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Peter E. Tanguay, M.D., F.A.C.P. - PETER E. TANGUAY, M.D., F.A.C.P. has shared the following information related to autism as part of his interview with StorkNet members. Please click here to read his interview.

The Checklist for Autism in Toddlers (CHAT)

Early 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.

What is CHAT?
The checklist 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 disorders.

What 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.

How common are social communications disorders?
Approximately one child in every 500 will have some form of social communication problem.

What 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.

How 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 juice.)

What supplies are needed for the CHAT?
Toy cup and doll or stuffed animal to pretend to feed.

How 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.

What 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.

What 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.

What are the advantages of CHAT?
Because 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.

CHAT Questionnaire

For routine communication screening at well baby exams from 18-36 months

Child's Name: ________________________________    Date of Birth:______________________

Age: ________ Child's phone number: ______________ Parent's name: ____________________

Child's address:__________________________________________________________________

Physician:__________________________  Section B completed by:_______________________

Section A: Ask Parent

Does your child enjoy being swung, bounced on your knee? Yes ___ No ___
Does your child take an interest in other children? Yes ___ No ___
Does your child like climbing on things, such as up stairs? Yes ___ No ___
Does your child enjoy playing peek-a-boo/hide-and-seek? Yes ___ No ___
Does your child ever PRETEND, for example, to make or serve milk and cookies with a toy cup and plate or pretend other things? Yes ___ No ___
Does your child ever use his/her index finger to point, to ASK for something? Yes ___ No ___
Does your child ever use his/her index finger to point, to indicate INTEREST in something? Yes ___ No ___
Can your child play properly with small toys, (e.g., cars or blocks) without mouthing, fiddling or dropping them? Yes ___ No ___
Does your child ever bring objects over to you to SHOW you something? Yes ___ No ___
Section B: Nurse Practitioner or Physician Observation  
During the appointment, has the child made eye contact with you? Yes ___ No ___
Get the child's attention, then point across the room at an interesting object and say,"Oh look! There's a (name of toy)!" Watch child's face. Does the child look across to see what you are pointing at?* Yes ___ No ___
Get the child's attention; then give the child a miniature toy cup. Say, "The doll (or stuffed animal) is thirsty. Can you give the doll (animal) some milk or juice?" If no response ask, "Would you like some milk?" Does the child pretend to drink the milk or juice?** Yes ___ No ___
Without pointing, look at the child and then at the light or an object which is out of reach and say, "Where's the light?" or "Show me the light." *** Yes ___ No ___
To record "Yes" on this item, ensure the child as not simply looked at your hand, but has actually looked at the object you are pointing at.
If you can elicit an example of pretending in some other game, score a "Yes" on this item.
*** Repeat this with, "Where's the teddy bear?" or some other unreachable object if the child does not understand the word "light." To record "Yes" on this item, the child must have looked up at your face around the time of pointing.

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