as accurate as the observations going in.

What the Screening Costs

Most health plans compliant with the Affordable Care Act cover preventive screening at no cost when provided by an in-network provider, with no copayment or coinsurance, even before you have met your deductible.⁸ Developmental screening with a standardized tool like the M-CHAT-R/F is billed under CPT code 96110. When the visit is billed correctly as a preventive well-child check with a developmental screening component, you should owe nothing for the screening itself. Coverage varies by plan, so confirm with your insurer if cost is a concern.

1
M-CHAT™. M-CHAT – Autism Screening
2
TRICARE. M-CHAT-R/F Autism Screening Form
3
Centers for Disease Control and Prevention. CDCs Developmental Milestones – Learn the Signs Act Early
4
M-CHAT™. M-CHAT-R/F Translations
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M-CHAT™. Scoring M-CHAT-R/F
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PMC (PubMed Central). Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
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Centers for Disease Control and Prevention. Accessing Services for Autism Spectrum Disorder
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HealthCare.gov. Preventive Health Services