Autism Checklist

Based on the ATEC (Autism Treatment Evaluation Checklist) by Bernard Rimland, Ph.D. & Stephen M. Edelson, Ph.D to assess the effects of treatment and monitor the general well-being of an individual over time.

The Autism Checklist consists of 4 sub-sections;

  1. Speech, Language & Communication
  2. Social Engagement
  3. Awareness & Sensory Behaviour
  4. State of Health & Behaviour

About You


Gender
Diagnosis

Speech, Language & Communication

Answer 'Not True', 'Somewhat True' or 'Very True' to the following statements

Knows his/her name

Understands 'No' or 'Stop'

Is able to follow commands?

Can use 1 single word (No/Eat/Yes..)

Can use 2 words together (Don't need/Thank you..)

Can use 3 words together (Want more water..)

Understands 10+ words

Uses sentences with four or more words

Communicates what he/she wants

Is able to ask appropriate questions

His/Her speech is relevant to the situation

Can use several successive sentences

Is able to have a conversation

He/she has normal ability to communicate for his/her age

Social Engagement

Indicate the truth of each statement below;

In his/her own world - unable to connect with him/her

Oblivious to other people

Pays very little attention when called/addressed

Uncooperative / Resistant

Doesn't look you in the eyes / No eye contact

Prefers to be by him/herself

Not affectionate to you or others

Doesn't greet parents

Avoids contact with others (hugging, kisses)

Doesn't imitate

Dislikes hugs/cuddles

Doesn't share or show

Doesn't wave 'bye'

Disagreeable

Frequent temper tantrums

Has no friends/companions

Doesn't smile very often

Lacks empathy/insensitive to others' feelings

Indifferent to being liked by others

Indifferent if parent(s) leave

Awareness & Sensory Behaviour

Please indicate how true each of the following statements are;

Responds to his/her name

Responds to praise/encouragement

Looks at animals and people

Looks at pictures

Engages in drawing, colouring-in, art

Knows how to play with toys

Has appropriate facial expressions

Understands and follows story-lines on TV

Understands explanations

Is aware of his/her environment

Is aware of danger

Is able to show imagination

Is able to initiate activities

Dresses him/herself

Is curious, interested

Likes to explore

Is 'tuned in' - not 'spacey'

Looks where others are looking

State of Health & Behaviour

Please indicate how true each of the following statements are;

Wets the bed

Wets pants/nappies

Soils pants/nappies

Diarrhoea

Constipation

Sleep

Eating too much/little

Very limited diet

Hyperactive

Lethargic

Self injurious behaviour

Hits/Injures others

Destructive

Sensitive to noise

Anxiety

Crying/Unhappy

Seizures

Obsessive speech

Rigid routines

Screams/Shouts

Demands things be the same

Frequently agitated

Not sensitive to pain

Fixated on certain items/topics

Repetitive behaviours (stimming, hand flapping, rocking etc.)