| 1. SOCIAL INTERACTION DIFFICULTIES (with same age peer) [how to rate]
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| 2. Poor eye contact, or staring from unusual angle |
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| 3. Ignores when called, pervasive ignoring, not turning head to voice |
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| 4. Excessive fear of noises (vacuum cleaner); covers ears frequently |
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| 5. In his/her own world (aloof) |
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| 6. Lack of curiosity about the environment |
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| 7. Facial expressions don’t fit situations |
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| 8. Inappropriate crying or laughing |
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| 9. Temper tantrums, overreacting when not getting his/her way |
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| 10. Ignores pain (bumps head accidentally without reacting) |
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| 11. Doesn’t like to be touched or held (body, head) |
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| 12. Hates crowds, difficulties in restaurants and supermarkets |
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| 13. Inappropriately anxious, scared |
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| 14. Inappropriate emotional response (not reaching to be picked up) |
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| 15. Abnormal joy expression when seeing parents |
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| 16. Lack of ability to imitate |
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| 1. SPEECH AND LANGUAGE DELAY [how to rate] |
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| 2. Loss of acquired speech |
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| 3. Produces unusual noises or infantile squeals |
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| 4. Voice louder than required |
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| 5. Frequent gibberish or jargon |
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| 6. Difficulty understanding basic things (“just can’t get it”) |
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| 7. Pulls parents around when wants something |
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| 8. Difficulty expressing needs or desires, using gestures |
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| 9. No spontaneous initiation of speech and communication |
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| 10. Repeats heard words, parts of words or TV commercials [Grading tips for #9-14] |
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| 11. Repetitive language (same word or phrase over and over) |
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| 12. Can’t sustain conversation |
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| 13. Monotonous speech, wrong pausing |
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| 14. Speaks same to kids, adults, objects (can’t differentiate) |
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| 15. Uses language inappropriately (wrong words or phrases) |
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| 1. ABNORMAL SYMBOLIC OR IMAGINARY PLAY [how to rate]
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| 2. Hand or finer flapping; self stimulation |
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| 3. Head banging |
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| 4. Self mutilation, inflicting pain or injury |
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| 5. Toe walking, clumsy body posture |
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| 6. Arranging toys in rows |
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| 7. Smelling, banging, licking or other inappropriate use of toys |
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| 8. Interest in toy parts, such as car wheels |
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| 9. Obsessed with objects or topics (trains, weather, numbers, dates) |
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| 10. Spinning objects, self, or fascination with spinning objects |
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| 11. Restricted interest, (watching the same video over and over) |
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| 12. Difficulty stopping repetitive “boring” activity or conversation |
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| 13. Attachment to unusual objects, (sticks, stones, strings, or hair) |
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| 14. Stubborn about rituals and routines; resists to change |
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| 15. Restricted taste by consistency, shape or form (refuses solids) |
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| 16. Savant ability, restricted skill superior to age group (reads early, memorizes books) |
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| 1. BEHAVIORAL DIFFICULTIES [how to rate] |
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| 1. LEVEL OF DYSFUNCTION |
TOTAL SCORE |
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