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Test Questions

Years and months 0.0.5 0.1.0 When figures are pried open, will grasp handle of spoon, rattle or like object but Must pass both a. Makes small throaty noises other than crying. b. !cti"ity ceases or lessens at the sound from a piece of paper when it is #crumpled up# close to ear, or to small blocks gently knocked together. 0.1.5 Must pass both a. When spoken to, regards the e$aminer%s face. b. When lying on back, can roll partway to side. 0.2.0 Must pass both &yes follow for at least '( second, a spoon, rattle or like object, as it is slowly mo"ed back and forth, from side to side, held about ) feet in front of infant%s face. *+ying on back or held in sitting position,. 0.2.5 0.3.0 +ifts head when lying on stomach for short '( second inter"al. *!rms in front for support,. -an too, chuckle or make gurgle sounds.

may quickly let go.

Sarsabz Foundation
Address

201-A, Peoples Colony No.1 Faisalabad Tel: 041-560751


Email Address

sarsabz@brain.net.pk,sarsabz@fsd.paknet.com.pk

Disability: Physical, Visual, Mental Accessibility Features: None Phone Number: +92 41 9220027 ,+92 41 9200120 Cell Number: Not provided Email: Not provided Website: Not Provided. Address:

Social el!are "o#ple$ %&'(round) Peoples "olony No. 1 *aisala+ad , Pun,a+

Office Timings:
Office Hours: -.00/M to 2.00PM Wor ing Days: Monday to *riday !er"ices Pro"ided: 0e1istration, #edical assess#ent and providin1 disa+ility certi!icate Publications: Not Provided

Childhood Autism Rating Scale


Typed by .aren, submitted by +ibby. /nknown copyright, don0t copy1

2irections3 4ate the beha"iors rele"ant to each item of the scale. !dd the '5 scores and use the scale at the end. 6ot responsible for typos 37, 8. 4elating to 9eople ' 6o e"ident of difficulty or abnormality in relating to people 7 The child0s beha"ior is appropriate for his or her age. :ome shyness, fussiness, or annoyance at being told what to do may be obser"ed, but not to an atypical degree. '.5 *if between these points, ) Mildly abnormal relationships 7 The child may a"oid looking the adult in the eye, a"oid the adult or become fussy if interaction is forced, be e$cessi"ely shy, not be as responsi"e to the adult as is typical, or cling to parents somewhat more than most children of the same age. ).5 *if between these points, ; Moderately abnormal relationships 7 The child shows aloofness *seems unaware of adult, at times. 9ersistent and forceful attempts are necessary to get the child0s attention at times. Minimal contact is initiated by the child. ;.5 *if between these points, < :e"erely abnormal relationships 7 The child is consistently aloof or unaware

of what the adult is doing. =e or she almost ne"er responds or initiates contact with the adult. >nly the most persistent attempts to get the child0s attention ha"e any effect.

88. 8mitation ' !ppropriate imitation 7 The child can imitate sounds, words, and mo"ements which are appropriate for his or her skill le"el. '.5 *if between these points, ) Mildly abnormal imitation 7 The child imitates simple beha"iors such as clapping or single "erbal sounds most of the time? occasionally, imitates only after prodding or after a delay. ).5 *if between these points, ; Moderately abnormal imitation 7 The child imitates only part of the time and requires a great deal of persistence and help from the adult? frequently imitates only after a delay. ;.5 *if between these points, < :e"erely abnormal imitation 7 The child rarely or ne"er imitates sounds, words, or mo"ements e"en with prodding and assistance from the adult.

888. &motional response ' !ge7appropriate and situation7appropriate emotional responses 7 The child shows the appropriate type and degree of emotional response as indicated by a change in facial e$pression, posture, and manner. '.5 *if between these points,

) Mildly abnormal emotional responses 7 The child occasionally displays a somewhat inappropriate type or degree of emotional reactions. 4eactions are sometimes unrelated to the objects or e"ents surrounding them. ).5 *if between these points, ; Moderately abnormal emotional responses 7 The child shows definite signs of inappropriate type and@or degree of emotional response. 4eactions may be quite inhibited or e$cessi"e and unrelated to the situation? may grimace, laugh, or become rigid e"en though no apparent emotion7producing objects or e"ents are present. ;.5 *if between these points, < :e"erely abnormal emotional responses 7 4esponses are seldom appropriate to the situation? once the child gets in a certain mood, it is "ery difficult to change the mood. -on"ersely, the child may show wildly different emotions when nothing has changed.

