ASSQ-REV Questionnaire English

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ASSQ-REV Questionnaire EnglishJohnny Kerr2024-09-18T11:11:50+01:00

ASSQ-REV Questionnaire English

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ASSQ-REV

Autism Spectrum Screening Questionnaire

Name of child*

Age of child*

Please enter a number greater than or equal to 0.

Child's date of birth*

Day

Month

Year

Sex*

Informant*

Rater*

Date of submission*

Day

Month

Year

This child stands out as different from other children of his/her age in the following way

1. Is old-fashioned or precocious*

0 No

1 Somewhat

2 Yes

2. Is regarded as an ”eccentric professor” by the other children*

0 No

1 Somewhat

2 Yes

3. Lives somewhat in a world of his/her own with restricted idiosyncratic intellectual interests*

0 No

1 Somewhat

2 Yes

4. Accumulates facts on certain subjects (good rote memory) but does not really understand the meaning*

0 No

1 Somewhat

2 Yes

5. Has literal understanding of ambiguous and metaphorical language*

0 No

1 Somewhat

2 Yes

6. Has a deviant style of communication with a formal, fussy, old-fashioned or “robot-like” language*

0 No

1 Somewhat

2 Yes

7. Invents idiosyncratic words and expressions*

0 No

1 Somewhat

2 Yes

8. Has a different voice or speech*

0 No

1 Somewhat

2 Yes

9. Expresses sounds involuntarily; clears throat, grunts, smacks, cries or screams*

0 No

1 Somewhat

2 Yes

10. Is surprisingly good at some things and surprisingly poor at others*

0 No

1 Somewhat

2 Yes

11. Uses language freely but fails to make adjustment to fit social contexts or the needs of different listeners*

0 No

1 Somewhat

2 Yes

12. Lacks empathy*

0 No

1 Somewhat

2 Yes

13. Makes naive and embarrassing remarks*

0 No

1 Somewhat

2 Yes

14. Has a deviant style of gaze*

0 No

1 Somewhat

2 Yes

15. Wishes to be sociable but fails to make relationships with peers*

0 No

1 Somewhat

2 Yes

16. Can be with other children but only on his/her terms*

0 No

1 Somewhat

2 Yes

17. Lacks best friend*

0 No

1 Somewhat

2 Yes

18. Lacks common sense*

0 No

1 Somewhat

2 Yes

19. Is poor at games: no idea of cooperating in a team, scores “own goals”*

0 No

1 Somewhat

2 Yes

20. Has clumsy, ill coordinated, ungainly, awkward movements or gestures*

0 No

1 Somewhat

2 Yes

21. Has involuntary face or body movements*

0 No

1 Somewhat

2 Yes

22. Has difficulties in completing simple daily activities because of compulsory repetition of certain actions or thoughts*

0 No

1 Somewhat

2 Yes

23. Has special routines: insists on no change*

0 No

1 Somewhat

2 Yes

24. Shows idiosyncratic attachment to objects*

0 No

1 Somewhat

2 Yes

25. Is bullied by other children*

0 No

1 Somewhat

2 Yes

26. Has markedly unusual facial expression*

0 No

1 Somewhat

2 Yes

27. Has markedly unusual posture*

0 No

1 Somewhat

2 Yes

28. Copies you (can be in a very discrete way)*

0 No

1 Somewhat

2 Yes

29. Episodes of eating problems*

0 No

1 Somewhat

2 Yes

30. No time perception*

0 No

1 Somewhat

2 Yes

31. Too much sympathy*

0 No

1 Somewhat

2 Yes

32. Extremely interested in pop/rock bands, soap operas or natural disasters*

0 No

1 Somewhat

2 Yes

33. Avoids demands*

0 No

1 Somewhat

2 Yes

34. Very determined*

0 No

1 Somewhat

2 Yes

35. Difficulties with choice; always avoids choosing*

0 No

1 Somewhat

2 Yes

36. Difficulties with self-care*

0 No

1 Somewhat

2 Yes

37. Carefree or over meticulous as regards physical appearance/dress*

0 No

1 Somewhat

2 Yes

38. Naive*

0 No

1 Somewhat

2 Yes

39. Comes too close to others*

0 No

1 Somewhat

2 Yes

40. Interacts mostly with younger children*

0 No

1 Somewhat

2 Yes

41. Engages in dangerous activities*

0 No

1 Somewhat

2 Yes

42. Exaggeratedly fanciful*

0 No

1 Somewhat

2 Yes

43. Talks without content*

0 No

1 Somewhat

2 Yes

44. Writes long stories (can be in stark contrast to level of talk)*

0 No

1 Somewhat

2 Yes

45. Acts or lives different parts (TV stars, videos, animals)*

0 No

1 Somewhat

2 Yes

Specify reasons other than above:

Title

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