Quantitative Checklist For Autism in Toddlers(Q-CHAT)

What is the Q-CHAT test

Q-CHAT introduction

The Q-CHAT is a famous tool and test for identifying the Autism. But it isn’t a self-report assessment tool and quesionnaire. This tool and questionnaire was prepared to find out the early signs and behavior of autism spectrum disorder (ASD) in very young children, those aged 18 to 30 months. Abusolutely, the young children can’t finish the quesionnaire.

The Q-CHAT serves as a parent-report questionnaire that includes 25 items, designed to assess various different behaviors and developmental milestones associated with autism. All the parents need to pay attention to their children and according to the observation to complete the paper get a score.

Professor Simon and his team at the University Cambridge created the Q-CHAT test for young people around the world. It is a famous and wonderful team around the world.

Purpose and Structure of Q-CHAT

The Q-CHAT aims to capture and find out a wide range of behaviors and signs indicative of autism with different aspects, including social interaction, communication skills, and repetitive behaviors.

It extends the original Checklist for Autism in Toddlers (Q-CHAT) by providing a more nuanced approach that allows for varying degrees and range of responses rather than a simple yes/no format. This setting will have a great impact on finding out the real problem.

Each item on the Q-CHAT is including 5-point Likert scale.Using the word to describe the frequency of behaviors is a good way. The higher scores indicate more pronounced autistic traits. So all parents need to choose the answer carefully. The wrong score will have a big impact on outcome.

The set 5-point Likert scale is useful. This structure helps clinicians and researchers better understand a child’s behavior and decide whether further assessment for autism is warranted.

Key Features of Q-CHAT

• Behavioral Focus: The Q-CHAT assesses critical behaviors such as eye contact, response to name calling, pointing to share interest, and engagement in social play. These behaviors are essential for identifying potential developmental concerns related to autism.
• Parent Involvement and joining: Parents should be careful. The questionnaire is aim to be completed by parents or caregivers. All the caregivers must ensure that their observations and memory are based on the child’s real behavior in familiar settings. Careless observation may make the wrong score.
• Scoring and Interpretation: The total score from the Q-CHAT can help determine the likelihood of autism.It usually is reliable. A higher score may indicate a greater need for further diagnostic evaluation. Make sure you calculate the right score on the test.

Application of Q-CHAT

The Q-CHAT is not a diagnostic tool but rather a screening instrument and quesionnaire that can guide clinicians in identifying children who may benefit from more comprehensive assessments for autism. The score of this test is just a possible outcomes, need more evidence from doctor.

Although it has been shown to have good sensitivity and specificity in distinguishing between children with and without autism, making it a valuable and useful resource in early childhood assessments. We think it is an easy and costless way. It demonstrates the researcher’s sense of responsibility and love for society and all children.

Who can use this Q-CHAT test?

For young children aged 18 to 30 months old who may have autism.

How to get the Q-CHAT score

In order to calculate the total score of the Quantitative Checklist for Autism in Toddlers (Q-CHAT), all the parents or caregivers need to learn the following steps:

Scoring Process of Q-CHAT

1. Complete the 25 Questionnaire: The Q-CHAT consists of 25 items parents or caregivers need to fill out based on their observations of the child’s behavior. Before you fill out the answer for the children, make sure you have understood all the specific descriptions. Each item is designed to assess specific behaviors associated with autism.
2. Response Options: Each item is rated on a 5-point scale, where responses indicate the frequency of behaviors:
   1. 0 points: Never
   2. 1 point: Rarely
   3. 2 points: Sometimes
   4. 3 points: Often
   5. 4 points: Many times a day

	Never	Rarely	Sometimes	Often	Many times a day
Score of items	0	1	2	3	4

3. Scoring Each Item: For each item, the response representing the most “autistic” symptomatology scores the highest points (4), while responses indicating less autistic behavior score lower.
4. Calculate Total Score: Sum the scores from each items in the test to get the total score. You need to pay attention to that The maximum score is 100. If you get a score higher than 100, you definitely wrong.
5. Interpreting Scores:
   1. A higher total score indicates a greater likelihood and possibility of autistic traits.
   2. In some studies and scientific paper, a cut-off score of 44 has been suggested to maximize sensitivity for identifying children with Autistic. Children with the same situations may need further diagnostic assessment. Finally get a more accurate outcome.

