Salford Learning Support Service
IN Salford
Nursery, Reception, Year 1 - Checklist
Possible indicators of autistic spectrum condition
Name of child:
Dob:
School:
Name of SENCo:
Year group:
Chronological age in years and months:
Date checklist completed:
Name of class teacher:

This checklist is to help identify children who are a cause for concern with social,
communication and interaction difficulties.
 This form should be completed by someone who knows the child well.
 Useful guidance: http://www.autism.org.uk/working-with/education/early-yearsand-autism.aspx
 http://www.autism.org.uk/teacherpack.
 To refer a child to the Learning Support Service please request a referral form
from: LSSreferrals@salford.gov.uk
Has this child any other known difficulties? If so – please specify:
Is this child EAL? Yes/no If yes – what is the child’s home language?
Social Communication
Talks a lot about a favourite topic, but finds it difficult to talk about a range of topics.
Does not bring objects to SHOW you something?
Responds to a question by repeating it, rather than answering it.
Has trouble taking turns in conversations, may like to do all the talking.
Repeats last word or phrases several times, makes verbal sounds while listening
(echolalia).
Pronouns used inappropriately e.g. "Give you a biscuit please" (instead of 'me').
Does not speak, or uses single words to communicate.
Additional comments:
Social Interaction
Does not take an interest in other children.
Does not use his/her index finger to point, to ASK for something?
Stands too close to others or lacks awareness of personal space.
Responds to social interactions, but does not initiate them.
Doesn’t seem to hear when others talk to him or her.
Doesn't share interests or achievements with others (drawings, toys).
Difficulty understanding jokes, figures of speech or sarcasm.
Difficulty reading facial expressions and body language.
Seems unable to understand another's feelings.
Prefers to be alone, aloft or overly-friendly.
Uses facial expressions that don't match what he or she is saying.
Unusual posture, clumsiness or eccentric ways of moving.
Additional comments:
1
Please tick
as
appropriate:
= most of
the time
= some of
the time
O = hardly
ever/never
Social Imagination/Flexibility
There is limited development of play activities, particularly imaginative play for
example, to make a cup of tea using a toy cup and teapot.
Difficulty transitioning from one activity to another.
Unusual attachments to toys or strange objects such as keys, light switches, or
rubber bands.
Obsessively lines things up or arranges them in a certain order.
Spends long periods of time arranging toys in specific ways, watching moving objects
such as a ceiling fan, or focusing on one specific part of an object such as the wheels
of a toy car.
Difficulty accepting changes to rules, routines or procedures.
Has poor understanding of abstract concepts e.g. time – tomorrow, today etc.
Difficulty with planning a task.
Demonstrates challenging behaviour e.g. kicking, hitting, biting others.
Self injurious behaviour e.g. head banging (on floors, walls or other surfaces), hair
pulling, biting.
Additional comments:
Sensory
Dislike of sudden loud noise.
Dislike of crowds e.g. in corridors, hall, refectory.
Becomes overwhelmed with too many verbal instructions.
Makes excessive vocal sounds or excessive banging of doors, objects.
Repeats the same actions or movements over and over again, such as flapping
hands, rocking, or twirling (known as self-stimulatory behaviour or “stimming”).
Seeks sensory stimulation – for example, she might like deep pressure, seek
vibrating objects like the washing machine or flutter fingers to the side of her eyes to
watch the light flicker is sensitive to sensory experiences.
Does not recognise familiar people in unfamiliar clothes.
Uses peripheral vision when doing a task.
Appears to dislike physical contact.
Appears insensitive to hot/cold temperatures.
May be unusually sensitive to light.
Inappropriate smelling e.g. other people’s hair.
Sensitive to the smell of perfume / aftershave from others.
Sensitive to the textures of clothes.
Additional comments:
2