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.)