Scale Aspergers Form – Fill Out and Use This PDF

1 not true

2 rarely true

3 sometimes true

4 often true

Social and Behavioral

1

2

3

4

1.

The child has few preferred friends.

1

2

3

4

2.

The child rarely initiates play with

others.

1

2

3

4

3.

The child rarely engages in imaginative

play.

1

2

3

4

4.

The child tends to play with particular

toys in a repetitive manner.

1

2

3

4

5.

The child avoids eye contact.

1

2

3

4

6.

The child makes limited use of facial

expressions and body language to facilitate

communication.

1

2

3

4

7.

The child attempts to control play

situations (fails to sustain an interest in the

play of others).

1

2

3

4

8.

The child has difficulty in crowds.

1

2

3

4

9.

The child cannot take the perspective of

others or understand that others have

feelings and thoughts.

1

2

3

4

10. The child lacks understanding of

others’ emotions.

1

2

3

4

11. The child has difficulty expressing his

or her emotions appropriately.

1

2

3

4

12. The child prefers structured activities

over nonstructured ones.

1

2

3

4

13. The child shows a lack of awareness of

others’ personal space.

1

2

3

4

14. The child has difficulty learning the

rules of a game or interaction.

Behavioral

1

2

3

4

1.

The child displays unusual fears.

1

2

3

4

2.

The child displays an obsessive interest

in narrow or atypical topics (is ritualistic).

1

2

3

4

3.

The child is rule bound (sees things in

black and white).

1

2

3

4

4.

The child displays unusual eating habits.

1

2

3

4

5.

The child engages in perseverative

behaviors.

1

2

3

4

6.

The child’s behavior is rigid (has

difficulty with changes and transitions,

needs sameness, needs order).

1

2

3

4

7.

The child is a perfectionist (cannot

tolerate mistakes, resists learning new

tasks).

1

2

3

4

8.

The child appears anxious.

Speech and Language

1

2

3

4

1.

The child uses words in a peculiar

manner.

1

2

3

4

2.

The child does not ask for the meaning

of words.

1

2

3

4

3.

The child does not ask for help.

1

2

3

4

4.

The child does not make jokes and has

difficulty understanding joking and teasing.

1

2

3

4

5.

The child does not initiate conversation.

1

2

3

4

6.

The child has difficulty maintaining

conversation in a reciprocal format

(conversational give-and-take).

1

2

3

4

7.

The child does not inquire about others.

1

2

3

4

8.

The child “sounds” like an adult.

1

2

3

4

9.

The child says things that embarrasses

others (comments on physical

characteristics, asks probing questions).

1

2

3

4

10. The child engages in obsessive

questioning.

1

2

3

4

11. The child engages in obsessive talking

about specific topics.

1

2

3

4

12. The child does not maintain another’s

topic when it does not pertain to his or her

own special interest.

1

2

3

4

13. The child has a large vocabulary

consisting primarily of nouns and verbs.

1

2

3

4

14. The child does not use language

socially (focuses conversations on facts or

special interests).

1

2

3

4

15. The child confuses “he” and “she.”

1

2

3

4

16. The child displays unusual intonation,

pitch, and/or loudness.

1

2

3

4

17. The child uses “language scripts” when

conversing (language consists of scripts or

parts of scripts from movies/TV/books).

1

2

3

4

18. The child interprets language on a

literal level.

1

2

3

4

19. The child misses the point or main idea

of a conversation.

1

2

3

4

20. The child insists upon verbal rituals

(repeats scripts from movies/TV/books,

shares too many details).

1

2

3

4

21. The child does not exhibit gestural

communication.

1

2

3

4

22. The child has difficulty maintaining the

topic in a conversation.

Cognition

1

2

3

4

1.

The child has difficulty understanding

abstract concepts (such as guessing,

wishing, time sequence).

1

2

3

4

2.

The child displays strong memory skills.

1

2

3

4

3.

The child has difficulty with fine motor

skills.

1

2

3

4

4.

The child interprets the behavior of

others on a literal level.

1

2

3

4

5.

The child does not generalize learning

from one situation to another.

1

2

3

4

6.

The child is easily distracted.

1

2

3

4

7.

The child has difficulty sustaining

attention.

Sensory

1

2

3

4

1.

The child displays unusual sensitivity to

noises.

1

2

3

4

2.

The child displays unusual sensitivity to

smells.

1

2

3

4

3.

The child displays unusual sensitivity to

tastes.

1

2

3

4

4.

The child displays unusual sensitivity to

textures.

1

2

3

4

5.

The child displays unusual sensitivity to

being touched.

1

2

3

4

6.

The child engages in repetitive or

stereotypic movements.

1

2

3

4

7.

The child displays difficulty with motor

functioning/ planning (tying shoes, riding a

bike).

Rating Scale Results

Score

Probability of Asperger’s Syndrome

or High-Functioning PDD

58-89

Very Low

90-118

Low

119-149

Mild to Moderate

150-177

Moderate to High

178-207

High to Very High

208-232

Very High