Example Scoring of Q-CHAT

If a child receives the following scores on selected items:

• Item 1: 3 points
• Item 2: 2 points
• Item 3: 4 points
• …
• Item 25: 1 point

You would add these scores together to get the total Q-CHAT score.

Subscale Breakdown of Q-CHAT Items

1. Social Communication
   1. The specific number of items of Q-CHAT: 1, 2, 3, 4, 5, 6, 7, 8
   2. Description: It was focus on two aspects.This subscale focuses on the child’s social interactions and communication skills, it includes the eye contact and response to social cues.
2. Repetitive Behaviors and Interests
   1. The specific number of items of Q-CHAT: 9, 10, 11, 12, 13
   2. Description: This subscale assesses the presence of repetitive behaviors or restricted interests that are common in children on the autism spectrum.
3. Non-Social Behavior
   1. The specific number of the Items of Q-CHAT: 14, 15, 16, 17
   2. Description: This subscale evaluates behaviors that do not directly involve social interaction but may still indicate atypical development.
4. Sensory Behaviors
   1. The specific number of items of Q-CHAT: 18, 19, 20
   2. Description: This subscale looks at sensory processing issues or unusual responses to sensory experiences.
5. General Developmental Concerns
   1. The specific number of items of Q-CHAT: 21, 22, 23, 24, 25
   2. Description: This subscale includes items that reflect broader developmental concerns that may be relevant to autism diagnosis. These item work greatly.

How to interpret your Q-CHAT scores?

Understanding Your Total Score of Q-CHAT

1. Total Score Range: The Q-CHAT total score can range from 0 to 100. A higher score suggests a greater likelihood of autistic traits.If you get a higher score, you need to be careful to find out the reason.
2. Cut-off Score: Many Research and scientific paper indicates that a cut-off score of 44 is commonly used to maximize sensitivity for identifying children who may need further diagnostic assessment. It means the score above 44 has a higher possibility of the Austim. It is better to do more evaluation in the furure. Need more evidence and test to get a reliable diagnose.

Score Interpretation of Q-CHAT

• Scores Below 44 is a good signal: When you finish the test and get the final score. A total score below 44 generally indicates that the child is less likely to exhibit significant autistic traits and may not require immediate further assessment for autism. This is a good outcome we hope each children get.
• Scores Between 44 and 49: This score range indicates a moderate level of concern and worried. It still need more advanced tests and evidence. The Children scoring in this range may benefit from monitoring and possibly additional screening or observation.
• Scores Above 49: Scores above 49 suggest a higher likelihood of autistic traits, and children in this category and situation should be considered for comprehensive diagnostic evaluations. To clarify their developmental profile more accurately.

Subscale Scores of Q-CHAT

The Q-CHAT also provides insights through subscale scores, which can help identify specific areas of concern:

1. Social/Communication Traits: This subscale assesses behaviors related to social interaction and communication skills. A higher score here indicates more pronounced difficulties in these areas.
2. Non-Social/Behavioral Traits: This subscale evaluates behaviors that are not directly related to social communication but may still indicate autism, such as repetitive behaviors or restricted interests.
3. Speech/Language Factor: This factor focuses on language development and use, which are critical components in assessing autism.

Is the Q-CHAT test reliable and valid?

Reliability of Q-CHAT

1. Internal Consistency: The Q-CHAT exhibits good internal consistency, particularly for its main factor scores. In studies, the Cronbach’s alpha values were reported as follows:
   1. Overall internal consistency: 0.83 to 0.94 depending on the sample and specific factors assessed.
   2. Social/communication traits: Acceptable internal consistency.
   3. Non-social/behavioral traits: Also showed acceptable internal consistency.
2. Test-Retest Reliability: The Q-CHAT has shown excellent test-retest reliability. For instance, in one study, a correlation coefficient of 0.82 was reported after a one-month interval, indicating that scores remained stable over time.

