A 3-year-old boy is referred for evaluation. His parents note he does not respond to his name, avoids eye contact, lines up toys repetitively, becomes extremely distressed with routine changes, and has no meaningful words. He can stack 6 blocks and enjoys spinning objects. Which is the most appropriate first-line screening tool for this presentation?
- A Denver Developmental Screening Test II (DDST-II)
- B Modified Checklist for Autism in Toddlers (M-CHAT-R) ✓
- C Ages and Stages Questionnaire (ASQ)
- D Childhood Autism Rating Scale (CARS)
Explanation
The M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) is the recommended first-level screening tool for autism spectrum disorder (ASD) in children aged 16–30 months in primary care settings. This child demonstrates core ASD features: social communication deficits (no eye contact, no response to name, absent meaningful speech), restricted/repetitive behaviors (lining toys, spinning, insistence on sameness). DDST-II and ASQ are general developmental screens. CARS is a diagnostic tool, not a first-line screen. Following a positive M-CHAT-R, the child should be referred for formal diagnostic evaluation using ADOS-2 and ADI-R.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.