WHY isn't the CHAT test used routinely?

[Jimjams]

IS there a reason? Does anyone know?

I found this in a report to paliament by the All Party Parliamentary Group for Autism - made in 2001- ie the year ds1 was busing failing all relevant areas of the CHAT test (which wasn't done) whilst I was being told he definitely wasn't autistic:

"early intervention can only be achieved by early identification ? the need for the national adoptionof the CHAT "

So WHY are they not doing that then????????????????

Now I would be on for everyone writing to thier local PCT/MP and asking why the CHAT isn't being used. Unless anyone knows a reason why it isn't.

Apolgies for kind of x posting as well.

I do see this as something that is a) worth campaigning for (especially having read the thread on B and D last week) and b) probably achievable. I do suspect that if they introduce the CHAT then they may be forced into providing early intervention.

[RainingCatsandDogs]

Thankyou again widemouth frog,you have been really lovely.

Just reading your book to ds again.

[Widemouthfrog]

terrible spelling -I'm cooking dinner and typing at the same time.

[Widemouthfrog]

raining
I've just had a 2yr check for my DS2 (seems very NT by the way) at my insistance. My HV (a new one) used a Denver scale (?) which I found when she went through it would have been far more informative if it had been used on DS1 than a CHAT test. In the social skills section he was not doing most of the expected things - mainly self help such as trying to brush his teeth or dress himself. Funnily enough, these are the things that he still has a lot of difficulty with. Anecdotally alot of ASD children have self-help difficulties, but these are not used as a diagnostic indicator. Good luck with your HV. You can always email me through MN if you want to chat further.

Cyberseraphim makes a good point -no one ones to be the first to say what they suspect might be wrong. As soo as i sain the word Autism, 3 separate professionals admitted that they had already used this word in connection to my son.

[RainingCatsandDogs]

Wide mouth frog,

Thankyou, I know you can't really comment on my ds but thanks for answering my question .His hand is just held slightly oddly and flaps at his side but only the right not the left and not in front of his face.BTW one of his favourite books is your name and so far he hasn't ripped it to pieces...

I am due for his 2 year check so I'll be interested if the health visitor mentions the CHAT test.Will ask her about a developmental paed .

Sorry for hijacking this old thread!

[cyberseraphim]

Great thread - well worth reviving. HVs are not the ones who are expected to drop the 'A bomb' on parents so naturally they will be evasive until a developmental paed has seen the child. It's hard to say how much is due to this factor- the HV is secretly thinking 'probably autism' but would not in a million years say that to the parent, and how much is due to genuine ignorance. I'm not sure about the significance of the imaginative play element at such a young age - if there aren't other obvious impairments in shared attention. My 20 month old is quite imaginative in a non ASD way but is not really into making cups of tea.

[Widemouthfrog]

Raining - only just seen your post - I thought this link was dead. I'm not really in a position to comment on your son. WRT to Ds, his hand flapping is exactly this -as he runs he flaps and twists his right hand in front of his face, and gets a glazed look. he will also twist his hand in front of his face if he is talking and gets excited. It is almost like an involuntary tick. He also tends to jump and flap all limbs, but this is something he has done as he has got older (he would not have had the coordination to do this at 2). You know your child better than anyone, and you obviously feel something is not quite right. I'd request a referral to a devlepomental paediatrician - that is where we were finally diagnosed. SALT hasn't been that useful to us, as language is one of DS's lesser problems. 23 months is still awfully young, though, so with the greatest will in the world, no professional is going to make any diagnosis at this age - it really is a case of time will tell. Try not to worry and just enjoy your son.

[RainingCatsandDogs]

Just to ask a question re wide mouth frog's post.My 23 month ds is delayed speaking - receptive OK but doesn't say much himself except when repeating words after you (have counted about 50 odd words used but only 20 without repeating after me and still won't say cup for instance when he wants his just points and moans even though he can say the word).
Imaginative play is poor although he points for wanting something and to express interest well .I have noted one hand always flaps when running - no other time.
I have seen a private SALT once and she said his expressive speech isn't great so I went to my GP to ask for NHS referral who said she didn't want to (wait and see...)as he was communicating in other ways and it is normal for alot of boys to speak later.
I also asked about autism because of lack of imaginative play (he does play cars,trains,bob the builder,hoovers alongside me but isn't interested in making cups of tea , playing with his kitchen) but again she dismissed me.
He hasn't had a CHAT test although I reckon he would have passed all except the 'make a cup of tea'.
Just wanted to know if I should go back and insist on SALT and developmental paed referral with different GP (she is classed a the baby/child specialist in the practice having a qualification in this area).Is the one hand flapping when running significant when he doesn't do it any other time?
DH thinks I am being neurotic and it is just delayed speech and we should just have some more private SALT then see how he goes for a couple more months.As he is only 23 months is te above significant?

[Widemouthfrog]

Oops.just seen the date on this thread too!! An accidental post brought it back up. Obviously pertinent still though.

[coppertop]

I've just realised that this thread is 3 years old.

Things now seem to be getting worse rather than better. The 2yr development checks have now been scrapped. Parents get a list to look at and then see the HV if they have concerns. Even relatively high-risk 2yr-olds aren't getting the checks (eg dd who has 2 brothers with ASD).

