It can be hard to know where to start when you suspect that either yourself or someone you love has Autism. With long waiting lists for formal evaluations many people are left wondering for months and even years. This checklist can be a helpful starting point but it is not meant to be used as a diagnostic tool. If you have any concerns it is best to speak with you or your child’s doctor, psychologist, mental health therapist, social worker or school for more information on where and how to get evaluated.
Autism Symptom Checklist
1. Persistent deficits in social communication and social interactions across multiple contexts, as manifested by the following currently or by history (Must meet criteria for A-C)
- A. Deficits in social emotional reciprocity
- Abnormal social approach
- Intrusive touching
- Licking others
- Use of others as tools
- Lack of “personal bubble”
- Failure of back and forth conversation
- Poor social use of language
- Does not clarify when misunderstood
- Does not provide background information
- Failure to respond when name is being called or being directly spoken to
- Does not initiation conversations
- One-sided conversations/monologues/tangential speech
- Stares without responding
- Reduced sharing of interests
- Lack of showing/bringing objects of interests to other people
- Lack of pointing to objects of interest
- Impairments in initiating and/or responding to joint attention
- Reduced sharing of emotions/affect
- Lack of responsive social smile
- Failure to share enjoyment, excitement or achievements with others
- Failure to respond to praise
- Does not show pleasure in social interactions
- Failure to offer comfort to others
- Indifference/aversion to physical contact or affection
- Does not share emotions/affect verbally
- Failure to initiate social interactions
- Only initiates to get help
- Limited social initiations
- Failure to respond to social interactions
- Failure to engage in simple social games
- Abnormal social approach
- B. Deficits in nonverbal communicative behaviors used to social interaction
- Poorly integrated verbal and nonverbal communication
- Abnormal speech prosody (features of speech that contribute to meaning)
- Volume (loud, soft)
- Pitch (high, low)
- Intonation (rising and falling of pitch of voice when saying word or sentence is abnormal)
- Rate (fast, slow)
- Rhythm (pattern is abnormal)
- Stress (emphasis on syllable or word is abnormal)
- Limited communication of affect through tone of voice
- Abnormalities in eye contact
- Avoidant eye contact
- Darting eye contact
- Overly intense direct eye contact
- Abnormal speech prosody (features of speech that contribute to meaning)
- Abnormalities in body language
- Facing away from listener
- Deficits in understanding and use of gestures
- Failure to follow where someone points without words
- Failure to point at things
- Failure to wave
- Failure to nod or shake head
- Limited communication of affect through gestures (crossed arms or puffing of chest when mad)
- Deficits in understanding and use of facial expression
- Impairment in the use of facial expressions
- Limited
- Exaggerated
- Lack of warm, joyful expressions directed at others
- Limited communication of affect through facial expression
- Inability or difficulty recognizing or interpreting other people’s nonverbal expressions
- Impairment in the use of facial expressions
- Deficits in understanding and use of nonverbal communication
- Inability to coordinate eye contact or body language with words
- Inability to coordinate eye contact with gestures
- Poorly integrated verbal and nonverbal communication
- C. Deficits in developing, maintaining and understanding relationships
- Difficulties adjusting behavior to suit various social contexts
- Unaware of social rules or appropriate behavior
- Lack of response to contextual cues indicating a change or behavior has been requested
- Does not notice another person’s lack of interest in an activity
- Does not recognize when not welcome to play or join conversation
- Does not notice when being teased
- Does not notice how their behavior impacts others
- Inappropriate expression of emotion (laughing or smiling out of context)
- Asks inappropriate questions or says inappropriate statements
- Difficulties in sharing imaginative play
- Lack of imaginative play with peers (over age 4 only)
- Difficulties making friends
- Does not play with people his or her age/developmental level (prefers younger or older)
- Lack of cooperative play (over age 2 only)
- Does not play in groups
- Does not try to make friends
- Does not have preferred friends
- Has an interest in friendships but lacks understanding of social conventions required to be successful
- Extremely directive or rigid
- Overly passive
- Inability to take another person’s perspective (over age 4 only)
- Absence of interest in peers
- Lack of interest in peers
- Withdrawn or in own world
- Unaware or oblivious of others
