M-CHAT-R

The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) is a screening test for Autism to be completed at the 18 month and 24 month WCC (valid from 16-30 months of age). It does NOT diagnose autism.  If asked, please complete this and bring it to your toddler's next WCC.

M-CHAT- R

  (English)

M-CHAT- R

 (Spanish)

PHQ-9

The Patient Health Questionnaire is completed to assess for depression.  The American Academy recommends a depression screen for all children 12 and over.  This form should be filled out by the child and NOT the parent.  If asked, please have your child complete this form and bring it to his/her next visit. 

PHQ-9

ADHD

If your doctor has asked you to fill out forms to help determine if your child has ADHD, follow these instructions:

a. Print two copies of the "parent initial questionnaire". Both parents (or any adult who is with the child in the home setting) should fill these out on their own. 

b. Print two copies of the "teacher initial questionnaire".  Give this to two different teachers, coaches, etc. to complete and return back to you. 

Parent Initial Questionnaire

Teacher Initial Questionnaire

If your child has a diagnosis of ADHD, your doctor may ask you to complete the following forms to determine if his/her current treatment is working. 

a. Print two copies of the "parent follow-up questionnaire". Both parents (or any adult who is with the child in the home setting) should fill these out on their own. 

b. Print two copies of the "teacher follow-up questionnaire".  Give this to two different teachers, coaches, etc. to complete and return back to you. 

Parent Follow-Up Questionnaire

Teacher Follow-Up Questionnaire