• 1. Do they join in playing games with other children easily?*
  YesNo
• 2. Do they come up to you spontaneously for a chat?*
  YesNo
• 3. Were they speaking by 2 years old?*
  YesNo
• 4. Do they enjoy sports?*
  YesNo
• 5. Is it important to them to fit in with the peer group?*
  YesNo
• 6. Do they appear to notice unusual details that others miss?*
  YesNo
• 7. Do they tend to take things literally?*
  YesNo
• 8. When they were 3 years old, did they spend a lot of time pretending (e.g., play-acting being a superhero, or holding teddy’s tea parties)?*
  YesNo
• 9. Do they like to do things over and over again, in the same way all the time?*
  YesNo
• 10. Do they find it easy to interact with other children?*
  YesNo
• 11. Can they keep a two-way conversation going?*
  YesNo
• 12. Can they read appropriately for their age?*
  YesNo
• 13. Do they mostly have the same interests as their peers?*
  YesNo
• 14. Do they have an interest which takes up so much time that they do little else?*
  YesNo
• 15. Do they have friends, rather than just acquaintances?*
  YesNo
• 16. Do they often bring you things they are interested in to show you?*
  YesNo
• 17. Do they enjoy joking around?*
  YesNo
• 18. Do they have difficulty understanding the rules for polite behavior?*
  YesNo
• 19. Do they appear to have an unusual memory for details?*
  YesNo
• 20. Is their voice unusual (e.g., overly adult, flat, or very monotonous)?*
  YesNo
• 21. Are people important to them?*
  YesNo
• 22. Can they dress themself?*
  YesNo
• 23. Are they good at turn-taking in conversation?*
  YesNo
• 24. Do they play imaginatively with other children, and engage in role-play?*
  YesNo
• 25. Do they often do or say things that are tactless or socially inappropriate?*
  YesNo
• 26. Can they count to 50 without leaving out any numbers?*
  YesNo
• 27. Do they make normal eye-contact?*
  YesNo
• 28. Do they have any unusual and repetitive movements?*
  YesNo
• 29. Is their social behavior very one-sided and always on their own terms?*
  YesNo
• 30. Do they sometimes say "you", "she", "him", or "them" when they mean "I"?*
  YesNo
• 31. Do they prefer imaginative activities such as play-acting or story-telling, rather than numbers or lists of facts?*
  YesNo
• 32. Do they sometimes lose the listener because of not explaining what they are talking about?*
  YesNo
• 33. Can they ride a bicycle (even if with stabilizers)?*
  YesNo
• 34. Do they try to impose routines on themself, or on others, in such a way that it causes problems?*
  YesNo
• 35. Do they care how they are perceived by the rest of the group?*
  YesNo
• 36. Do they often turn conversations to their favourite subject rather than following what the other person wants to talk about?*
  YesNo
• 37. Do they have odd or unusual phrases?*
  YesNo
• 38. Have teachers/health visitors ever expressed any concerns about their development?*
  YesNo
• 39. Have they ever been diagnosed with Language delay, ADHD, hearing or visual difficulties, Autism Spectrum Condition (including Asperger’s Syndrome), or a physical disability?*
  YesNo
• Score
• Level
• Qualified
  Please Select New Qualified Unqualified
• Parent/Guardian First Name*
• Parent/Guardian Last Name*
• Email*
  example@example.com
• Phone Number*
  Please enter a valid phone number.
• State*
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• Zip Code*
• Child First Name*
• Child Last Name*
• Insurance*
  Please Select Aetna Anthem Blue Cross Blue Shield Cigna Tricare Medicaid Other
• WP Form ID
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