- Does not try to attract attention of others
- Limited interactions with others
- Prefers solitary activities
- Difficulties adjusting behavior to suit various social contexts
2. Restricted, repetitive patterns of behavior, interests or activities as manifested by at least 2 of the following currently or by history (Must meet criteria for 2 items in D-G)
- D. Stereotyped or repetitive motor movements, use of objects or speech
- Stereotyped or repetitive motor movements
- Repetitive one or two step actions
- Repetitive hand movements
- Clapping or flapping
- Finger flicking or hand twisting
- Repetitive whole body movements
- Rocking or swaying
- Spinning
- Abnormalities of posture
- Toe walking
- Full body posturing
- Extreme body tensing
- Unusual facial grimacing
- Excessive teeth grinding
- Repetitive picking
- Stereotyped or repetitive use of objects
- Nonfunctional play with objects
- Waving sticks, dropping items, spinning tires
- Lines up toys or objects
- Puts toys or objects into piles
- Stacks toys or objects
- Repetitively opens and closes doors
- Repetitively turns lights on and off
- Nonfunctional play with objects
- Stereotyped or repetitive speech
- Echolalia (immediate or delayed echoing)
- Repetition of words, phrases, songs or dialogues
- Unusually formal language
- Jargon or gibberish (over age 2 only)
- Use of rote language (memorized language)
- Idiosyncratic or metaphorical language (language that only has meaning to those familiar with the individual’s style of communication)
- Neologisms
- Preservative language (repetition of a particular response)
- Repetitive vocalizations
- Guttural sounds, unusual squealing, repetitive humming
- Pronoun reversals “you” and “I”
- Refers to self by own name instead of using “I”
- Echolalia (immediate or delayed echoing)
- Stereotyped or repetitive motor movements
- E. Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior
- Insistence on sameness
- Excessive resistance to change
- Drives same route each day
- Eats same food each day
- Difficulty with transitions (beyond what is age-appropriate)
- Overreaction to trivial changes (moving a lamp to other side of chair)
- Excessive resistance to change
- Inflexible adherence to routines (3+ step behavior patterns)
- Insistence on rigidly following routines
- Unusual routines
- Ritualized patterns of verbal or nonverbal behavior
- Repetitive questioning about a particular topic
- Verbal rituals
- Says one or more things in a specific way
- Requires others to say something to them in a specific way
- Compulsions (turning in a circle 3 times before entering a room)
- Rigid thinking
- Rigid behaviors
- Rigid thought patterns
- Being overly perfectionistic
- Inability to understand non-literal speech (irony or implied meanings)
- Inability to understand humor
- Insistence on sameness
- F. Highly restricted, fixated interests that are abnormal in intensity or focus
- Narrow range of interests
- Highly restricted/fixated interests
- Abnormal in intensity (depth of knowledge is abnormal)
- Obsessions or preoccupations
- Abnormal in focus (topic of knowledge is abnormal)
- Preoccupation with numbers, letters or symbols
- Preoccupation with color, historical events, weather
- Excessive focus on non-relevant or non-functional parts of objects
- Attachment to unusual inanimate object (rubber band or piece of string)
- Having to carry around or hold specific or unusual objects (cracker, card, rock; not stuffed animals or blankets)
- Unusual fears (people wearing earrings)
- Abnormal in intensity (depth of knowledge is abnormal)
- G. Hyper-reactivity or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment
- Hyper-reactivity: avoids / overreacts to
- Visual (sight)
- Tactile (light touch, deep pressure, texture, temperature, vibration, pain)
- Olfactory (smell)
- Auditory (hearing)
- Gustatory (taste)
- Vestibular (sense of movement)
- Proprioceptive (body awareness from sensations from joints, muscles, connective tissues)
- Hypo-reactivity: seeks / does not notice
- Visual (sight)
- Tactile (light touch, deep pressure, texture, temperature, vibration, pain)
- Olfactory (smell)
- Auditory (hearing)
- Gustatory (taste)
- Vestibular (sense of movement)
- Proprioceptive (body awareness from sensations from joints, muscles, connective tissues)
- Unusual interests in sensory aspects of environment
- Hyper-reactivity: avoids / overreacts to
Please note:
The ability to use verbal language is not mentioned in the official Autism criteria. Verbal language is a cognitive skill and the ability to speak depends on whether certain areas of the brain are working correctly. Autism does not impact these areas directly but many conditions associated with Autism like Fragile X, seizure disorders, global developmental delays can impact the language areas of the brain resulting in a person not being able to verbally communicate.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)