8A. Body /se ' !ge appropriate body use 7 The child mo"es with the same ease, agility, and coordination of a normal child of the same age. '.5 *if between these points, ) Mildly abnormal body use 7 :ome minor peculiarities may be present, such as clumsiness, repetiti"e mo"ements, poor coordination, or the rare appearance of more unusual mo"ements. ).5 *if between these points, ; Moderately abnormal body use 7 Beha"iors that are clearly strange or unusual for a child of this age may include strange finger mo"ements, peculiar finger or body posturing, staring or picking at the body, self7directed aggression, rocking, spinning, finger7wiggling, or toe7walking.

;.5 *if between these points, < :e"erely abnormal body use 7 8ntense or frequent mo"ements of the type listed abo"e are signs of se"erely abnormal body use. These beha"iors may persist despite attempts to discourage them or in"ol"e the child in other acti"ities.

A. >bject /se ' !ppropriate use of, and interest in, toys and other objects 7 The child shows normal interest in toys and other objects appropriate for his or her skill le"el and uses these toys in an appropriate manner. '.5 *if between these points, ) Mildly inappropriate interest in, or use of, toys and other objects 7 The child may show atypical interest in a toy or play with it in an inappropriate childish way *e.g., banging or sucking on the toy,. ).5 *if between these points, ; Moderately inappropriate interest in, or use of, toys and other objects 7 The child may show little interest in toys or other objects, or may be preoccupied with using an object or toy in some strange way. =e or she may focus on some insignificant part of a toy, become fascinated with light reflecting off the object, repetiti"ely mo"e some part of the object, or play with one object e$clusi"ely. ;.5 *if between these points, < :e"erely inappropriate interest in, or use of, toys or other objects 7 The child may engage in the same beha"iors as abo"e, with greater frequency and intensity. The child is difficult to distract when engaged in these inappropriate acti"ities.

A8. !daptation to -hange ' !ge appropriate response to change 7 While the child may notice or comment on changes in routine, he or she accepts these changes without undue distress. '.5 *if between these points, ) Mildly abnormal adaptation to change 7 When an adult tries to change tasks the child may continue the same acti"ity or use the same materials. ).5 *if between these points, ; Moderately abnormal adaptation to change 7 The child acti"ely resists changes in routine, tries to continue the old acti"ity, and is difficult to distract. =e or she may become angry and unhappy when an established routing is altered. ;.5 *if between these points, < :e"erely abnormal adaptation to change 7 The child shows se"ere reactions to change. 8f a change is forced, he or she may become e$tremely angry or uncooperati"e and respond with tantrums.

A88. Aisual 4esponse ' !ge appropriate "isual response 7 The child0s "isual beha"ior is normal and appropriate for that age. Aision is used together with other senses as a way o e$plore a new object. '.5 *if between these points, ) Mildly abnormal "isual response 7 The child much be occasionally reminded to look at objects. The child may be more interested in looking at mirrors or lighting than peers, may occasionally stare off into space, or may also a"oid looking people in the eye.

).5 *if between these points, ; Moderately abnormal "isual response 7 The child must be reminded frequently to look at what he or she is doing. =e or she may stare into space, a"oid looking people in the eye, look at objects from an unusual angle, or hold objects "ery close to the eyes. ;.5 *if between these points, < :e"erely abnormal "isual response 7 The child consistently a"oids looking at people or certain objects and may show e$treme forms of other "isual peculiarities described abo"e.

A888. +istening 4esponse ' !ge appropriate listening response 7 The child0s listening beha"ior is normal and appropriate for age. +istening is used together with other senses. '.5 *if between these points, ) Mildly abnormal listening response 7 There may be some lack of response, or mild o"erreaction to certain sounds. 4esponses to sounds may be delayed, and sounds may need repetition to catch the child0s attention. The child may be distracted by e$traneous sounds. ).5 *if between these points, ; Moderately abnormal listening response 7 The child0s responses to sounds "ary? often ignores a sound the first few times it is made? may be startled or co"er ears when hearing some e"eryday sounds. ;.5 *if between these points, < :e"erely abnormal listening response 7 The child o"erreacts and@or under

reacts to sounds to an e$tremely marked degree, regardless of the type of sound.

