ASSQ Autism Spectrum Screening Questionnaire (7-16 years)
Ehlers, Gillberg, Wing 1999
Name of Child
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date
Gender
Who completed the answers?
First Name
Last Name
Relationship to Child
Email address (that you would like the results sent to)
example@example.com
Address
Street Address
Street Address Line 2
City
County
Post code
Phone Number
-
Area Code
Phone Number
Date of completion
-
Day
-
Month
Year
Date
This child stands out as different from other children of his/her age in the following way
No (0)
Somewhat (1)
Yes (2)
1. Is old-fashioned or precocious
2. Is regarded as an ”eccentric professor” by the other children
3. Lives somewhat in a world of his/her own with restricted idiosyncratic
intellectual interests
4. Accumulates facts on certain subjects (good rote memory) but does not
really understand the meaning
5. Has literal understanding of ambiguous and metaphorical language
6. Has a deviant style of communication with a formal, fussy, old-fashioned
or “robot-like” language
7. Invents idiosyncratic (peculiar/individual) words and expressions.
8. Has a different voice or speech
9. Expresses sounds involuntarily; clears throat, grunts, smacks, cries or
screams
10. Is surprisingly good at some things and surprisingly poor at others
11. Uses language freely but fails to make adjustment to fit social contexts
or the needs of different listeners
12. Lacks empathy
13. Makes naive and embarrassing remarks
14. Has a deviant style of gaze (looks away)
15. Wishes to be sociable but fails to make relationships with peers
16. Can be with other children but only on his/her terms
17. Lacks best friend
18. Lacks common sense
19. Is poor at games: no idea of cooperating in a team, scores “own goals”
20. Has clumsy, ill coordinated, ungainly, awkward movements or gestures
21. Has involuntary face or body movements
22. Has difficulties in completing simple daily activities because of
compulsory repetition of certain actions or thoughts
23. Has special routines: insists on no change
24. Shows idiosyncratic (unusual) attachment to objects
25. Is bullied by other children
26. Has markedly unusual facial expression
27. Has markedly unusual posture
28. Copies you (can be in a very discrete way)
29. Episodes of eating problems
30. No time perception
31. Too much sympathy
32. Extremely interested in pop/ rock bands, soap operas or natural
disasters
33. Avoids demands
34. Very determined
35. Difficulties with choice; always avoids choosing
36. Difficulties with self-care
37. Carefree or over meticulous as regards physical appearance/dress
38. Naive
39. Comes too close to others
40. Interacts mostly with younger children
41. Engages in dangerous activities
42. Exaggeratedly fanciful
43. Talks without content
44. Writes long stories (can be in stark contrast to level of talk)
45. Acts or lives different parts (TV stars, videos, animals)
Specify reasons other than above:
Submit
Should be Empty: