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* 1. Info

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* 2. Social & Behavioral

  Not True Rarely True Sometimes True Often True
1. The child has few preferred friends.
2. The child rarely initiates play with others.
3. The child rarely engages in imaginative play.
4. The child tends to play with particular toys in a repetitive manner
5. The child avoids eye contact
6. The child makes limited use of facial expressions and body language to facilitate communication.
7. The child attempts to control play situations (fails to sustain an interest in the play of others).
8. The child has difficulty in crowds
9. The child cannot take the perspective of others or understand that others have feelings & thoughts.
10.  The child lacks understanding of others' emotions.
11. The child has difficulty expressing his or her emotions appropriately.
12. The child prefers structured activities over not structured ones.
13. The child show a lack of awareness of others' personal space.
14. The child has difficulty learning the rules of a game or interaction.
Below is a list of behaviors.  For each item please select the choice that most accurately describes the child's behavior.  Please answer all items.  When completed, total items in all sections will be added.  Higher sores indicate the child or adolescent is displaying more behaviors that may interfere with daily functioning.

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* 3. Behavioral

  Not True Rarely True Sometimes True Often True
1. The child displays unusual fears.
2. The child displays an obsessive interest in narrow or atypical topics (is ritualistic).
3. The child is rule bound (sees things in black and white.
4. The child displays unusual eating habits.
5.  The child engages in preservative behaviors.
6. The child's behavior is rigid (has difficulty with changes and transitions
7. The child is a perfectionist (cannot tolerate mistakes, resists learning new tasks). 
8. The child appears anxious

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* 4. Speech & Language

  Not True Rarely True Sometimes True Often True
1. The child uses his words in a peculiar manner
2. The child does not ask for the meaning of words.
3. The child does not ask for help.
4. The child does not make jokes and has difficulty understanding joking and teasing.
5. The child does not initiate conversation.
6. The child has difficulty maintaining conversation in a reciprocal format (conversational give and take)
7. The child does not inquire about others.
8. The child "sounds" like an adult
9. The child says things that embarrasses others (comments on physical characteristics, asks probing questions.
10.  The child engage in obsessive questioning.
11. The child engages is obsessive talking about specific topics.
12. The child does not maintain another's topic when it does not pertain to his or her own special interest. 
13 The child has a large vocabulary consisting pimarily of nouns and verbs
14. The child doe not use language socially (focuses conversations on facts or special interests).
15. The child confuses "he" and "she".
16. The child displays unusual intonation, pitch, and/ or loudness
17. The child uses "language scripts" when conversing (language consists of scripts or parts of scripts from movies/TV/books).
18. The child interprets language on a literal level.
19. The child misses the point or main idea of a conversation.
20. The child insists upon verbal rituals (repeats scripts from movies/TV/books, shares to many details).
21. The child does not exhibit gestural communication.
22. The child has difficulty maintaining the topic in a conversation.

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* 5. Cognition

  Not True Rarely True Sometimes True Often True
1. The child has difficulty understanding abstract concepts (such as guessing, wishing, & time sequence).
2. The child displays strong memory skills.
3. The child has difficulty with fine motor skills.
4. The child interprets the behavior of others in a literal manner.
5. The child does not generalize learning from one situation to another.
6. The child is easily distracted.
7. The child has difficulty sustaining attention.

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* 6. Sensory

  Not True Rarely True Sometimes True Often True
1. The child displays an unusual sensitivity to noises.
2. The child displays an unusual sensitivity to smalls.
3. The child displays an unusual sensitivity to tastes.
4. The child displays an unusual sensitivity to textures.
5. The child shows an unusual sensitivity to being touched.
6. The child engages in repetitive or stereotypic movements.
7. The child displays difficulty with motor functioning/ planning (tying shoes, riding a bike).

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