The assessment processes for individuals with autism spectrum disorder are categorized into three groups: screening, diagnosis, and developmental data collection. Screening involves identifying children at risk of being diagnosed with autism spectrum disorder to facilitate early diagnosis, while diagnosis is the process of determining whether children observed to have any deficits in social and communication behaviors actually have autism spectrum disorder. Developmental assessment can be defined as the collection of information from various sources and using different tools to identify children’s strengths and weaknesses in order to take necessary measures, implement an intervention program, or evaluate the effects of such a program on their development.
Based on information obtained from the parents, teachers, or caregivers of children between 16 and 30 months of age, this is a screening tool used to identify the risk of ASD in these children. The test can be administered individually or in a group. The administration of the test takes approximately 5–10 minutes. It consists of 23 items. To administer the scale effectively, one must have a thorough understanding of the symptoms of autism and be familiar with the children being assessed.
The M-CHAT was developed in the United Kingdom by Baron-Cohen, Allen, and Gillberg (1992) and consists of two sections. The first section contains 9 items asked by the evaluator to a parent or primary caregiver. Each of these items relates to a specific area of development. The five items in the second section are answered based on the evaluator’s observations during interactions with the child in a play setting. All items in both sections are answered with YES or NO. Items 5 and 7 in the first section and items 2, 3, and 4 in the second section are critical for autism. Failure on all of these items indicates that the child is at high risk for autism.
The scale’s items and their explanations are as follows:
Item 1. Does your child enjoy being rocked in your arms or bounced on your lap? This item is among those not related to autism/ASD. If the parent answers “No” to this item, the child is considered to have failed. If the parent answers “Yes,” the child is considered to have passed.
Item 2. Does your child show interest in other children? This item is among those related to autism/ASD. For this item, an explanation regarding the area being assessed should be provided to the parent. There are specific behaviors that indicate “interest in other children.” Looking in the direction of other children, wanting to be with them, sharing toys, wanting to play together, and responding to other children’s invitations to play and joining them are some of these behaviors. If the parent indicates that the child exhibits these behaviors, a “yes” response is given to this item. The child is considered to have met this criterion. If the child does not go over to other children, does not join their games, does not look in their direction, or acts as if other children do not exist, a “no” response is given to this item. The child is considered to have failed this criterion.
Item 3. Does your child enjoy climbing on objects such as stairs? This item is among those not related to autism/ASD. If the child does not exhibit these behaviors, a “no” response is given, and the child is considered unsuccessful. If the parent answers “yes,” the child is considered successful on this item.
Item 4. Does your child enjoy playing “Ce-e” or hide-and-seek? This item is among those related to autism/ASD. If parents have difficulty understanding the “Ce-e” game, you may need to demonstrate it using your hands. In some regions, the “Ce-e” game may be known by different names. For this reason, whenever this item is explained, the “Ce-e” game must be demonstrated by the evaluator. If the child can play “Ce-e” or hide-and-seek interactively, a “yes” response is given to this item, and the child is considered successful on this item. If the child shows no interest in or does not participate in these games, a “no” response is given, and the child is considered unsuccessful on this item.
Item 5. Does your child engage in symbolic play (for example, while playing with a toy car or doll, acting as if he is driving the car from one place to another or putting the doll to sleep)? This item is among those related to autism/ASD. It assesses the child’s ability to engage in “pretend play” (symbolic play). An explanation regarding the area being assessed should be provided to the parent. For girls: pretending to give the doll water to drink with a toy cup, feeding the doll with a toy spoon, or rocking the doll to sleep; for boys, making sounds like “beep-beep-beep” while driving a car, racing cars, pretending to crash two cars together, pretending to park, or pretending to drive under or over a bridge
are all signs of symbolic play skills. If the child exhibits these types of behaviors, answer “yes” to this item, and the child is considered to have met the criterion. For girls, playing with only a specific part of the doll—such as its eye, arm, or hair—or simply carrying the doll in his hand requires answering “no” to this item. Similarly, for boys, focusing on only a single part of a car—such as a wheel or a door—or simply driving the car back and forth in a repetitive manner requires a “no” answer to this item. If you observe symbolic behavior in any other type of play besides the examples given above, mark “yes” for this question. Some children may have a special interest in cars. They may also engage in repetitive behaviors, such as lining up cars side by side. These repetitive behaviors differ from pretend play. They have no specific purpose. In situations where repetitive behaviors are observed instead of pretend play, “No” should be marked.
Item 6. Does your child ever use his index finger to ASK for something? This item is among those related to autism/PDD. For a child to pass this item, he must use his index finger to point at something he wants. If he demonstrates this behavior, answer “yes,” and the child is considered to have passed. If the child does not use his index finger to point at something he wants—but instead extends his entire hand or takes a parent’s hand and guides it toward the desired object to indicate his request—answer “no” to this item, and the child is considered to have failed.