Adapted by CAAS from the Australian Asperger’s Scale. This form involves retrospective completion for when the adult was a child.

This form is for use by parents or relatives of patients. In the absence of a parent or relative, it can be completed by the patient.

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Postal address Required
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Social and emotional abilities

Each item has a scale rated 0 - 6, where 0 is 'not at all' and 6 is 'totally'.

 

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Communication skills

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Cognitive skills

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Specific interests

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Movement skills

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For this section, tick whether the child showed any of the following characteristics:

Unusual fear or distress due to: Required
A tendency to flap or rock when excited or distressed Required
A lack of sensitivity to low levels of pain Required
Late in acquiring speech Required
Unusual facial grimaces or tics Required
Privacy policy Required