Autism Spectrum Disorder Evaluation Template
EVALUATION RESULTS AND/OR EXISTING DATA:
Autism Specialist
Autism Behavior Checklist (ABC)
Autism Diagnostic Observation Scale (ADOS)
Childhood Autism Rating Scale (CARS)
Gilliam Asperger Disorder Scale (GADS)
Gilliam Autism Rating Scale-2 (GARS-2)
Short Sensory Profile
The Autism Social Assessment for School Planning
School Assessment Rating Scale for Asperger’s Syndrome
School Function Assessment
Autism Spectrum Structured Student Interview
Systematic Classroom Observation
Autism Behavior Checklist (ABC)
The Autism Behavior Checklist (ABC) is a checklist of non-adaptive behaviors; capable of providing how an individual
“Looks” in comparison to others. This checklist reflects an individual’s challenges to respond appropriately to daily life
situation. XXX’s parents and the educational team at XXX School completed the check lists.
XXX received a total score of XX from his parents which was indicating that there MAY / may NOT be a presence of autism.
XXX received a total score of XX from his educational team which was indicating that there MAY / may NOT be a presence
of autism.
Differences in behaviors were noted in the following areas:
Sensory Behaviors:
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Poor use of visual discrimination when learning
Seems not to hear, so that a hearing loss is suspected
Sometimes shows no “startle response” to loud noise”
Sometimes painful stimuli such as bruises, cuts, and injections evoke no reaction
Often will not blink when bright light is directed toward eyes
Covers ears at many sounds
Squints, frowns, or covers eyes when in the presence of natural light
Frequently has no visual reaction to a “new” person
Stares into space for long periods of time
Relating Behaviors:
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Frequently does not attend to social/environmental stimuli
Has no social smile
Does not reach out when reached for
Not responsive to other people’s facial expressions/feelings
Actively avoids eye contact
Resists being touched or held
Is flaccid when held in arms
Is stiff and hard to held
Does not imitate other children at play
Has not developed any friendships
Often frightened or very anxious
“Looks through” people
Body and Object Use Behaviors:
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Whirls self for long periods of time
Does not use toys appropriately
Insists on keeping certain objects with him/her
Rocks self for long periods of time
Does a lot of lunging and darting
Flaps hands
Walks on toes
Hurts self by banging head, biting hand, etc…
Twirls, spins, and bangs objects a lot
Will feel, smell, and/or taste objects in the environment
Gets involved in complicated “rituals” such as lining things up, etc…
Is very destructive
Language Behaviors:
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Does not follow simple commands given once
Has pronoun reversal
Speech is atonal
Does not respond to own name when called out among two others
Seldom says “yes” or “I”
Does not follow simple commands involving prepositions
Gets desired objects by gesturing
Repeats phrases over and over
Cannot point to more than five named objects
Uses 0-5 spontaneous words per day to communicate wants and needs
Repeats sounds or words over and over
Echoes questions or statements made by others
Uses at least 15 but less than 30 spontaneous phrases daily to communicate
Language Behaviors:
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Learns a simple task but “forgets” quickly
Strong reactions to changes in routine/environment
Has “special abilities” in one area of development, which seems to rule out mental retardation
Severe temper tantrums and/or frequent minor tantrums
Hurts others by biting, hitting, kicking, etc…
Does not wait for needs to be met
Difficulties with toileting
Does not dress self without frequent help
Frequently unaware of surroundings, and may be oblivious to dangerous situations
Prefers to manipulate and be occupied with inanimate things
A developmental delay was identified at or before 30 months of age
Autism Diagnostic Observation Scale (ADOS)
The Autism Diagnostic Observation Scale (ADOS) is a semi-structured, standardized assessment of communication, social
interaction, play, and imaginative use of materials for individuals who have been referred because of a possible autism
spectrum disorder. Specific tasks were presented because they were likely to induce particular behaviors relevant to autism
spectrum disorders.
During the session, XXX displayed brief hand and finger mannerisms including
The assessment, observation, and scoring was completed by XXX and XXX, a team of XXX from Lakes XXX. The following
scores were obtained:
Communication Total
XX
(met criteria - Autism Cut-Off 5)
Reciprocal Social Interaction
XX
(met criteria – Autism Cut-Off 6)
Total
XX
(met criteria – Autism Cut-Off 12)
In the area of communication, XXX met/did not meet the cut-off score for Autism Spectrum due to
In the area of social interaction, XXX met/did not meet the cut-off score for Autism Disorder due to
When the scores are totaled, XXX meets/does not meet eligibility for Autism.
