asd program

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UCC HF: To be used for students with higher functioning autism, including Asperger and PDD-NOS.

SOCIAL:

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
3	Has difficulty maintaining personal space, physically intrudes on others
4	Lacks tact or appears rude
5	Has difficulty keeping and making friends
6	Has difficulty joining an activity
7	Is naïve, easily taken advantage of, or bullied
8	Tends to be less involved in group activities than most same-age individuals
9	Has difficulty understanding others’ nonverbal communication
10	Has difficulty understanding jokes
11	Other (describe)

RESTRICTED PATTERNS OF BEHAVIOR, INTERESTS, & ACTIVITIES:

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)
12	Expresses strong need for routine or “sameness”
13	Expresses desire for repetition
14	Has eccentric or intense preoccupations or absorption in own unique interests
15	Asks repetitive questions
16	Seems to be unmotivated by customary rewards
17	Displays repetitive motor movements (e.g. hand flapping, paces, flicks fingers in front of eyes)
18	Has problems handling transition and change
19	Has strong need for closure or difficulty stopping a task before it is completed
20	Other: describe

COMMUNICATION

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)
21	Makes sounds or states words or phrases repeatedly (non-echolalic), such as humming, “well actually”
22	Makes up new words or creates alternate meanings for words or phrases
23	Displays immediate or delayed echolalia (e.g. recites lines from movies, repeats questions or statements, etc)
24	Interprets words or conversations literally, has difficulty understanding figurative language
25	Has difficulty with rules of conversations (e.g interrupts others, asks inappropriate questions, makes poor eye contact, difficulty maintaining conversations)
26	Fails to initiate or respond to social greetings
27	Has difficulty using gestures and facial expressions
28	Has difficulty starting, joining, and or ending a conversation
29	Has difficulty asking for help
30	Makes irrelevant comments
31	Has difficulty expressing thoughts and feelings
32	Speaks in an overly formal way
33	Gives false impression of understanding more than he/she actually does
34	Talks incessantly, little back-and-forth
35	Uses an advanced vocabulary
36	Uses mechanical, “sing-song” voice or speech sounds unusual in other ways (e.g. prosody, cadence, tone)
37	Has difficulty following instruction
38	Has difficulty understanding language with multiple meanings, humor, sarcasm, or synonyms
39	Has difficulty talking about others’ interests
40	Other: describe

SENSORY DIFFERENCES:

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)
41	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)
42	Responds in an unusual manner to pain (e.g. overreacts or seems unaware of illness or injury)
43	Responds in an unusual manner to taste (e.g. resists certain textures, flavors, brands)
44	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)
45	Responds in an unusual manner to temperature
46	Responds in an unusual manner to smells (e.g. may comment on smells that others do not detect)
47	Seeks activities that provide touch, pressure, or movement (e.g swinging, hugging, pacing)
48	Avoids activities that provide touch, pressure, or movement (e.g. resists wearing certain types of clothing, strongly dislikes to be dirty, resists hugs)
49	Makes noises such as humming or singing frequently
50	Other: Describe

COGNITIVE DIFFERENCES:

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)
51	Displays extensive knowledge in narrow areas of interest
52	Displays poor problem solving skills
53	Has poor organizational skills
54	Withdraws into complex, inner worlds/fantasizes often
55	Is easily distracted by unrelated details—has difficulty knowing what is relevant or makes off-topic comments
56	Displays weaknesses in reading comprehension with strong word recognition
57	Knows many facts and details but has difficulty with abstract reasoning (i.e, weak central coherence)
58	Has difficulty applying learned skills in new settings
59	Has academic skill deficits
60	Has attention problems
61	Displays very literal understanding of concepts
62	Recalls information inconsistently (i.e. seems to forget previously learned information)
63	Has difficulty understanding the connection between behavior and resulting consequences
64	Other: describe

MOTOR DIFFERENCES:

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)
65	Has balance difficulties
66	Resists or refuses handwriting tasks
67	Has poor handwriting
68	Has poor motor coordination (e.g. accident prone, difficulty using fasteners)
69	Writes slowly
70	Displays atypical activity level (e.g. over-active/hyperactive or under-active/hypoactive)
71	Has athletic skills deficits
72	Displays an awkward gait
73	Displays unusual body postures and movements or facial expressions (e.g. odd postures, stiffness, “freezing,” facial grimacing)
74	Has difficulty starting or completing actions (e.g. may rely on physical or verbal prompting by others)
75	Other: Describe

EMOTIONAL VULNERABILITY:

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)
76	Is easily stressed—worries obsessively
77	Appears to be depressed or sad
78	Has unusual fear responses (e.g. lacks appropriate fears or awareness of danger or is overly fearful)
79	Appears anxious
80	Exhibits rage reactions or “meltdowns”
81	Injures self (e.g bangs head, picks skin, bites nails until they bleed, bites self)
82	Makes suicidal comments or gestures
83	Displays inconsistent behaviors
84	Has difficulty tolerating mistakes
85	Has low frustration tolerance
86	Has low self-esteem, makes negative comments about self
87	Has difficulty identifying, quantifying, expressing and/or controlling emotions (e.g. expresses emotions only in extremes, or emotionally “flat”)
88	Has a limited understanding of own and others’ emotional responses
89	Has difficulty managing stress and/or anxiety
90	Other: Describe