8C. Taste, :mell, and Touch 4esponse and /se ' 6ormal use of, and response to, taste, smell, and touch 7 The child e$plores new objects in an age appropriate manner, generally by feeling and looking. Taste or smell may be used when appropriate. When reacting to minor, e"eryday pain, the child e$presses discomfort but does not o"erreact. '.5 *if between these points, ) Mildly abnormal use of, and response to, taste, smell, and touch 7 The child may persist in putting objects in his or her mouth? may smell or taste inedible objects? may ignore or o"erreact to mild pain that a normal child would e$press as discomfort. ).5 *if between these points, ; Moderately abnormal use of, and response to, taste, smell, and touch 7 The child may be moderately preoccupied with touching, smelling, or tasting objects or people. The child may either react too much or too little. ;.5 *if between these points, < :e"erely abnormal use of, and response to, taste, smell, and touch 7 The child is preoccupied with smelling, tasting, or feeling objects more for the sensation than for normal e$ploration or use of the objects. The child may completely ignore pain or react "ery strongly to slight discomfort.

C. Dear or 6er"ousness ' 6ormal fear or ner"ousness 7 The child0s beha"ior is appropriate both to the situation and to his or her age.

'.5 *if between these points, ) Mildly abnormal fear or ner"ousness 7 The child occasionally shows too much of too little fear or ner"ousness compared to the reaction of a normal child of the same age in a similar situation. ).5 *if between these points, ; Moderately abnormal fear or ner"ousness 7 The child shows either quite a bit more or quite a bit less fear than is typical e"en for a younger child in a similar situation. ;.5 *if between these points, < :e"erely abnormal fear or ner"ousness 7 Dears persist e"en after repeated e$perience with harmless e"ents or objects. 8t is e$tremely difficult to calm or comfort the child. The child may, con"ersely, fail to show appropriate regard for haEards which other children of the same age a"oid.

C8. Aerbal -ommunication ' 6ormal "erbal communication, age and situation appropriate. '.5 *if between these points, ) Mildly abnormal "erbal communication 7 :peech shows o"erall retardation. Most speech is meaningful? howe"er, some echolalia or pronoun re"ersal may occur. :ome peculiar words or jargon may be used occasionally. ).5 *if between these points, ; Moderately abnormal "erbal communication 7 :peech may be absent. When present, "erbal communication may be a mi$ture of some meaningful speech and some peculiar speech such as jargon, echolalia, or pronoun re"ersal.

9eculiarities in meaningful speech include e$cessi"e questioning or preoccupation with particular topics. ;.5 *if between these points, < :e"erely abnormal "erbal communication 7 Meaningful speech is not used. The child may make infantile squeals, weird or animal7like sounds, comple$ noises appro$imating speech, or may show persistent, biEarre use of some recogniEable words or phrases.

C88. 6on"erbal -ommunication ' 6ormal use of non"erbal communication, age and situation appropriate. '.5 *if between these points, ) Mildly abnormal use of non"erbal communication 7 8mmature use of non"erbal communication? may only point "aguely, or reach for what he or she wants, in situations where same7age child may point or gesture more specifically to indicate what he or she wants. ).5 *if between these points, ; Moderately abnormal use of non"erbal communication 7 The child is generally unable to e$press needs or desires non"erbally, and cannot understand the non"erbal communication of others. ;.5 *if between these points, < :e"erely abnormal use of non"erbal communication 7 The child only uses biEarre or peculiar gestures which ha"e no apparent meaning, and shows no awareness of the meanings associated with the gestures or facial e$pressions of others.

