asd program

Item

Description

Notes/examples on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

1

Has difficulty recognizing the feelings and thoughts of others (mindblindness)

2

Uses poor eye contact or fails to orient to others

3

Shows little interest or response to praise

4

Does not seek others’ attention in order to share an experience (e.g. bring an object to show, point out an item or person)

5

Interacts with others as if they were objects (e.g. cause and effect)

6

Has difficulty maintaining personal space, physically intrudes on others

7

Has difficulty taking turns in social interactions or activities

8

Has difficulty imitating the actions or words of others

9

Fails to respond to the eye gaze or pointing of others—does not orient to the object or person

10

Has difficulty making or keeping friends

11

Has difficulty joining an activity

12

Is naïve, easily taken advantage of, or bullied

13

Has difficulty waiting

14

Chooses or prefers solitary activities

15

Has difficulty understanding non-verbal communication (e.g. tone of voice, facial expressions, body language)

16

Appears to be unresponsive to others (e.g. unaware of presence of others; ignores greetings, questions, and requests)

17.

Shows little curiosity or interest in others or the immediate environment—appears to be in “own world”

18.

Other: Describe

Item

Description

Notes/examples on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

19

Expresses strong need for routine or “sameness”—has difficulty with change

20

Displays rituals/non-functional routines (e.g. must perform activities in an unusual and specific way)

21.

Uses objects in repetitive, atypical manner (e.g. meticulously lines up objects, purposefully drops objects to see them fall)

22

Seeks repetition of specific sounds, words, phrases, or music

23

Has distinct preference for objects that move

24

Has eccentric or intense preoccupations—absorbed in own unique interests

25

Attached to unusual objects

26

Seems to be unmotivated by customary rewards (e.g. stickers, social praise)

27

Displays repetitive motor movements (e.g. flaps hands, paces, rocks)

28

Has difficulty transitioning from a preferred activity

29

Has strong need for closure or difficulty stopping a task before it is completed

30

Displays difficulty engaging in activities other than intense special interests

31

Other : Describe

Item

Description

Notes/examples on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

32

Has little or no speech

33

Has difficulty expressing wants and needs

34

Makes frequent mistakes using pronouns (e.g. reverses he and she)

35

Makes sounds or states words or phrases repeatedly

36

Does not respond or shows delayed response when name is called

37

Makes up new words or creates alternate meanings for words or phrases

38

Displays immediate or delayed echolalia (e.g. recites lines from movies, repeats another person’s questions or statements, repeats sounds)

39

Asks repetitive questions

40

Talks to self excessively

41

Interprets words or conversations literally—has difficulty understanding figurative language

42

Has difficulty with rules of conversation (e.g. interrupts others, asks inappropriate questions, makes poor eye contact, has difficulty maintaining conversation, staying on topic)

43

Fails to initiate or respond to greetings

44

Communicates needs through behaviors such as crying, aggression, destruction of property

45

Has difficulty using gestures and facial expressions or makes unusual facial expressions

46

Has difficulty staring, joining, and/or ending a conversation

47

Has difficulty asking for help

48

Does not respond to comments—may speak only when asked a direct question

49

Has difficulty expressing thoughts and feelings

50

Displays absence of smile or “vacant” smile

51

Has unusual voice or speech qualities (e.g. babbles, hums, grunts; uses “sing-song” or mechanical speech)

52

Has difficulty following instructions

53

Has difficulty understanding language with multiple meanings, humor, sarcasm, or synonyms

54

Displays little pretend or imaginative play or thought

55

Other: Describe

Item

Description

Notes on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

56

Responds in an unusual manner to sounds (e.g. ignores sounds or overreacts to sudden, unexpected noises, high-pitched continuous sounds, or complex/multiple noises)

57

Responds in an unusual manner to pain (e.g. overreacts or seems unaware of illness or injury)

58

Responds in an unusual manner to taste (e.g. resists certain textures, flavors, brands)

59

Responds in an unusual manner to light or color (e.g. focuses on shiny items, shadows, reflections, shows preference or strong dislike for certain colors)

60

Responds in an unusual manner to temperature

61

Responds in an unusual manner to smells (e.g. may comment on smells that others do not detect)

62

Seeks activities that provide touch or pressure, or movement (e.g swinging, hugging, pacing)

63

Seeks activities that provide movement (e.g swinging, rocking, spinning, pacing)

64

Avoids activities that provide touch, pressure (e.g. resists wearing certain types of clothing, strongly dislikes to be dirty, resists hugs)

65

Avoids activities that provide movement (e.g. running, sports)

66

Preoccupied with sensory exploration of objects (e.g. mouths, licks, chews, sniffs, holds close to eyes, rubs, squeezes, or uses objects to make sounds)

67

Makes noises such as humming or singing frequently

68

Other: Describe

Item

Description

Notes on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

69

Has below-average or severely delayed intellectual abilities

70

Has excellent memory for details (e.g. facts, stories, movies, songs)

71

Demonstrates learned skills erratically/inconsistently (i.e. may not demonstrate skill upon request)

72

Displays weaknesses in reading comprehension but has strong word recognition

73

Has difficulty applying learned skills in new settings

74

Demonstrates academic skills deficits

75

Has attention problems

76

Has difficulty organizing self in order to initiate or complete an activity

77

Displays very literal understanding of concepts

78

Recalls information inconsistently (i.e. seems to forget previously learned information)

79

Has difficulty understanding the connection between behavior and resulting consequences

80

Other: Describe

Item

Description

Notes on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

81

Has difficulty with handwriting

82

Has atypical or weak grasp

83

Has poor motor coordination or is accident prone

84

Has difficulty using hands for fine-motor tasks (e.g. fastening, buttoning, zipping, tying shoes, using eating utensils)

85

Displays atypical activity level (e.g. over-active/hyperactive, under-active/hypoactive)

86

Has difficulty moving through environment (e.g. in and out of buildings, using stairs, walking on uneven surfaces)

87

Has athletic skills deficits

88

Displays an awkward gait

89

Displays unusual body postures and movements or facial expressions (e.g. odd postures, stiffness, “freezing, facial grimacing)

90

Has difficulty starting or completing actions (e.g. may rely on physical or verbal prompting by others)

91

Other: Describe

Item

Description

Notes on your particular student (you will complete this section if the item is applicable to your student)

Intervention (describe one specific thing you would do to address this need)

92

Is anxious or easily stressed

93

Appears to be depressed or sad

94

Becomes stressed when presented with new task or novel situation (e.g. does not initially attempt new things)

95

Has unusual fear responses—lacks appropriate fears or is overly fearful

96

Exhibits rage reactions or “meltdowns” in response to apparently minor events

97

Injures self (e.g. bangs head, picks skin, bites nails until they bleed, bites self)

98

Displays inconsistent behaviors

99

Has difficulty tolerating mistakes—own and others’

100

Has low frustration tolerance

101

Has difficulty identifying, quantifying, expressing and/or controlling emotions (e.g. can only recognize and express emotions in extremes or fails to express emotions—“emotionally “flat”)

102

Has a limited understanding of own and others’ emotional responses

103

Other: Describe