Last time I was at the child health clinic one of the mothers of a 2yr-old boy was telling the HV that her ds wasn't talking yet. The HV said to leave it for another 6 months to see how he goes. I don't know what the current waiting list for SALT is like but it used to be 6mths for an assessment and another 6mths for actual therapy. If there is a problem then this little boy won't be getting any help until he's 3.5yrs old. So much for early intervention.

I also agree with Widemouthfrog. Ds2 (AS) could possibly have passed his 2yr development check. He could say their minimum requirement of 20 words, and I'm not sure that the HV would've picked up on it all being colours, shapes and numbers. He could build towers of bricks etc. He picked up toys but again I'm not sure whether the HV would have had the necessary training to realise that any play actually involved him repeating the same sequence over and over. I can remember the SALT being pleased when ds2 played with toy cars in a garage - until she realised that he was just pushing them all in the same order to the same places about 20 times in a row... A SALT would (hopefully!) be able to recognise the subtle stuff but a HV probably wouldn't.

[Widemouthfrog]

I would like to add my support for using CHAT as a screening tool. However I would just like to add a word of caution. My DS would have passed all the criteria on the chat test - he pointed, he made eye contact, and he would pretend play with a teapot and his cars. And he was very attached to his cuddly duck. He could build a tower of bricks. Even so we knew our boy was unusual -he was very single minded and did not follow his peers, though he was quite happy for them to engage him. We now have a 5 year old with a diagnosis of Asperger's syndrome -he meets every criteria on the ICD10 checklist, so it is a very clear cut diagnosis. I was aware of CHAT and it took me a long time to realise that my DS was difficult to handle because of an ASD - his expressive language is very good, though we now realise his receptive language is far weaker.

My fear would be that if other children at the HF end of the spectrum were passing a CHAT test then it could encourage the health professionals and parents alike to take their eye of the ball so to speak. Of course good training should compensate for this. I have poor faith in the reliability of any judgement passed by a HV - I was told by my HV who witnessed my 3yr old running and flapping in a classic autistic nmanner that all childern do it!

[myredcardigan]

Oh how did that happen? Sorry, wrong thread. Was answering a post in childbirth or so I thought.

[myredcardigan]

I think you can theoretically choose any hospital you like. I was offered 3 within about 15mile radius of home. All 3 were in a different PCT area.

I think you should make your choice based on the logistics of getting there. What are your reasons for choosing that hospital? If it's close to work or family then that could be argued. If you needed stay in, could your DH get there easily?

Not much help,sorry.

[expatinscotland]

No apology necessary, homemama!

A lot of us will never know the cause of our childrens' special needs.

If it weren't for MN, I'd still be groping around in the dark trying to figure out how to help my daughter best.

[homemama]

TBH Davros, I don't know enough about the condition as perhaps we all should. But even to me it seemed like what she was saying made perfect sense. ie early diagnosis=early intervention=better outcome.
I apologise to you mums of SN kids if that sounds clinical. All my admiration to you x

[Davros]

Wow homemama, I'm impressed! Don't know what they do here tbh, its 8 yrs since DS was dx.

[homemama]

Jimjams, I wondered if you might be interested to know that here (cheshire) my HV did a watered down version of CHAT with my DS at his 8mth check.
She said that whilst many children regress, many more are autistic from birth and the sooner it is caught the better. She went through things like eye contact, social interaction, whether he had enjoyed his baby gym etc.
She said if there are any worries they'll check again at 12mths and that the health authority's long term aim was diag. at 18-24mths.
I just thought the test must be standard until I notised your thread.

[jenkins88]

I only know about this test because of MN and cannot understand why it isn't being used routinely to screen all children. It's scary to think that this is a deliberate act to keep children from gaining early intervention due to a lack of funds.

My DS is 3.6 now so I can't truely say how he would have done in this test. I've tried to go back and remember how he was a couple of years ago, and I can say with complete certainty that he would have failed on quite alot of the criteria.

Will definetly write to my local MP with a copy of the CHAT test and suggest that it should be used routinely, and ask why it isn't already being used seeing as it was devloped by a British team.

[Jimjams]

IN what way- did she say? It certainly misses children who later go onto develop autism (although some of those will regress anyway), but the published research (as far as I can tell from abstracts) seems to say its pretty much close to 100% right - in that if all 5 important tests within it are failed then the child is pretty much certainly autistic. If some are failed and others passed then it suggests other langauge/communication disorders.

[louismama]

I actually had the nerve to ask the rep. of the cdc (a SALT) why CHAT had not been used at 18months (i had requested asmt. due to concerns and guess what -fobbed off) she said shed worked on another health authority who had used CHAT and they had found it to be unreliable!

[Jimjams]

I've rounded up a few interested campaigners down here as well ...........

[Davros]

Jimjams, I don't see why the NAS shouldn't be interested in a formal campaign. I'll see what I can find out and also ask VB at PACE. I think it would be a great thing to campaign on.

[bundle]

[expatinscotland]

But oh no! Then they'd have to pay for those who failed to be evaluated by a specialist. Wouldn't want to spend precious pounds on children now, would we?

[bundle]

I see, that would make sense then, so not just if the parents/hv think there's a problem. makes perfect sense.