C888. !cti"ity +e"el ' 6ormal acti"ity le"el for age and circumstances 7 The child is neither more acti"e nor less acti"e than a normal child of the same age in a similar situation. '.5 *if between these points, ) Mildly abnormal acti"ity le"el 7 The child may either be mildly restless or somewhat FlaEyF and slow mo"ing at times. The child0s acti"ity le"el interferes only slightly with his or her performance. ).5 *if between these points, ; Moderately abnormal acti"ity le"el 7 The child may be quite acti"e and difficult to restrain. =e or she may ha"e boundless energy and may not go to sleep readily at night. -on"ersely, the child may be quite lethargic, and need a great deal of prodding to get him or her to mo"e about. ;.5 *if between these points, < :e"erely abnormal acti"ity le"el 7 The child e$hibits e$tremes of acti"ity or inacti"ity and may e"en shift from one e$treme to the other.

C8A. +e"el and -onsistency of 8ntellectual 4esponse ' 8ntelligence is normal and reasonably consistent across "arious areas 7 The child is as intelligent as typical children of the same age and does not ha"e any unusual intellectual skills or problems. '.5 *if between these points, ) Mildly abnormal intellectual functioning 7 The child is not as smart as typical children of the same age? skills appear fairly retarded across all areas.

).5 *if between these points, ; Moderately abnormal intellectual functioning 7 8n general, the child is not as smart as typical children of the same age? howe"er, the child may function nearly normally in one or more intellectual areas. ;.5 *if between these points, < :e"erely abnormal intellectual functioning 7 While the child is not as smart as the typical child of his age, he or she may function e"en better than the normal child of the same age in one or more areas.

CA. General 8mpressions ' 6o autism 7 The child shows none of the symptoms characteristic of autism. '.5 *if between these points, ) Mild autism 7 The child shows only a few symptoms or only a mild degree of autism. ).5 *if between these points, ; Moderate autism 7 The child shows a number of symptoms or a moderate degree of autism. ;.5 *if between these points, < :e"ere autism 7 The child shows many symptoms or an e$treme degree of autism.

'57;( 7 6on7autistic

;(7;H 7 Mildly7Moderately autistic ;H7I( 7 :e"erely autistic


:eptember '), 'JJK :hannon !nderson

M-CHAT Online Test

M-CHAT (Modified Checklist for Autism in Toddlers)


Instructions for Taking and Scoring the M-CHAT (Available in other languages here.) A child should be referred for further evaluation when any three answers suggest risk for ASD, as indicated by the list of ASD risk responses that follow the questions. Please answer questions to reflect your childs usual behaviors. If the behavior is rare (e.g., you've seen it only once or twice), answer as if the child has not acquired the behavior. 1. Does your child en oy being swung, bounced on your knee, etc.! Answer 1 1. Yes

2. No Does your child take an interest in other children!

!nswer ) 1. 2. !nswer ; 1. 2. !nswer < 1. 2. Yes No Yes No


Does your child en oy playing peek#a#boo$hide#and#seek!

Yes No
Does your child like cli"bing on things such as stairs!

Does your child ever pretend, for e%a"ple, to talk on the phone or take care of a doll or other pretend things!

!nswer 5 1. 2. !nswer I 1. 2. !nswer H 1. 2. !nswer K 1. 2. !nswer J 1. 2. !nswer '( 1. 2. !nswer '' 1. 2. !nswer ') 1. 2. !nswer '; 1. 2. Yes No
Does your child respond to his$her na"e when you call!

Yes No
Does your child ever use an inde% finger to point, to ask for so"ething!

Yes No
Does your child ever use an inde% finger to point, to indicate interest in so"ething!

Yes No
&an your child play properly with s"all toys (e.g. cars or blocks) without ust "outhing, fiddling, or dropping the"!

Yes No
Does your child ever bring ob ects over to you (parent) to show you so"ething!

Yes No
Does your child look you in the eye for "ore than a second or two!

Yes No
Does your child ever see" oversensitive to noise! (e.g., plugging ears)

Yes No
Does your child s"ile in response to your face or your s"ile!

Yes No
Does your child i"itate you! (e.g. 'f you "ake a face, will your child do so!)

!nswer '< 1. 2. !nswer '5 1. 2. !nswer 'I 1. 2. !nswer 'H 1. 2. !nswer 'K 1. 2. !nswer 'J 1. 2. !nswer )( 1. 2. !nswer )' 1. 2. !nswer )) 1. 2. !nswer ); 1. Yes Yes No
Does your child look at your face to check your reaction when faced with the unfa"iliar!

