Question 1 of 25 Social Attention Does your child look at you when you call his/her name? Never Rarely Sometimes Usually Always Next Question 2 of 25 Social Attention How easy is it for you to get eye contact with your child? Impossible Very difficult Quite difficult Quite easy Very easy Previous Next Question 3 of 25 Repetitive Behavior When your child is playing alone, does s/he line objects up? Never Rarely Sometimes Usually Always Previous Next Question 4 of 25 Communication and Language Can other people easily understand your child's speech? My child does not speak Rarely Sometimes Usually Always Previous Next Question 5 of 25 Communication and Language Does your child point to indicate that s/he wants something? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 6 of 25 Social Attention Does your child point to share interest with you? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 7 of 25 Repetitive Behavior How long can your child's interest be maintained by a spinning object? Less than a minute A couple of minutes Ten minutes Half an hour Several hours Previous Next Question 8 of 25 Communication and Language How many words can your child say? None - s/he has not started speaking yet Less than 10 words 10-50 words 51-100 words Over 100 words Previous Next Question 9 of 25 Play and Imagination Does your child pretend (e.g. care for dolls, talk on a toy phone)? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 10 of 25 Social Attention Does your child follow where you're looking? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 11 of 25 Sensory Sensitivity How often does your child sniff or lick unusual objects? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 12 of 25 Communication and Language Does your child place your hand on an object when s/he wants you to use it? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 13 of 25 Motor and Sensory Traits Does your child walk on tiptoe? Never Rarely Sometimes Usually Always Previous Next Question 14 of 25 Flexibility and Adaptation How easy is it for your child to adapt when his/her routine changes? Impossible Very difficult Quite difficult Quite easy Very easy Previous Next Question 15 of 25 Social Attention If someone in the family is visibly upset, does your child show signs of wanting to comfort them? Never Rarely Sometimes Usually Always Previous Next Question 16 of 25 Repetitive Behavior Does your child do the same thing over and over again? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 17 of 25 Communication and Language Would you describe your child's first words as: Very typical Quite typical Slightly unusual Very unusual My child doesn't speak Previous Next Question 18 of 25 Communication and Language Does your child echo things s/he hears? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 19 of 25 Communication and Language Does your child use simple gestures (e.g. wave goodbye)? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 20 of 25 Repetitive Behavior Does your child make unusual finger movements near his/her eyes? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 21 of 25 Social Attention Does your child spontaneously look at your face to check your reaction when faced with something unfamiliar? Never Rarely Sometimes Usually Always Previous Next Question 22 of 25 Repetitive Behavior How long can your child's interest be maintained by just one or two objects? A couple of minutes Ten minutes Half an hour Several hours Most of the day Previous Next Question 23 of 25 Repetitive Behavior Does your child twiddle objects repetitively? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 24 of 25 Sensory Sensitivity Does your child seem oversensitive to noise? Never Rarely Sometimes Usually Always Previous Next Question 25 of 25 Repetitive Behavior Does your child stare at nothing with no apparent purpose? Never Less than once a week A few times a week A few times a day Many times a day Previous Generate Report
Question 1 of 25 Social Attention Does your child look at you when you call his/her name? Never Rarely Sometimes Usually Always Next Question 2 of 25 Social Attention How easy is it for you to get eye contact with your child? Impossible Very difficult Quite difficult Quite easy Very easy Previous Next Question 3 of 25 Repetitive Behavior When your child is playing alone, does s/he line objects up? Never Rarely Sometimes Usually Always Previous Next Question 4 of 25 Communication and Language Can other people easily understand your child's speech? My child does not speak Rarely Sometimes Usually Always Previous Next Question 5 of 25 Communication and Language Does your child point to indicate that s/he wants something? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 6 of 25 Social Attention Does your child point to share interest with you? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 7 of 25 Repetitive Behavior How long can your child's interest be maintained by a spinning object? Less than a minute A couple of minutes Ten minutes Half an hour Several hours Previous Next Question 8 of 25 Communication and Language How many words can your child say? None - s/he has not started speaking yet Less than 10 words 10-50 words 51-100 words Over 100 words Previous Next Question 9 of 25 Play and Imagination Does your child pretend (e.g. care for dolls, talk on a toy phone)? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 10 of 25 Social Attention Does your child follow where you're looking? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 11 of 25 Sensory Sensitivity How often does your child sniff or lick unusual objects? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 12 of 25 Communication and Language Does your child place your hand on an object when s/he wants you to use it? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 13 of 25 Motor and Sensory Traits Does your child walk on tiptoe? Never Rarely Sometimes Usually Always Previous Next Question 14 of 25 Flexibility and Adaptation How easy is it for your child to adapt when his/her routine changes? Impossible Very difficult Quite difficult Quite easy Very easy Previous Next Question 15 of 25 Social Attention If someone in the family is visibly upset, does your child show signs of wanting to comfort them? Never Rarely Sometimes Usually Always Previous Next Question 16 of 25 Repetitive Behavior Does your child do the same thing over and over again? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 17 of 25 Communication and Language Would you describe your child's first words as: Very typical Quite typical Slightly unusual Very unusual My child doesn't speak Previous Next Question 18 of 25 Communication and Language Does your child echo things s/he hears? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 19 of 25 Communication and Language Does your child use simple gestures (e.g. wave goodbye)? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 20 of 25 Repetitive Behavior Does your child make unusual finger movements near his/her eyes? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 21 of 25 Social Attention Does your child spontaneously look at your face to check your reaction when faced with something unfamiliar? Never Rarely Sometimes Usually Always Previous Next Question 22 of 25 Repetitive Behavior How long can your child's interest be maintained by just one or two objects? A couple of minutes Ten minutes Half an hour Several hours Most of the day Previous Next Question 23 of 25 Repetitive Behavior Does your child twiddle objects repetitively? Never Less than once a week A few times a week A few times a day Many times a day Previous Next Question 24 of 25 Sensory Sensitivity Does your child seem oversensitive to noise? Never Rarely Sometimes Usually Always Previous Next Question 25 of 25 Repetitive Behavior Does your child stare at nothing with no apparent purpose? Never Less than once a week A few times a week A few times a day Many times a day Previous Generate Report