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1. The American Academy of Pediatrics (AAP) has recommended that all children be screened with an autism-specific instrument during well-child visits, at ages 18 and 24 months.  This survey has 7 questions and will take less than 2
minutes to complete.  Do you currently use the M-CHAT (Modified Checklist for Infants and Toddlers) to screen for Autism in your pediatric patients?

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2. If you do use it, do you complete one at the recommended 18 months and 24
months?

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3. If not at those two times, when do you complete it?

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4. Do you use another screening tool? 

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5. If so, what other screening tool do you use?

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6. If you do not screen for autism, what is your reason why?  Choose an many as
apply.

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7. Do you have any other comments, questions, or concerns?

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