Checklist for Autism in Toddlers (CHAT)
intervention designed to teach autistic children social communication
skills using hands-on, interpersonal, multi-sensory approaches
can be effective in helping autistic children gain interpersonal
skills. Research has also shown that the most effective interventions
are ones which are begun as early as 24 months of age. Dr. Simon
Baron-Cohen and his colleagues in England have developed a screening
instrument, the Checklist for Autism in Toddlers (CHAT), which
has been tested on several thousand children. Ninety-five percent
of the children who failed were later found to have either autism
or severe language problems. The CHAT is designed to be used by
a pediatrician or pediatric nurse practitioner at the time of
a child's 18-month well-baby checkup. It consists of nine questions
about the child's social behaviors which the parent addresses,
and five observations of the child's social behavior during the
session. The screening takes approximately eight minutes to administer.
Currently, pediatric residents at the University of Louisville
are being trained to use the CHAT. Eventually, such a screening
instrument should be part of every well-baby 18-month checkup.
- Peter Tanguay, M.D.
for autism in toddlers (CHAT) is a short questionnaire which is
filled out by the parents and a primary health care worker at
the 18-month developmental check-up. It aims to identify children
from 18-36 months of age who are at risk for social communication
is social communication?
Social communication disorders are conditions in which the child
has problems interacting with other people. There may be a problem
with making friends, relating to other people and generally understanding
the patterns of everyday interactions. Often the child is also
delayed in his/her language development. The most severe of these
social communication conditions is autism. Children with autism
are not only delayed in their language development and find it
difficult to interact in the social world, but also have restricted
patterns of behaviors and interests. Less severe social communication
conditions include Asperger's Syndrome, atypical autism and Pervasive
Developmental Disorder and language delays.
common are social communications disorders?
Approximately one child in every 500 will have some form of social
causes social communication disorders?
There is considerable evidence that a genetic link exists. This
means that if you have one child who has a social communication
disorder, the chances are increased that your other children will
also have one of the conditions. However, other factors may also
play a role.
is the CHAT administered?
The CHAT consists of two sections (see below). The first nine
items are questions asked of the parents, and the last four items
are observations made by the nurse practitioner or the physician.
The key items look at behaviors which, if absent at 18 months,
put a child at risk for social communication disorder. These behaviors
are (a) point attention, including pointing to show and
gaze monitoring (e.g., looking to where the parenting is pointing)
and (b) pretend play (e.g., pretending to serve milk or
supplies are needed for the CHAT?
Toy cup and doll or stuffed animal to pretend to feed.
is CHAT scored?
The CHAT is very easy to score. There are five key items. A5 (pretend
play), A7 (protodeclarative pointing), Bii
(following the point), Biii
(pretending) and Biv
(producing a point.) If a child fails all five key items, he or
she is at risk for a severe social communication disorder. Children
who fail items A7 and Biv
are at risk for a moderate social communication disorder.
happens if a child fails the CHAT?
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 and also to focus efforts on children
who are failing consistently. Any child who fails the CHAT for
a second time should be referred to a specialist clinic for diagnosis
since the CHAT is not a diagnostic tool.
happens if a child passes the CHAT?
If a child passes the CHAT during the first administration, it
should be repeated at 24, 30 and 36 months. Early intervention
is critical in the formative months. Passing at 18 months does
not guarantee that a child will not go on to develop a social
communication problem of some form. Most such problems are apparent
by age three years and many appear earlier.
are the advantages of CHAT?
there is no single known medical cause of social communication
disorders, it is very unlikely that there will be a medical test
available in the near future. Whatever the cause of these problems,
the behavioral characteristics have been identified and this is
what the CHAT is based on. In addition, the CHAT is cheap, quick
and easy to administer. Currently, autism is rarely detected before
the age of three, and for the other social communications disorders,
age of detection can be even later. The CHAT, however, can be
administered at 18, 24, 30 and 36 months of age. The earlier a
diagnosis can be made, the earlier intervention methods can be
implemented and family stress reduced.