The following questionnaire is most appropriate for toddlers between the ages of 1 and 4 years. It is adapted from the M-Chat (Modified Checklist for Autism in Toddlers) parent questionnaire. Each question has a weighted answer that will be scored automatically for you. Some answers may have a negative weight and reduce the score obtained. If you decide to take this questionnaire, answer the questions honestly. The test is only designed to alert you as parents to potential signs of autism and the need for further evaluation. No one wants to describe their child’s negative behaviors or poor play/social skills; but to admit the truth puts your child on a path to becoming the best they can be. Please answer the following questions about how your child usually acts or behaves. Please try to answer every question. If the behavior is rare (e.g., you’ve seen it once or twice), please answer as if the child does not do it.

Does your child enjoy begin swung, bounced on your knee, etc.?
Does your child take an interest in other children?
Does your child like climbing on furniture, objects or stairs?
Does your child enjoy playing peek-a-boo/hide-and seek?
Does you child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things?
Does your child ever use his/her index finger to point to or ask for something?
Can your child play properly with toys (e.g. cars or blocks) without just mouthing, fiddling or dropping them?
Does your child ever bring objects over to you (parent) to show you something?
Does your child look you in the eye for more that a second or two?
Does your child seem oversensitive to noises (crying or covering ears)?
Does your child smile in response to your face or smile
Does your child imitate you? (e.g., you make a face – will your child imitate such?)
Does your child respond to his/her name when called?
If you point at a toy across the room, does you child look at it?
Does your child walk?
Does your child look at things you are looking at?
Does your child make unusual finger movements near their face?
Does your child try to attract your attention to his/her own activity?
Have you ever wondered if your child could not hear (deaf)?
Does your child understand what people say?
Does your child often stare at nothing or wander with no purpose?
Does you child look at your face to check your reaction when faced with something unfamiliar?
Total Score:

Check your scores against the following results key. If your score is:
Below 10 - There is need for further evaluation
Between 11 - 19 - There are potential warning signs of an Autism Sprectrum Disorder
Above 19 -  Autism Spectrum Disorder should be considered.  Furhter evaluation may be warranted.

Find additional information on Autism Spectrum Disorders.