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Screening Toddlers 18 to 36 Months

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The American Academy of Pediatrics recommeds that every child receive an "MCHAT" evaluation (Modified Checklist of Autism in Toddlers) between 18 and 24 months. Ivy Chong, Ph.D., discusses diagnosing autism in toddlers.

The first three years of life are crucial to a child’s development. Children make several visits to their pediatrician during this period for well-baby/child check-ups, vaccinations and general developmental screenings.

The American Academy of Pediatrics now recommends that the 18 and 24 month well check-ups also include developmental screening for autism spectrum disorders, or ASD’s, for all children using the Modified Checklist for Autism in Toddlers, or MCHAT. 

The MCHAT 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 who are risk for social-communication disorders.

The questions address areas of your child’s development and behavior, including social and emotional development, language and communication skills, as well as thinking and learning ability. I will address the MCHAT in more detail in just a moment.

However, since parents are usually the first to notice that something is wrong, you should keep a close eye on your toddler’s developmental milestones at all times.  Although autism is challenging to diagnose before 24 months, symptoms often surface between 12 and 18 months. 

If signs are detected by 18 months of age, intensive treatment, such as Applied Behavior Analysis, or ABA therapy, may help reverse the symptoms.

At 18 months, your child should walking and pointing to things to show others. At this age your child should also recognize familiar items such as a brush or a spoon. Children at this age often copy others and should have at least 6 words. An 18 month old child should also notice when a caregiver leaves and returns.

If you notice that any of these behaviors are absent in your child, immediately contact your pediatrician.

By 24 months your child should be using two word phrases, such as “drink milk.” Children at 24 months should know what to do with common objects such as a phone, a brush, fork or spoon. Your toddler should be also walking steadily and following simple instructions at 24 months.

If your child is lacking any of these skills or behaviors, it warrants a visit to the pediatrician, even if the child successfully completed the MCHAT screen at 18 months.   Immediately take your child to your pediatrician should there be any sudden loss of language ability.

By 36 months or three years, warning signs for autism include falling down or trouble walking, drooling or unclear speech, and not speaking in complete sentences. By 36 months, your toddlers should be able to work simple toys such as peg boards and cranks, and simple puzzles.

Social interaction red flags for autism at this age include a persistent lack of eye contact, a lack of interest in pretend play or lack of playing with other children. Again, any sudden loss of language or skills previously developed warrants an immediate trip to your child’s doctor. 

As I mentioned, the recommended method for autism screening in toddlers is the Modified Checklist for Autism in Toddlers, or MCHAT. The MCHAT is a scientifically validated tool for screening children between 16 and 30 months of age that assesses risk for autism spectrum disorder.

Any child who fails the MCHAT should be re-screened approximately one month later. As with any screening instrument, a second MCHAT 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.

Early diagnosis and intervention are critical for children with autism. The earlier a diagnosis can be made, the earlier intervention methods, such as Applied Behavior Analysis, or ABA therapy, can be implemented. Be sure your toddler receives the MCHAT screening at 18 months and if you suspect autism in your toddler or identify any of the warning signs, don’t wait! Have your toddler diagnosed as soon possible during this critical developmental period. 

You should use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism or its associated medical conditions. The information in this Autism Advisor tool kit is solely for educational purposes, not medical advice.