M-CHAT-R Autism Screening for 20-Month-Olds
At 20 months, children are typically mid-way through an important social-communication growth period. The M-CHAT-R screens for whether key behaviours — symbolic play, joint attention, and social responsiveness — are developing as expected.
- Questions
- 20
- Format
- Yes / No
- Time
- ~5 minutes
- Completed by
- Parent or caregiver
- Age range
- 16–30 months
About the M-CHAT-R
By 20 months, children typically have a vocabulary of around 50 words and are beginning to engage in symbolic play — using objects to represent other things (e.g. a banana as a phone). Following two-step instructions and showing clear interest in interactive play with familiar adults are expected at this age.
Several M-CHAT-R items directly target these milestones: pretend play, pointing, and social responsiveness. A parent who has daily observations of their child's behaviour is in the best position to complete this checklist accurately.
Source: Modified Checklist for Autism in Toddlers, Revised — Robins, Fein & Barton (2009)
Frequently asked questions
- What is symbolic play, and when should my child show it?
- Symbolic play involves using one object to represent another — for example, using a banana as a phone or feeding a toy with an empty spoon. It typically emerges between 18 and 24 months. Some M-CHAT-R items assess whether a child engages in this kind of pretend or make-believe play, which is an early form of symbolic thinking.
- My child had repeated ear infections — could this affect M-CHAT-R results?
- Temporary hearing loss from ear infections can affect name response and language during that period. If your child has recently recovered, a screen at 20 months reflects their current behaviour more accurately than one taken during an active infection. Note any ear infection history when discussing results with your paediatrician.
- What happens if my child screens at risk?
- A positive screen means enough reported behaviours are present to warrant further evaluation. The recommended next step is a referral to a developmental paediatrician, paediatric psychologist, or specialist autism diagnostic service. Early referral leads to earlier access to support.
- Does a positive screen mean my child has autism?
- No. A positive screen is not a diagnosis. Many children who screen positive do not receive an autism diagnosis after full evaluation. Only a qualified clinician carrying out a comprehensive assessment can diagnose autism spectrum disorder.
- How long does the screening take?
- Most parents complete the M-CHAT-R in 3 to 5 minutes. Results and guidance are available immediately after the last question.
Free · Private · Results in under 15 minutes