Validity of Q-CHAT

1. Convergent Validity: The Q-CHAT has demonstrated convergent validity with other established measures of autistic traits. For example, it correlated well with the Pervasive Developmental Disorders subscale of the Child Behavior Checklist (CBCL), supporting its effectiveness in identifying autistic traits.
2. Discriminant Validity: Studies have shown that children with established clinical diagnoses of autism spectrum disorder (ASD) scored significantly higher on the Q-CHAT compared to unselected samples, providing evidence that the Q-CHAT can effectively differentiate between children with and without autism.
3. Factor Structure: The Q-CHAT has been found to have a three-factor structure that accounts for a significant portion of the variance in scores:
   1. Social/communication traits
   2. Non-social/behavioral traits
   3. A speech/language factor

The Q-CHAT Test

Please answer the following questions about your child.

1. Does your child look at you when you call his/her name?
   1. Always
   2. Usually
   3. Sometimes
   4. Rarely
   5. Never
2. How easy is it for you to get eye contact with your child?
   1. Very easy
   2. Quite easy
   3. Quite difficult
   4. Very difficult
   5. Impossible
3. When your child is playing alone, does s/he line objects up?
   1. Always
   2. Usually
   3. Sometimes
   4. Rarely
   5. Never
4. Can other people easily understand your child’s speech?
   1. Always
   2. Usually
   3. Sometimes
   4. Rarely
   5. Never
   6. My child does not speak
5. Does your child point to indicate that s/he wants something (e.g. a toy that is out of reach)?
   1. Many times a day
   2. A few times a day
   3. A few times a week
   4. Less than once a week
   5. Never
6. Does your child point to share interest with you (e.g. pointing at an interesting sight)?
   1. Many times a day
   2. A few times a day
   3. A few times a week
   4. Less than once a week
   5. Never
7. How long can your child’s interest be maintained by a spinning object (e.g. washing machine, electric fan, toy car wheels)?
   1. Several hours
   2. Half an hour
   3. Ten minutes
   4. A couple of minutes
   5. Less than a minute
8. How many words can your child say?
   1. None – s/he has not started speaking yet
   2. Less than 10 words
   3. 10 – 50 words
   4. 51 – 100 words
   5. Over 100 words
9. Does your child pretend (egg care for dolls, talk on a toy phone)?
   1. Many times a day
   2. A few times a day
   3. A few times a week
   4. Less than once a week
   5. Never
10. Does your child follow where you’re looking?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
11. How often does your child sniff or lick unusual objects?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
12. 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)?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
13. Does your child walk on tiptoe?
    1. Always
    2. Usually
    3. Sometimes
    4. Rarely
    5. Never
14. How easy is it for your child to adapt when his/her routine changes or when things are out of their usual place?
    1. Very easy
    2. Quite easy
    3. Quite difficult
    4. Very difficult
    5. Impossible
15. 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)?
    1. Always
    2. Usually
    3. Sometimes
    4. Rarely
    5. Never
16. 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)?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
17. Would you describe your child’s first words as:
    1. Very typical
    2. Quite typical
    3. Slightly unusual
    4. Very unusual
    5. My child doesn’t speak
18. Does your child echo things s/he hears (e.g. things that you say, lines from songs or movies, sounds)?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
19. Does your child use simple gestures (e.g. wave goodbye)?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
20. Does your child make unusual finger movements near his/her eyes?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
21. Does your child spontaneously look at your face to check your reaction when faced with something unfamiliar?
    1. Always
    2. Usually
    3. Sometimes
    4. Rarely
    5. Never
22. How long can your child’s interest be maintained by just one or two objects?
    1. Most of the day
    2. Several hours
    3. Half an hour
    4. Ten minutes
    5. A couple of minutes
23. Does your child twiddle objects repetitively (e.g. pieces of string)?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never
24. Does your child seem oversensitive to noise?
    1. Always
    2. Usually
    3. Sometimes
    4. Rarely
    5. Never
25. Does your child stare at nothing with no apparent purpose?
    1. Many times a day
    2. A few times a day
    3. A few times a week
    4. Less than once a week
    5. Never