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Q.1
If you point at something across the room, does your child look at it?
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Yes
No
Q.2
Have you ever wondered if your child might be deaf?
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Yes
No
Q.3
Does your child make unusual finger movements near their eyes? (For example, does your child wiggle their fingers close to their eyes?)
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Yes
No
Q.4
Does your child get upset by everyday noises? (For example, do they scream or cry over noise such as a vacuum cleaner or loud music?)
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Yes
No
Q.5
Does your child appear to notice unusual details that others miss?
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Yes
No
Q.6
Does your child like to do things over and over again, in the same way all the time?
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Yes
No
Q.7
Does your child have an interest that takes up so much time that he or she does little else?
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Yes
No
Q.8
Does your child have difficulty understanding the rules for polite behavior?
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Yes
No
Q.9
Does your child appear to have an unusual memory for details?
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Yes
No
Q.10
If something new happens, does your child look at your face to see how you feel about it? (For example, if they hear a strange or funny noise, will they look at your face before reacting?)
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Yes
No
Q.11
Does your child understand when you tell him or her to do something? (FOR EXAMPLE, if you don't point, can your child understand "put the book on the chair" or "bring me the blanket"?)
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Yes
No
Q.12
Does your child try to get you to watch him or her? (FOR EXAMPLE, does your child look at you for praise, or say "look" or "watch me"?)
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Yes
No
Q.13
If you turn your head to look at something, does your child look around to see what you are looking at?
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Yes
No
Q.14
Does your child try to copy what you do? (FOR EXAMPLE, wave bye-bye, clap, or make a funny noise when you do)
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Yes
No
Q.15
Does your child look you in the eye when you are talking to them, playing with them, or dressing them?
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Yes
No
Q.16
When you smile at your child, do they smile back at you?
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Yes
No
Q.17
Does your child respond when you call their name? (For example, do they look up, talk or babble, or stop what they are doing when you call their name?)
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Yes
No
Q.18
Does your child show you things by bringing them to you or holding them up for you to see—not to get help, but just to share? (FOR EXAMPLE, showing you a flower, a stuffed animal, or a toy truck)
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Yes
No
Q.19
Is your child interested in other children? (For example, does your child watch other children, smile at them, or go to them?)
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Yes
No
Q.20
Does your child point with one finger to show you something interesting? (For example, pointing to an airplane in the sky or a big truck in the road. This is different from your child pointing to ask for something.)
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Yes
No
Q.21
Does your child point with one finger to ask for something or to get help? (For example, pointing to a snack or toy that is out of reach.)
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Yes
No
Q.22
Does your child like climbing on things? (FOR EXAMPLE, furniture, playground equipment, or stairs)
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Yes
No
Q.23
Does your child play pretend or make-believe? (For example, pretend to drink from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?)
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Yes
No
Q.24
Does your child like movement activities? (For example, being swung or bounced on your knee)
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Yes
No
Q.25
Does your child join in playing games with other children easily?
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Yes
No
Q.26
Does your child come up to you spontaneously for a chat?
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Yes
No
Q.27
Was your child speaking by 2 years old?
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Yes
No
Q.28
Does your child enjoy playing sports?
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Yes
No
Q.29
Is it important to your child to fit in with his or her peer group?
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Yes
No
Q.30
Can your child keep a two-way conversation going?
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Yes
No
Q.31
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