Assessment Test

Social Interaction Difficulties

  1. Poor eye contact, or starring from unusual angle

    Resolved
    Mild
    Moderate
    Severe
    None

  2. Ignores when called, pervasive ignoring, not turning head to voice

    Resolved
    Mild
    Moderate
    Severe
    None

  3. Excessive fear of noises (vacuum cleaner); covers ears frequently

    Resolved
    Mild
    Moderate
    Severe
    None

  4. In his/her own world (aloof)

    Resolved
    Mild
    Moderate
    Severe
    None

  5. Lack of curiosity about the environment

    Resolved
    Mild
    Moderate
    Severe
    None

  6. Facial expressions don't fit situations

    Resolved
    Mild
    Moderate
    Severe
    None

  7. Inappropriate crying or laughing

    Resolved
    Mild
    Moderate
    Severe
    None

  8. Temper tantrums, overreacting when not getting his/her way

    Resolved
    Mild
    Moderate
    Severe
    None

  9. Ignores pain (bumps head accidentally without reacting)

    Resolved
    Mild
    Moderate
    Severe
    None

  10. Doesn't like to be touched or held (body, head)

    Resolved
    Mild
    Moderate
    Severe
    None

  11. Hates crowds, difficulties in restaurants and supermarkets

    Resolved
    Mild
    Moderate
    Severe
    None

  12. Inappropriate emotional response (not reaching to be picked up)

    Resolved
    Mild
    Moderate
    Severe
    None

  13. Abnormal joy expression when seeing parents or loved ones

    Resolved
    Mild
    Moderate
    Severe
    None

  14. Lack of ability to imitate

    Resolved
    Mild
    Moderate
    Severe
    None

Speech and Language Delay

  1. Loss of acquired speech

    Resolved
    Mild
    Moderate
    Severe
    None

  2. Produces unusual noises or infantile squeals

    Resolved
    Mild
    Moderate
    Severe
    None

  3. Voice louder than required

    Resolved
    Mild
    Moderate
    Severe
    None

  4. Frequent gibberish or jargon

    Resolved
    Mild
    Moderate
    Severe
    None

  5. Difficulty understanding basic things

    Resolved
    Mild
    Moderate
    Severe
    None

  6. Pulls parents around when wants something

    Resolved
    Mild
    Moderate
    Severe
    None

  7. Difficulty expressing needs or desires, using gestures

    Resolved
    Mild
    Moderate
    Severe
    None

  8. No spontaneous initiation of speech and communication

    Resolved
    Mild
    Moderate
    Severe
    None

  9. Repeats heard words, parts of words or TV commercials

    Resolved
    Mild
    Moderate
    Severe
    None

  10. Repetitive language (same word or phrase over and over)

    Resolved
    Mild
    Moderate
    Severe
    None

  11. Can't sustain a conversation

    Resolved
    Mild
    Moderate
    Severe
    None

  12. Monotonous speech, wrong pausing

    Resolved
    Mild
    Moderate
    Severe
    None

  13. Speaks same to kids, adults, objects (can't differentiate)

    Resolved
    Mild
    Moderate
    Severe
    None

  14. Uses language inappropriately (wrong words or phrases)

    Resolved
    Mild
    Moderate
    Severe
    None

Abnormal Symbolic or Imaginary Play

  1. Hand or finer flapping; self stimulation

    Resolved
    Mild
    Moderate
    Severe
    None

  2. Head banging

    Resolved
    Mild
    Moderate
    Severe
    None

  3. Self mutilation, inflicting pain or injury

    Resolved
    Mild
    Moderate
    Severe
    None

  4. Toe walking, clumsy body posture

    Resolved
    Mild
    Moderate
    Severe
    None

  5. Arranging toys in rows

    Resolved
    Mild
    Moderate
    Severe
    None

  6. Smelling, banging, licking or other inappropriate use of toys

    Resolved
    Mild
    Moderate
    Severe
    None

  7. Interest in toy parts, such as car wheels

    Resolved
    Mild
    Moderate
    Severe
    None

  8. Obsessed with objects or topics (trains, weather, numbers, dates)

    Resolved
    Mild
    Moderate
    Severe
    None

  9. Spinning objects, self, or fascination with spinning objects

    Resolved
    Mild
    Moderate
    Severe
    None

  10. Restricted interest (watching the same video over and over)

    Resolved
    Mild
    Moderate
    Severe
    None

  11. Difficulty stopping repetitive "boring" activity or conversation

    Resolved
    Mild
    Moderate
    Severe
    None

  12. Attachment to unusual objects (stick, stones, strings, or hair

    Resolved
    Mild
    Moderate
    Severe
    None

  13. Stubborn about rituals and routines; resists change

    Resolved
    Mild
    Moderate
    Severe
    None

  14. Restricted taste by consistency of shape or form (refuses solids)

    Resolved
    Mild
    Moderate
    Severe
    None

  15. Savant ability, restricted skill superior to age group (reads early, memorizes books)

    Resolved
    Mild
    Moderate
    Severe
    None