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No
Resolved
Mild
Moderate
Severe
SOCIAL=20
INTERACTION DIFFICULTIES (with same age peer) [how to rate ]
1. =
Poor eye contact, or staring from unusual =
angle =20
2. =
Ignores when called, pervasive ignoring, =
not turning=20
head to voice
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3. =
Excessive fear of noises (vacuum cleaner); =
covers=20
ears frequently
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4. =
In his/her own world (aloof) =
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5. =
Lack of curiosity about the =
environment =20
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6. =
Facial expressions don't fit =
situations =20
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7. =
Inappropriate crying or laughing =
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8. =
Temper tantrums, overreacting when not =
getting=20
his/her way
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9. =
Ignores pain (bumps head accidentally =
without=20
reacting)
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10. =
Doesn't like to be touched or held (body, =
head) =20
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11. =
Hates crowds, difficulties in restaurants =
and=20
supermarkets
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12. =
Inappropriately anxious, scared =
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13. =
Inappropriate emotional response (not =
reaching to be=20
picked up)
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14. =
Abnormal joy expression when seeing =
parents =20
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15. =
Lack of ability to imitate =
=20
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SPEECH AND=20
LANGUAGE DELAY [how to rate ]
=20
=20
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=20
1. =
Loss of acquired speech
=20
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2. =
Produces unusual noises or infantile =
squeals =20
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3. =
Voice louder than required =
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4. =
Frequent gibberish or jargon =
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5. =
Difficulty understanding basic things =
("just can't=20
get it")
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6. =
Pulls parents around when wants =
something =20
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7. =
Difficulty expressing needs or desires, =
using=20
gestures
=20
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8. =
No spontaneous initiation of speech and=20
communication
=20
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9. =
Repeats heard words, parts of words or TV=20
commercials [Grading tips for #9-14 ]
=20
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10. =
Repetitive language (same word or phrase =
over and=20
over)
=20
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11. =
Can't sustain conversation =
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12. =
Monotonous speech, wrong pausing =
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13. =
Speaks same to kids, adults, objects =
(can't=20
differentiate)
=20
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14. =
Uses language inappropriately (wrong words =
or=20
phrases)
=20
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ABNORMAL=20
SYMBOLIC OR IMAGINARY PLAY [how to rate ]
=20
=20
=20
=20
=20
1. =
Hand or finer flapping; self =
stimulation =20
=20
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=20
2. =
Head banging
=20
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=20
3. =
Self mutilation, inflicting pain or =
injury =20
=20
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4. =
Toe walking, clumsy body posture =
=20
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=20
5. =
Arranging toys in rows
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6. =
Smelling, banging, licking or other =
inappropriate=20
use of toys
=20
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7. =
Interest in toy parts, such as car =
wheels =20
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8. =
Obsessed with objects or topics (trains, =
weather,=20
numbers, dates)
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9. =
Spinning objects, self, or fascination =
with spinning=20
objects
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10. =
Restricted interest, (watching the same =
video over=20
and over)
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11. =
Difficulty stopping repetitive "boring" =
activity or=20
conversation
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12. =
Attachment to unusual objects, (sticks, =
stones,=20
strings, or hair)
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13. =
Stubborn about rituals and routines; =
resists to=20
change
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14. =
Restricted taste by consistency, shape or =
form=20
(refuses solids)
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15. =
Savant ability, restricted skill superior =
to age=20
group (reads early, memorizes books)
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BEHAVIORAL=20
DIFFICULTIES [how to rate ]
=20
=20
=20
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=20
LEVEL OF =
DYSFUNCTION
TOTAL SCORE
=20
=
=20
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