1. Dr Nur Syaheeda Date：19th May 2023
MCHAT &
Autism Management

2. 01/MCHAT
02/Referral and Diagnosis
03/Behavioural Treatments
05/ Complementary & Alternative Treatments
Contents
04/Medical Management

3. MCHAT (Modified Checklist for Autism in
Toddlers)
This template can change color, shape, content, etc. It is commercially available and pleasant to
cooperate withally available and pleasant
• Develop as a screening tool for autism to be given to all
children at 18 to 30 months of age.
• It is most widely used screening tool. However if use alone, it
has poor predictive value and a high false-positive rate.
• So the author have since published the Modified Checklist for
Autism in Toddlers -Revised with Follow up (MCHAT-R/F)

4. NO for item other
than 2,5 and 12
indicate ASD risk.
YES for item 2,5 and
12 indicate ASD risk.

6. MCHAT (Malay)

7. Referral and Diagnosis
• Evaluation for ASD should include a comprehensive
assessment preferably by an interdisciplinary team.
• The evaluation aim to definitively diagnose ASD exclude
condition and determine the child’s level of functioning.
• In the absence of a team, an individual clinician with expertise
in evaluating ASD is appropriate.

8. Behavioural
Treatments
• Early extensive behavioural intervention is an immersive
behavioural therapy for at least 25 hours per week that is
recommended for preschool to early school aged children with
ASD.
• It seeks to teach new skills by reinforcing desirable behaviours
encouraging generalization of these skills and decreasing
undesiarable behaviours.
• Behaviour analysis-based early intensive behavioural
intervention delivered over an extended time frame leads to
improvement in cognitive ability, language and adaptive skills.

9. • Cognitive behaviour therapy substantially reduces anxiety
symptoms in older children with ASD who have average to
above average IQ.
• Targeted play has led to improvements in early social
communication skills.
• Social skills training has demonstrated short-term
improvement in social skills and emotional recognition in
school-aged children without intellectual dysfunction.
• Parent training and education programs improve language
skills and decrease disruptive behaviour in children.

10. Medical Management
• There is no medication available to treat the composite symptoms of ASD,
medical management can be a beneficial adjunct.
• It targets specific maladaptive behaviours for which intensive behavioural
therapy has not been effective.
• It may also target comorbid diagnoses such as anxiety disorders,attention
deficit/hyperactive disorders (ADHD) and sleep disorders.
• Aripiprazole and Risperidone are the only medications approve for the
treatment of ASD in USA. These atypical antipsychotics are approved for
ASD-associated irritability and in some trials have proven beneficial for
treating aggression, explosive outbursts and self-injury.

11. • Aripiprazole is approved for children age 6 to 17 years of age.
• Risperidone is approved for children age 5 to 16 years of age.
• Although the medication may provide some benefits, they must be
weighed against serious potential adverse effects including sedation,
weight gain, tremor and extrapyrimidal symptoms.
• Subspecialty referral should be strongly considered for these
treatment.
• Stimulant such as Methylphenidate (Ritalin) may prove benefit in
children with comorbid ADHD but treatment effects are less significant
than in children without ASD and adverse effects are more common.
• Non-stimulant-based treatments may have a larger role in children wth
comorbid ADHD and have shown fewer adverse effects.

12. Complementary &
Alternative Treatments
• There is a strong evidence that melatonin helps manage sleep disorders,
improve daytime behaviour and has minimal adverse effects.
• Massage therapy has been studied in several single-blinded randomized
controlled trials that demonstrated benefits on ASD symptoms, sleep,
language, repetitive behaviours and anxiety. Massage can be performed by
parents and has no evidence of harm.
• Vitamin B6 and magnesium in larger doses have been studied for use in
children with ASD to improve behaviours, speech and language. Results
equivocal and at suprtherapeutic doses, there is risk of neuropathy from
vitamin B6 and diarrhoea from magnesium toxicity.

13. • Additional treatments that are not recommended because they
have not show benefit across several randomized clinical trials
include auditory interation training, facilitated
communication, gluten- or casein-free diets, hyperbaric
oxygen and secretin.

14. THANK YOU