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OBSERVATION CHECKLIST EXPLANATION

The four page Observation Checklist is designed to assist a school’s child study team
with information to decide whether to initiate an evaluation of Autism Spectrum
Disorder (ASD). When using this checklist, information must be gathered for all four
pages. There should be significant dysfunction (several checks) in all four areas
(pages), if ASD is a possibility. If it is noted that many checks are on the sensory page,
and not on the other pages, an occupational therapy evaluation in the area of sensory
dysfunction may need to be considered. If many checks are on the language page
only, then a speech and language evaluation only may be needed. If only behavioral
and/or social skill problems are indicated, then an evaluation for emotional impairment
may be necessary. Be cautious here – carefully review the sensory section for it is
often the basis for the social and behavioral problems that arise. When all four pages
contain many checks, then the child study team should consider a referral for a special
education evaluation for ASD.

When considering the possibility of Autism Spectrum Disorder in the middle school
and/or high school student, the profile may initially appear quite different. Often these
students have a high IQ when tested, but are performing below their ability level.
Sometimes they test low yet seem brighter than the IQ suggests. What often stands
out is the lack of friends their own age and their poor social understanding. Sensory
differences are disguised or accommodated so as not to stand out. The observer will
need to review anecdotal notes and records from previous years, especially preschool
and early elementary years. A video of the student’s first birthday or other social event
in the preschool years may provide valuable information. The observation checklist
becomes an interview/record review compilation rather than an observation checklist.
When and how did the student learn to speak, and how did he speak in those early
years? What behavioral issues have surfaced, and can they be explained by looking
through the lens of ASD? Was the student ”different” but successful with teacher
support in the elementary years, but having more difficulty now that there is no longer
one teacher, but many? This checklist is much more difficult to fill out quickly when
used with an older student in middle or high school.
The Autism Society of America has provided the following 18 traits, half of which
should occur across many different situations and be inappropriate for the age of the
student, if the student does have ASD. These symptoms can range from mild to
severe.

 Difficulty mixing with other children

 Inappropriate laughing and giggling
 Little or no eye contact
 Apparent insensitivity to pain
 Prefers to be alone; aloof manner
 Spins objects
 Insistence on sameness; resists changes in routine
 No real fear of dangers
 Sustained odd play
 Echolalia (repeating words or phrases in place of normal language)
 May not want cuddling or act cuddly
 Not responsive to verbal cues; acts as deaf
 Inappropriate attachment to objects
 Noticeable physical over-activity or extreme under-activity
 Unresponsive to normal teaching methods
 Difficulty in expressing needs; uses gestures or pointing instead of words
 Tantrums-displays extreme distress for no apparent reason
 Uneven gross/fine motor skills (may not want to kick ball but can stack blocks)
 Observation Checklist
Sensory Responses
Observer name:_____________________________________________________________

Student name:______________________________________________________________

Date:______________________________________________________________________

SIGHT Taste

_____Scrutinizes visual detail for prolonged periods of time _____Has strong food preferences
_____Regards own hands for prolonged periods of time _____Has strong texture preferences
_____Regards reflection for prolonged periods of time _____Likes only a limited number of foods
_____Stares _____Existence of pica
_____Looks out of peripheral vision
_____Attends to changing levels of illumination SMELL
_____Squints or covers eyes in natural light
_____Closely regards spinning objects _____Smells food items before eating
_____Fails to blink at bright lights _____Is intensely aware of smells
_____Is fascinated with shiny objects _____Smells many objects
_____Smells parts of the body
HEARING
PAIN
_____Hums or vocalizes to block noise
_____Sometimes acts as though deaf _____Delayed response to pain
_____Closely attends to self-induced sounds _____Lacks response to injuries
_____Closely regards own screaming _____Does not seem to feel pain normally
_____Lacks startle response to loud noise
_____Delayed response to verbal directions BODY
_____Covers ears
_____Places fingers in ears _____Makes darting-lunging movements
_____Bangs objects repetitively _____Rolls fingers
_____Behavioral changes with noise _____Flips hands
_____Inability to tolerate group noise _____Rocks
_____Sensitivity to daily noises (phone ring, cough, dog bark) _____Paces
_____Runs in circles
BALANCE _____Jumps repetitively
_____Bangs head repetitively
_____Has poor balance _____Hits/bites self
_____Seeks movement _____Has facial grimaces
_____Avoids activities that challenge balance _____Grinds teeth
_____Whirls body _____Has stiff posture
_____Walks on toes _____Has flaccid body posture
_____Has unusual body posture
TOUCH _____Lacks motor coordination

_____Flinches or gives other exaggerated response when

touched
_____Does not seem to notice extreme temperature change
such as when going outdoors in cold
_____Rubs surfaces for prolonged periods of time
_____Examines surfaces with fingers
_____Removes clothing frequently
_____Is very aware of different textures
_____Rubs body where touched by another
_____Withdraws from possibility of being touched
_____Avoids getting messy
_____Needs excessive personal space
 Observation Checklist
Behavior

