The Q-CHAT assessment is typically used for children between the ages of 18-36 months. Outside of this range, it will not be reliable.
Yes
No
Email
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Child's Gender
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Male
Female
Date of Birth
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Today Y-M-D
Child's age in years:
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View equation Please correct date of birth if age is incorrect.
Has your child lost any skills (movement, language, etc...) that they once had?
Yes
No
Please describe the lost skills, and when this occurred.
Today, does your child have a current diagnosis of any of the following:
Other diagnosis for child (please specify):
In which language domain did your child receive a diagnosis?
Has your child's sibling been diagnosed with any of the following at any point in their childhood:
Other sibling diagnosis (please specify):
Deaf or moderately-to-severely hearing impaired
Pervasive Developmental Disorder, Not Otherwise Specified
Attention Deficit Hyperactivity Disorder (ADHD)
Is your child receiving Early Intervention or any therapy services such as speech, occupational, etc...?
Yes
No
Please describe which services your child is receiving, and when.
Does your child have any unusual behaviors?
Yes
No
Please describe the unusual behaviors.
Does your child look at you when you call his/her name?
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always usually sometimes rarely never
How easy is it for you to get eye contact with your child?
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very easy quite easy quite difficult very difficult impossible
When your child is playing alone, does s/he line objects up?
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always usually sometimes rarely never
Can other people easily understand your child's speech?
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always usually sometimes rarely never OR my child does not speak
Does your child point to indicate that s/he wants something (e.g. a toy that is out of reach)
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many times a day a few times a day a few times a week less than once a week never
Does your child point to share interest with you (e.g. pointing at an interesting sight)?
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many times a day a few times a day a few times a week less than once a week never
How long can your child's interest be maintained by a spinning object (e.g. washing machine, electric fan, toy car wheels)?
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several hours half an hour 10 min a couple of minutes less than a minute
How many words can your child say?
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none-s/he has not started speaking yet less than 10 words 10-50 words 51-100 words over 100 words
Does your child pretend (e.g. care for dolls, talk on a toy phone)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child follow where you're looking?
* must provide value
many times a day a few times a day a few times a week less than once a week never
How often does your child sniff or lick unusual objects?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child place your hand on an object when s/he wants you to use it (e.g. on a door handle when s/he wants you to open the door, on a toy when s/he wants you to activate it)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child walk on tiptoe?
* must provide value
always usually sometimes rarely never
How easy is it for your child to adapt when his/her routine changes or when things are out of their usual place?
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very easy quite easy quite difficult very difficult impossible
If you or someone else in the family is visibly upset, does your child show signs of wanting to comfort them? (e.g. stroking their hair, hugging them)?
* must provide value
always usually sometimes rarely never
Does your child do the same thing over and over again (e.g. running the tap, turning the light switch on and off, opening and closing doors)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Would you describe your child's first words as:
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very typical quite typical slightly unusual very unusual my child doesn't speak
Does your child echo things s/he hears (e.g. things that you say, lines from songs or movies, sounds)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child use simple gestures (e.g. wave goodbye)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child make unusual finger movements near his/her eyes?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child spontaneously look at your face to check your reaction when faced with something unfamiliar?
* must provide value
always usually sometimes rarely never
How long can your child's interest be maintained by just one or two objects?
* must provide value
most of the day several hours half an hour ten minutes a couple of minutes
Does your child twiddle objects repetitively (e.g. pieces of string)?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Does your child seem oversensitive to noise?
* must provide value
always usually sometimes rarely never
Does your child stare at nothing with no apparent purpose?
* must provide value
many times a day a few times a day a few times a week less than once a week never
Do you have any other concerns about your child's development?
Yes
No
Please describe your concerns here.
Q-CHAT (Quantitative CHecklist for Autism in Toddlers) Score:
View equation After you submit the survey, you will be advised how to interpret your score.
Your results will be provided on the next page, and will also be emailed to you. Please click Submit to complete the survey.
