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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