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    Autism Spectrum Disorder Checklist: Criterion

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    Archana Sharma
    This document provides an autism spectrum disorder checklist based on the DSM-5 diagnostic criteria. It includes two main criteria: persistent deficits in social communication/interaction and restricted, repetitive behaviors/interests. For each criteria, it lists specific symptoms and asks the evaluator to indicate how each symptom is documented, such as through an ADOS assessment or observation. It also includes specifiers like intellectual impairment, language impairment, known etiological factors, associated disorders, and severity level. The checklist is used to systematically document whether a child meets the diagnostic criteria for autism spectrum disorder.

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    Autism Spectrum Disorder Checklist: Criterion

    Uploaded by

    Archana Sharma
    176 views1 page
    This document provides an autism spectrum disorder checklist based on the DSM-5 diagnostic criteria. It includes two main criteria: persistent deficits in social communication/interaction and restricted, repetitive behaviors/interests. For each criteria, it lists specific symptoms and asks the evaluator to indicate how each symptom is documented, such as through an ADOS assessment or observation. It also includes specifiers like intellectual impairment, language impairment, known etiological factors, associated disorders, and severity level. The checklist is used to systematically document whether a child meets the diagnostic criteria for autism spectrum disorder.

    Original Description:

    ASD criteria

    Original Title

    3-20-autismDSM5checklist

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    This document provides an autism spectrum disorder checklist based on the DSM-5 diagnostic criteria. It includes two main criteria: persistent deficits in social communication/interaction and restricted, repetitive behaviors/interests. For each criteria, it lists specific symptoms and asks the evaluator to indicate how each symptom is documented, such as through an ADOS assessment or observation. It also includes specifiers like intellectual impairment, language impairment, known etiological factors, associated disorders, and severity level. The checklist is used to systematically document whether a child meets the diagnostic criteria for autism spectrum disorder.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    176 views1 page

    Autism Spectrum Disorder Checklist: Criterion

    Uploaded by

    Archana Sharma
    This document provides an autism spectrum disorder checklist based on the DSM-5 diagnostic criteria. It includes two main criteria: persistent deficits in social communication/interaction and restricted, repetitive behaviors/interests. For each criteria, it lists specific symptoms and asks the evaluator to indicate how each symptom is documented, such as through an ADOS assessment or observation. It also includes specifiers like intellectual impairment, language impairment, known etiological factors, associated disorders, and severity level. The checklist is used to systematically document whether a child meets the diagnostic criteria for autism spectrum disorder.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Autism Spectrum Disorder Checklist

    (DSM-5 Diagnostic Criteria)


    Child: Evaluator:
    DOB Program:
    B23#
    Please indicate in the space next to each criterion how the diagnostician knows that the child meets the criteria
    (for example, an ADOS 2 or other instrument, or observation).
    A. Persistent deficits in social communication and social interaction across multiple contexts,
    as manifested by all the following, currently or by history:
    Criterion Please indicate how documented in this column:
    1. Deficits in social-emotional reciprocity

    2. Deficits in nonverbal communicative behaviors


    used for social interactions
    3. Deficits in developing, maintaining, and
    understanding relationships.
    B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least
    two of the following, currently or by history:
    1. Stereotyped or repetitive motor movements, use
    of objects or speech
    2. Insistence on sameness, inflexible adherence to
    routines or ritualized patterns of verbal or
    nonverbal behavior
    3. Highly restricted, fixated interests that are
    abnormal in intensity or focus
    4. Hyper- or hyporeactivity to sensory input or
    unusual interest in sensory aspects of the
    environment
    Specifiers:
    1. With or without accompanying intellectual
    impairment
    2. With or without accompanying language impairment
    3. Known etiological factor (s) present (for example
    medical condition, genetic syndrome,
    environmental factor):

    4. Associated with another neurodevelopmental,


    mental, or behavioral disorder
    5. Severity (Please circle appropriate level):
    Level 1: Requiring support:
    Level 2: Requiring substantial support:
    Level 3: Requiring very substantial support:
    Person completing form (print and sign) credentials/date

    CT Birth to Three Form:3-20 (5/1/2015)

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