The ASD Assessment Scale / Screening Questionnaire
This is an experimental screening tool that requires a traditionally established ASD diagnosis.
NAME OF CHILD
 *
AGE OF CHILD
 *
DATE
 *
MM
/
DD
/
YYYY
1. SOCIAL INTERACTION DIFFICULTIES (with same age peer) 
 *
2. Poor eye contact, or staring from unusual angle
 *
3. Ignores when called, pervasive ignoring, not turning head to voice
 *
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