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.)