File name: M-Chat Questionnaire Pdf
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M-CHAT-R™ (Modified Checklist for Autism in Toddlers Revised) Child’s name: Date: Age: Relationship to child. M-CHAT-R (Modified Checklist for Autism in Toddlers Revised) Please answer these questions about your child. Keep in mind how your child usually behaves. If you have seen your child do . MODIFIED CHECKLIST FOR AUTISM IN TODDLERS (M-CHAT-R/F) Patient Name: Date of Birth: Doctor Name: Today’s Date: Please answer these questions about your child. Keep in . Modified Checklist for Autism in Toddlers (M-CHAT) Please fill out the following about how your child usually is. 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. 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No 2. Modified Checklist for Autism in Toddlers (M-CHAT-R) Please fill out the following about how your child usually is. Please try to answer every question. If the behaviour is rare (e.g., you've seen it once or twice), please answer no. Yes No 1. If you point at something across the room, does your child look at it? 2. Please answer these questions about your child. Keep in mind how your child usually behaves. If you have seen your child do the behavior a few times, but he or she does not usually do it, then please answer no.