Asperger's Syndrome Checklist

1

Name* This field is required.

First Name

Last Name

2

Age Range* This field is required.

3

Gender* This field is required.

4

Email* This field is required.

example@example.com

5

1. General social skills: He/she wants to socialise with others but does not understand how to interact.* This field is required.

YESNO

6

2. Relating to others: He/she does not accurately understand others' emotions or social responses in a group situation. He/she may not know if an activity or conversation is boring or upsetting to another person.* This field is required.

YESNO

7

3. Difficulty playing with others: He/she may not understand how to initiate play with his/her peers or how to play by common social rules. For example, he/she may take a ball from a group of children playing a game without asking to join the game first. He/she will not return the ball if they ask for the ball back.* This field is required.

YESNO

8

4. Problems with a two-way conversation: He/she has trouble initiating and maintaining a two-way conversation. He/she may appear to talk at someone than with him. Conversation topics may focus on an obsessive interest. He/she speaks inappropriately such as talking too loudly or softly.* This field is required.

YESNO

9

5. Inability to understand common social cues: He/she may not comprehend common social cues such as facial expressions, body language or gestures.* This field is required.

YESNO

10

6. Rigid range of interests for social interaction: He/she will only engage in a narrow range of activities or talk about certain subjects.* This field is required.

YESNO

11

7. Inappropriate responses: He/she may behave or respond to social situations in an unusual or inappropriate manner. For example, an affected person may laugh at something sad.* This field is required.

YESNO

12

8. Eye contact: He/she may not make eye contact.* This field is required.

YESNO

13

9. Unusual gestures: He/she might make unusual or inappropriate gestures during conversation.* This field is required.

YESNO

14

10. Facial expression: Facial expressions are either absent or inappropriate to the conversation or situation. He/she may have facial tics.* This field is required.

YESNO

15

11. Personal space issues: He/she might stand too close to a person during conversation.* This field is required.

YESNO

16

12. Monotone speech: He/she may speak in a monotone voice, without expression or emotion.* This field is required.

YESNO

17

13. Easily distracted: He/she has trouble concentrating his attention on people and objects that are not connected with his favourite subjects.* This field is required.

YESNO

18

14. Difficulty with language use: He/she has difficulty using language appropriately in social situations. He/she may also misunderstand common word meanings.* This field is required.

YESNO

19

15. Unusual use of words: He/she may use words in an unusual way or create her own words.* This field is required.

YESNO

20

16. Language rituals: He/she might have specific word scripts that he/she repeats ritualistically in conversation with others.* This field is required.

YESNO

21

17. Difficulty processing language: He/she does not always understand verbal speech or misunderstands the meaning of a conversation. He/she may have trouble making a decision or answering a question.* This field is required.

YESNO

22

18. Literal interpretation of words: He/she interprets most language on a literal level and misses abstract meanings.* This field is required.

YESNO

23

19. Mindblindness: He/she has mindblindness, meaning he/she cannot determine what others think and feel in social situations or relationships.* This field is required.

YESNO

24

20. Problem-solving issues: He/she has trouble figuring out how to solve problems outside of his/her routine.* This field is required.

YESNO

25

21. Organisational skills difficulties: He/she experiences difficulty with planning, implementing and completing tasks. * This field is required.

YESNO

26

22. Difficulty with imaginative play: He/she does not engage in imaginative play as a child. * This field is required.

YESNO

27

23. Visually: He/she has trouble learning without visual aids.* This field is required.

YESNO

28

24. Problems with coordination: He/she may have problems with both fine and gross motor skills. Common examples of motor skill difficulty include bike riding, handwriting and playing ball games.* This field is required.

YESNO

29

25. Strict schedule: He/she prefers a rigid schedule and experiences anxiety when the schedule is interrupted.* This field is required.

YESNO

30

26. Narrow range of interests and obsessions: He/she is intensely interested in a small number of activities and subjects and refuses to engage in other activities.* This field is required.

YESNO

31

27. Self-stimulatory behaviour: He/she may engage in "stimming" behaviour such as hand-flapping, rocking back and forth or twirling.* This field is required.

YESNO

32

28. Odours: He/she may react strongly to certain smells.* This field is required.

YESNO

33

29. Sounds: He/she might be hypersensitive to different sounds.* This field is required.

YESNO

34

30. Touch: He/she may not want to be touched.* This field is required.

YESNO

35

31. Limited food choices: He/she may choose and reject foods based on smell or texture.* This field is required.

YESNO

36

Your Score

37

You answered

Yes to {yourScore}

out of 31 Questions

If you have a majority of positives on this checklist this may indicate that referral for a more in-depth assessment is desirable.

PLEASE CHECK YOUR JUNK OR TRASH FOLDER, IF THE EMAIL WITH YOUR RESULTS FAILS TO ARRIVE IN YOUR INBOX