Please read the following questions carefully, and choose the appropriate answer. All responses are confidential.
Does your child join in playing games with other children easily.
boolean
Does s/he come up to you spontaneously for a chat?
boolean
Was s/he speaking by 2 years old?
boolean
Does your child enjoy sports.
boolean
Is it important to him/her to fit in with the peer group?
boolean
Does s/he appear to notice unusual details that others miss?
boolean
Does s/he tend to take things literally?
boolean
When s/he was 3 years old, did s/he spend a lot of time pretending (e.g., play-acting being a superhero, or holding teddy's tea parties)?
boolean
Does s/he like to do things over and over again, in the same way all the time?
boolean
Does s/he find it easy to interact with other children?
boolean
Can s/he keep a two-way conversation going?
boolean
Can s/he read appropriately for his/her age?
boolean
Does s/he mostly have the same interests as his/her peers?
boolean
Does s/he have an interest which takes up so much time that s/he does little else?
boolean
Does s/he have friends, rather than just acquaintances?
boolean
Does s/he often bring you things s/he is interested in to show you?
boolean
Does s/he enjoy joking around?
boolean
Does s/he have difficulty understanding the rules for polite behavior?
boolean
Does s/he appear to have an unusual memory for details?
boolean
Is his/her voice unusual (e.g., overly adult, flat, or very monotonous)?
boolean
Are people important to him/her?
boolean
Can s/he dress him/herself?
boolean
Is s/he good at turn-taking in conversation?
boolean
Does s/he play imaginatively with other children, and engage in role-play?
boolean
Does s/he often do or say things that are tactless or socially inappropriate?
boolean
Can s/he count to 50 without leaving out any numbers?
boolean
Does s/he make normal eye-contact?
boolean
Does s/he have any unusual and repetitive movements?
boolean
Is his/her social behavior very one-sided and always on his/her own terms?
boolean
Does s/he sometimes say "you" or "s/he" when s/he means "I"?
boolean
Does s/he prefer imaginative activities such as play-acting or story-telling, rather than numbers or lists of facts?
boolean
Does s/he sometimes lose the listener because of not explaining what s/he is talking about?
boolean
Can s/he ride a bicycle (even if with stabilizers)?
boolean
Does s/he try to impose routines on himself/herself, or on others, in such a way that it causes problems?
boolean
Does s/he care how s/he is perceived by the rest of the group?
boolean
Does s/he often turn conversations to his/her favorite subject rather than following what the other person wants to talk about?
boolean
Does s/he have odd or unusual phrases?
boolean
Special Needs Section: Please complete as appropriate
Have teachers/health visitors ever expressed any concerns about his/her development?
boolean
Have teachers/health visitors ever expressed any concerns about his/her development? If yes, please specify
text
Has s/he ever been diagnosed with any of the following?: Language delay
boolean
Has s/he ever been diagnosed with any of the following?: Hyperactivity/Attention Deficit Disorder (ADHD)
boolean
Has s/he ever been diagnosed with any of the following?: Hearing or visual difficulties
boolean
Has s/he ever been diagnosed with any of the following?: Autism Spectrum Condition, including Asperger's Syndrome
boolean
Has s/he ever been diagnosed with any of the following?: A physical disability
boolean
Diagnosed other
text