Feb 12, 2020
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Autism Spectrum Checklist

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Autism Spectrum Intervention/Treatment Evaluation Checklist

The purpose of this checklist is to determine the baseline standard by which the person’s development is going to be measured or compared to. During the assessment period it is suggested to complete the checklist (this is called the baseline assessment), then to introduce one new intervention, then to redo the checklist in 2-4 weeks time (during which you are doing the intervention) to assess how well the person is responding to the intervention or treatment.

Date of Baseline Assessment:

Date of Next Assessment:

Type of Intervention or Treatment:

Assessment Checklist

For each statement mark N,S, or V for N = Not true, S = Somewhat true, V = Very True as to the validity of the statement.

SYMPTOM: DEFICITS IN COMMUNICATION

  1. Speech/Language Communication
  2. Knows own name
  3. Responds to ‘No’ or ‘Stop’
  4. Can follow some commands
  5. Can use one word at a time
  6. Can use 2 words at a time
  7. Can use 3 words at a time
  8. Knows 10 or more words
  9. Can use sentences with 4 or more words
  10. Explains what he/she wants
  11. Asks meaningful questions
  12. Speech tends to be meaningful / relevant
  13. Often uses several successive sentences
  14. Carries on fairly good conversation
  15. Has normal ability to communicate for his/her age

SYMPTOM: SOCIAL IMPAIRMENT

  1. Sociability
  2. Seems to be in a shell – you cannot reach him/her
  3. Ignores other people
  4. Pays little or no attention when addressed
  5. Uncooperative and resistant
  6. No eye contact
  7. Prefers to be left alone
  8. Shows no affection
  9. Fails to greet parents
  10. Avoids contact with others
  11. Does not imitate
  12. Dislikes being held/cuddled
  13. Does not share or show
  14. Does not wave ‘bye bye’
  15. Disagreeable/not compliant
  16. Temper tantrums
  17. Lacks friends/companions
  18. Rarely smiles
  19. Insensitive to other’s feelings
  20. Indifferent to being liked
  21. Indifferent if parent(s) leave

III. Sensory/Cognitive Awareness

  1. Responds to own name
  2. Responds to praise
  3. Looks at people and animals
  4. Looks at pictures (and T.V.)
  5. Does drawing, coloring, art
  6. Plays with toys appropriately
  7. Appropriate facial expression
  8. Understands stories on T.V.
  9. Understands explanations
  10. Aware of environment
  11. Aware of danger
  12. Shows imagination
  13. Initiates activities
  14. Dresses self
  15. Curious, interested
  16. Venturesome – explores
  17. “Tuned in” – Not spacey
  18. Looks where others are looking

SYMPTOM: RIGID, REPETITIVE BEHAVIOURS AND INTERESTS

  1. Health/Physical/Behavior
  2. Bed-wetting
  3. Wets pants/diapers
  4. Soils pants/diapers
  5. Diarrhea
  6. Constipation
  7. Sleep problems
  8. Eats too much/too little
  9. Extremely limited diet
  10. Hyperactive
  11. Lethargic
  12. Hits or injures self
  13. Hits or injures others
  14. Destructive
  15. Sound-sensitive
  16. Anxious/fearful
  17. Unhappy/crying
  18. Seizures
  19. Obsessive speech
  20. Rigid routines
  21. Shouts or screams
  22. Demands sameness
  23. Often agitated
  24. Not sensitive to pain
  25. “Hooked” or fixated on certain objects/topics
  26. Repetitive movements

Source: The Autism Treatment Evaluation Checklist (ATEC) was developed by Bernard Rimland and Stephen M. Edelson of the Autism Research Institute

There is a triad of symptoms for the autism spectrum:

  • Social impairment
  • Deficits in communication – different kinds of problems, may not be able to talk, or may have lots of languages but have problems with communicating with people in a social context
  • Rigid, repetitive behaviors and interests – less well defined, ranging from repetitive motor movement like hand flapping or insisting on a particular schedule or particular routine
  • Problems in all three areas above are classified as an autism spectrum disorder
Autism Spectrum Intervention/Treatment Evaluation Checklist The purpose of this checklist is to determine the baseline standard by which the person’s development is going to be measured or compared to. During the assessment period it is suggested to complete the checklist (this is called the baseline assessment), then to introduce one new intervention, then to redo the checklist in 2-4 weeks time (during which you are doing the intervention) to assess how well the person is responding to the intervention or treatment. Date of Baseline Assessment: Date of Next Assessment: Type of Intervention or Treatment: Assessment Checklist For each statement mark N,S, or V for N = Not true, S = Somewhat true, V = Very True as to the validity of the statement. SYMPTOM: DEFICITS IN COMMUNICATION Speech/Language Communication Knows own name Responds to ‘No’ or ‘Stop’ Can follow some commands Can use one word at a time Can use 2 words at a time Can use 3 words at a time Knows 10 or more words Can use sentences with 4 or more words Explains what he/she wants Asks meaningful questions Speech tends to be meaningful / relevant Often uses several successive sentences Carries on fairly good conversation Has normal ability to communicate for his/her age SYMPTOM: SOCIAL IMPAIRMENT Sociability Seems to be in a shell – you cannot reach him/her Ignores other people Pays little or no attention when addressed Uncooperative and resistant No eye contact Prefers to be left alone Shows no affection Fails to greet parents Avoids contact with others Does not imitate Dislikes being held/cuddled Does not share or show Does not wave ‘bye bye’ Disagreeable/not compliant Temper tantrums Lacks friends/companions Rarely smiles Insensitive to other’s feelings Indifferent to being liked Indifferent if parent(s) leave III. Sensory/Cognitive Awareness Responds to own name Responds to praise Looks at people and animals Looks at pictures (and T.V.) Does drawing, coloring, art Plays with toys appropriately Appropriate facial expression Understands stories on T.V. Understands explanations Aware of environment Aware of danger Shows imagination Initiates activities Dresses self Curious, interested Venturesome – explores “Tuned in” – Not spacey Looks where others are looking SYMPTOM: RIGID, REPETITIVE BEHAVIOURS AND INTERESTS Health/Physical/Behavior Bed-wetting Wets pants/diapers Soils pants/diapers Diarrhea Constipation Sleep problems Eats too much/too little Extremely limited diet Hyperactive Lethargic Hits or injures self Hits or injures others Destructive Sound-sensitive Anxious/fearful Unhappy/crying Seizures Obsessive speech Rigid routines Shouts or screams Demands sameness Often agitated Not sensitive to pain “Hooked” or fixated on certain objects/topics Repetitive movements Source: The Autism Treatment Evaluation Checklist (ATEC) was developed by Bernard Rimland and Stephen M. Edelson of the Autism Research Institute There is a triad of symptoms for the autism spectrum: Social impairment Deficits in communication – different kinds of problems, may not be able to talk, or may have lots of languages but have problems with communicating with people in a social context Rigid, repetitive behaviors and interests – less well defined, ranging from repetitive motor movement like hand flapping or insisting on a…

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