Yes No
'f you point at a toy across the roo", does your child look at it!

Yes No
Does your child walk!

Yes No
Does your child look at things you are looking at!

Yes No
Does your child "ake unusual finger "ove"ents near his$her face!

Yes No
Does your child try to attract your attention to his$her own activity!

Yes No
(ave you ever wondered if your child is deaf!

Yes No
Does your child understand what people say!

Yes No
Does your child so"eti"es stare at nothing or wander with no purpose!

2.

No
M-CHAT (Modified Checklist for Autism in Toddlers) M-CHAT Risk Score: 16
)his score suggests that your toddler is at elevated risk for autis" or another develop"ental disorder and should be evaluated by a specialist for early intervention services. *or resources in your area, see our website+s list of Autis" )reat"ent ,etwork clinics and state#by#state -esource .uide. /ou can also call or e"ail our Autis" -esponse )ea"0 111#A2)'S34 (411#5674)8 fa"ilyservices9autis"speaks.org. )his questionnaire is designed to screen for autis", not other develop"ental issues. 'f you have concerns about any area of your child+s develop"ent or behavior, please discuss these concerns with your child+s doctor. :rint &o"pleted )est ; -esults )he &(A) (&hecklist for Autis" in )oddlers) test is given to children ages 11 "onths to 45 years. 't is a quick five "inute test that can show a care giver or a "edical provider if a child has several "arkers that "ay indicate the presence of autis" spectru" disorder. 't should be "entioned that your pediatrician should be consulted i""ediately if you consider that your child "ay have a develop"ental delay. )he sooner a child receives treat"ent, the better his or her response "ay be to therapy. Autis" is actually a diagnosis that enco"passes several different disorders, all of which affect a child causing develop"ental delays. 3ost notably, in autis" there tends to be "a or speech and co""unicative delays, but in so"e other for"s of Autis" Spectru" Disorder, the speech and co""unication develops nor"ally, so"eti"es even at an accelerated pace, such as Aspergers Syndro"e. &reated by0 <anet =owser of <ust A 3o", )hat+s 3ore )han >nough

1. What is your age?

(your link here "ore info)

/nder 'K Lears >ld 'K to )< Lears >ld )5 to ;( Lears >ld ;' to <( Lears >ld <' to 5( Lears >ld 5' to I( Lears >ld >"er I( Lears >ld
2. What is your gender?

Male Demale
3. Does your child enjoy being swung, bounced on your knee, etc?

yes no
4. Does your child take an interest in other children?

yes no
5. Does your child like climbing on things, such as u stairs?

yes no
!. Does your child enjoy laying eek"a"boo#hide"and"seek?

yes no
$. Does your child e%er retend, &or e'am le, to talk on the hone or take care o& dolls, or retend other things?

yes no
(. Does your child e%er use his#her inde' &inger to oint, to ask &or something?

yes no
). *an your child lay ro erly with small toys +e.g. cars or bricks, without just mouthing, &iddling, or dro ing them?

yes

no
1-. Does your child e%er bring objects o%er to you + arent, to show you something?

yes no
11. Does your child look you in the eye &or more than a second or two?

yes no
12. Does your child e%er seem o%ersensiti%e to noise? +e.g., lugging ears,

yes no
13. Does your child smile in res onse to your &ace or your smile?

yes no
14. Does your child imitate you? +e.g., you make a &ace"will your child imitate it?,

yes no
15. Does your child res ond to his#her name when you call?

yes no
1!. .& you oint at a toy across the room, does your child look at it?

yes no
1$. Does your child walk?

yes no
1(. Does your child look at things you are looking at?

yes no
1). Does your child make unusual &inger mo%ements near his#her &ace?

yes no
2-. Does your child try to attract your attention to his#her own acti%ity?

yes no
21. /a%e you e%er wondered i& your child is dea&?

yes no
22. Does your child understand what eo le say?

yes no

23. Does your child sometimes stare at nothing or wander with no ur ose?

yes no
24. Does your child look at your &ace to check your reaction when &aced with something un&amiliar?

yes no
Su+#it /ns2 ers