The Autism Symptoms Checklist – Monitoring the 60 Signs of ...

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Please refer to our link Autism Symptoms Checklist for information on how to use this form.

The Autism Symptoms Checklist ? Monitoring the 60 Signs of Autism

BEHAVIOR SYMPTOMS

Ignoring his/her own name

Ignoring sudden or loud sounds

Adverse reaction to sudden or loud sounds

Ignoring or not understanding instructions

Defiant (Talking back, arguing)

Yelling for no particular reason

Hitting others for no particular reason

Biting non food items (Pica)

ASSESSMENT

REPETITIVE

CONTRIBUTING FACTORS

Yes / Not Really / No

Yes / Not Really / No

Yes / Not Really / No

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Pushing hard against objects or people

Throwing toys and other objects

Eats only with Hands

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Won't drink from the glass

Provoking a fight with mates or siblings

Destructive mentality

Mean to pets

Overly possessive

Bullying others or get bullied often

Laughing inappropriately

Tries to run away from situations

Hides from unknown fear

Seeks revenge

Obsessive about wanting to control

Poor communication skills

Speech problems

Does not understand other's emotions

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Cannot control his/her emotions

Cannot understand consequences of actions

Does not get motivated by rewards

Avoids difficult or unknown tasks

Doesn't like to be touched, hugged or kissed

Adverse reactions to certain smells

Has a hard time sleeping or waking up

Unwilling to try new foods

Unwilling to try new clothes or designs

Sensitive to certain fabric materials

Reclusive, prefers to be alone

Fearless to the point of danger

Afraid to the point of not attempting

No friends (for boys) or 1 friend (for girls)

Unwilling to play with others of same age

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Avoids other children

Single-minded with choice of toys

Will not play a game (indoor or outdoors)

Takes thing too personally

Does not believe in taking turns

Unwilling to share with mates and siblings

Does not role-play nor with puppets, etc

Struggles with potty training

Hides to go potty

Jealous for parent's attention

Shows signs of learning disability

Development is slow compared to peers

Shows repetitive hand or body movement

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Uses unknown or random words

Doesn't like to watch movies or animations

Obsessed about road directions

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

Will try to do things same way every time

Listens to the same track/album every time

Hates social occasions

Usually uninterested in gifts

Yes / Not Really / No

Yes / Not Really / No Yes / Not Really / No Yes / Not Really / No

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