_____Strongly dislikes changes in routine Student shows a strong interest in:

_____Excessively tidy or precise
_____Repetitive gestures _____Phone numbers
_____Repetitive movements _____Vacuums
_____Becomes upset when his/her things are moved _____Trains
_____Cannot problem solve in active social situation _____Vehicles
_____Understands only from his/her own viewpoint _____Biology
_____Unable to empathize with others _____Weather
_____Reads for information only _____Science fiction
_____Difficulty generalizing skills learned _____Has a special interest area not listed
_____Does not handle criticism/correction well
_____Invades the personal space of others Student shows exceptional talent in:
_____Perfectionist
_____Difficulty stopping mid-task _____Decoding
_____Rigid thinking _____Memorization
_____One track mind _____Music
_____Does not learn from mistakes _____Knowledge of calendar/dates
_____Math
During the student’s spare/free time he/she: _____History

_____Watches television Student reacts to approach from peers by:

_____Usually game shows
_____Usually credits _____Ignoring
_____Usually preschool shows _____Moving away
_____Usually specific videos _____Directing
_____Plays video games _____Tantrums
_____Moves about _____Yelling
_____Manipulates objects repetitively _____Increase in repetitive behavior
_____Lines things up
_____Holds specific/familiar objects Student reacts to approach by a familiar
_____Reads adult by:
_____Plays with building toys
_____Plays with infant toys _____Ignoring
_____Plays alone _____Moving away
_____Watches others _____Directing
_____Tantrums
Student is fascinated/preoccupied with: ____Yelling
_____Increase in repetitive behavior
_____Television commercials
_____Game shows Student reacts to approach from stranger
_____Dates of the calendar by:
_____Clock times
_____People’s watches _____Ignoring
_____Numbers _____Moving away
_____Reading _____Directing
_____ _____________________________________ _____Tantrums
_____Yelling/Screaming
_____Increase in repetitive behavior
_____Is overly friendly
 Observation Checklist
Speech and Language

_____Non-verbal _____Speech is repetitive

_____Minimal speech _____Speech lacks spontaneity

Typically makes needs known by:

_____Seems to have many ideas which he/she is
_____a vague distress sound unable to express verbally

_____a vague gesture _____Has difficulty initiating conversations

_____a well-defined gesture

_____Conversation is repetitive
_____signing

_____other alternative communication system _____Has a limited number of preferred

conversation topics
_____words
_____Is not able to productively contribute to
_____phrases or sentences conversation initiated by another

_____Repeats words he/she hears immediately _____Does not use social greetings flexibly
after hearing them

_____Repeats commercials almost word for word _____Has difficulty understanding causality

_____Speech frequently lacks meaning _____Language has little evidence of

imagination or symbolism

_____Utters words, phrases, or sentences which _____Often interprets words literally

appear to have no meaningful connection
to situation in which they are said
_____Uses aberrant behavior as a form of
_____Talks to self communication

_____Understands and enjoys slap stick humor

_____Makes non-communicative sounds but fails to get the point of verbal humor

_____Talks at others rather than engaging in

_____Frequently uses personal pronouns incorrectly reciprocal conversation

_____Has difficulty understanding the ‘point of

_____Communication limited to requesting and/or view’ of others
protesting
_____Voice is overly loud or soft
_____Usually cannot answer ‘who, where, what, why’
questions
_____Uses monotonous intonation
 Observation Checklist
Social Skills
_____Does not use objects or toys in the same way _____Fails to seek comfort when distressed
as other children his/her age do

_____Uses objects or toys in unusual ways _____Often does not smile back when people smile
(peculiar or perseverative) back at him/her

_____Does not typically imitate other children in play _____Sometimes smiles or laughs ‘for no known reason’

_____Does not typically initiate play with other children _____Frequently looks frightened or anxious ‘for no
known reason’

_____Does not try to engage others in play by _____Becomes irritable ‘for no known reason’
bringing them toys, etc.

_____Engages in sensuous play rather than using _____Prefers working alone

toys symbolically

_____Will imitate pretend play when it has been taught _____Prefers being alone
to him/her

_____Engages in imaginative play but is quite repetitious _____Difficulty working in cooperative groups

_____Will respond to game or play session if approached _____Is aloof when around other people
by others

_____Seems to enjoy interactions with others, but remains _____Is indiscriminately friendly
passive

_____Has developed some relationships but more with _____Is perceived as being odd or peculiar by others
adults than peers

_____Relates to adults in more immature fashion than _____Lacks awareness of other people’s feelings
intellectual ability would suggest

_____Enjoys rough physical play primarily _____Is frequently inadvertently rude

_____Does not have a ‘best friend’ in the community _____Seems unaware of normal social conventions

_____Lacks the skills for initiating and maintaining long _____Frequently does not respond when his/her
term relationships name is called

_____Has difficulty understanding the concept of _____Is very independent, seeking very little help
taking turns from others

_____Often does not look at people when they talk to _____Often rejects affection
him/her

_____Seems to deliberately refuse to look at people _____Accept affection only when he/she feels like it
sometimes

_____When he/she looks at people he/she often _____Is preoccupied with non-living things
‘looks through’ them

_____Face often does not show emotion _____Forms attachments to unusual objects