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.)