CHAT & DSMIV Appendix III and IV APPENDIX III Checklist for Autism in Toddlers A Screening Tool The following test can be used by a pediatrician or family doctor during the 18 month developmental check-up. The CHAT should not be used as a diagnostic instrument, but can alert the primary health professional to the need for an expert referral. SECTION A: Ask Parent __ 1. Does your child enjoy being swung, bounced on your knee, etc.? __ 2. Does your child take an interest in other children? __ 3. Does your child like climbing on things, such as up stairs? __ 4. Does your child enjoy playing peek-a-boo/hide-and-seek? __ *5. Does your child ever pretend, for example, to make a cup of tea using a toy cup and teapot, or pretend other things (pouring juice)? __ 6. Does your child ever use his/her index finger to point, to ask for something? __ *7. Does your child ever use his/her index finger to point, to indicate interest in something? __ 8. Can your child play properly with small toys (e.g.: car or blocks) without just mouthing, fiddling, or dropping them? __ 9. Does your child ever bring objects over to you (parent), to show you something?   SECTION B: GP or HV Observation __ i. During the appointment, has the child made eye contact with you? __ *ii. 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 the child’s face. Does the child look across to see what your are pointing at? __ *iii. Get the child’s attention, then give child a miniature toy cup and teapot and say, "Can you make a cup of tea?" (Substitute toy pitcher and glass and say, "Can you pour a glass of juice?) Does the child pretend to pour out tea (juice), drink it, etc.? __ *iv. Say to the child, "Where’s the light?," or "Show me the light." Does the child point with his/her index finger at the light? __ v. Can the child build a tower of bricks (blocks)? (If so how many?) (Number of bricks....) *Indicates critical questions that are most indicative of autistic characteristics.  The British Journal of Psychiatry (1996), 168, pp. 158-163. The British Journal of Psychiatry (1992), 161, pp. 839-843. APPENDIX IV DSM-4 Criteria for Autistic Disorder and Pervasive Developmental Disorder, Not Otherwise Specified (PDD NOS) To be diagnosed with autistic disorder at least one sign (each) from parts A, B, and C must be present plus at least six overall. Those meeting fewer criteria are diagnosable as PDD NOS. A. Qualitative impairments in reciprocal social interaction: Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction. Failure to develop peer relationships appropriate to developmental level Lack of spontaneous seeking to share enjoyment, interests, or achievements with others. Lack of socioemotional reciprocity. B. Qualitative impairments in communication: A delay in, or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime). Marked impairment in the ability to initiate or sustain a conversation with other despite adequate speech. Stereotyped and repetitive use of language or idiosyncratic language. Lack of varied spontaneous make- believe play or social imitative play appropriate to developmental level. C. Restricted, repetitive, and stereotyped patterns of behavior, interest, or activity: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest, abnormal either in intensity or focus. An apparently compulsive adherence to specific nonfunctional routines or rituals. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping, or twisting, or complex whole body movements). Persistent preoccupation with parts of objects. Abnormal or impaired development prior to age three manifested by delay or abnormal functioning in at least one of the following areas: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. Source: The Diagnostic and Statistical Manual, 4th Edition, American Psychiatric Association, 1994.

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