He/She displays symptoms and needs in the areas of communication, social interaction, and stereotyped behaviors and
restricted interests.
Childhood Autism Rating Scale (CARS)
The Childhood Autism Rating Scale (CARS) is a 15 item behavioral rating scale developed to identify children with autism
and to categorize these behaviors from mild to moderate to severe. The total CARS score may range from a low of 15
(obtained when the child¹s behavior is rated as falling within normal limits on all 15 scales) to a high of 60 (obtained when the
child¹s behavior is rated as severely abnormal on all 15 scales). The score represents placement on a continuum: the lower the
score, the fewer autistic behaviors the child exhibits; the higher the score, the more autistic behaviors the child exhibits.
School Rating Completed by XXXX. The results were as follows:
Relating to People
Emotional Response
Imitation
Body Use
Object Use
Adaptation to Change
Listening Response
Taste, Smell, Touch
Visual Response
Fear or Nervous
Verbal Communication
Activity Level
Nonverbal Communication
Level & Consistency of Intellectual Response
General Impression
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
Total Score
XX
The Childhood Autism Rating Scale was completed utilizing information provided by XXXXX. Based on his/her observations
and evaluation, XXXXX received an overall rating score of XX, placing him within the XXXX autistic range.
XXXX displays a marked difference in his/her social skills (including), his/her communication skills (including) and his/her
repertoire of interests and activities (including) as well as his/her sensory responses (including).
Gilliam Asperger’s Disorder Scale (GADS)
The Gilliam Asperger’s Disorder Scale (GADS) is used for the assessment of individuals ages 3 through 22 who present
unique behavioral problems. It’s purpose is to help professionals identify Asperger’s Disorder characteristics within the school
setting. It is used to help educational teams determine whether a child may meet MN State Educational Criteria for receiving
special education services under the Autism Spectrum Disorder category. The GADS provides information about four
categories of behavior – social interaction, restricted patterns of behavior, cognitive patterns, and pragmatic skills. Even if the
person is not diagnosed with Asperger’s Disorder, the GADS provides information that is usefully in the diagnosis and
treatment of other behavioral disorders. Educational staff at XXXX School and XXXX’s parents completed the GADS.
The results were as follows:
HOME Rating
Rater: XXX Name
Stand. Score %ile
Social Interaction
Restricted Patterns of Behavior
Cognitive Patterns
Pragmatic Skills
XX
XX
XX
XX
Sum of Standard Scores
XX
Rater: XXX Name
XX%
XX%
XX%
XX%
XX
XX
XX
XX
Stand. Score %ile
Social Interaction
Restricted Patterns of Behavior
Cognitive Patterns
Pragmatic Skills
XX
XX
XX
XX
Sum of Standard Scores
XX
XX%
XX%
XX%
XX%
XX
Asperger’s Disorder Quotient
XX
XX%
Asperger’s XXXX Probable
SCHOOL Rating
Rater: XXX Name
Standard Score %ile
XX
XX%
Asperger’s XXXX Probable
Rater: XXX Name
XX%
XX%
XX%
XX%
Asperger’s Disorder Quotient
XX
XX%
Asperger’s XXXX Probable
Standard Score %ile
XX
XX
XX
XX
XX%
XX%
XX%
XX%
XX
XX
XX%
Asperger’s XXXX Probable
The following items were rated frequently observed in each of the following categories:
Social Concerns Identified:
 Is inattentive to social/environmental stimuli
 Has difficulty cooperating in a group
 Has difficulty playing with other children
 Seems unaware of social conventions or codes of conduct
 Lacks empathy (Understanding how others feel)
 Needs an excessive amount of reassurance if things are changed or go wrong
 Lacks subtlety in expression of emotion (shows distress or affection out of proportion to the situation)
 Requires specific instruction to begin tasks
 Becomes frustrated quickly when unsure of what is required
Restricted Patterns of Behavior Subscale:
 Stares or looks unhappy or unexcited when praised, humored, or entertained
 Is unaware of or insensitive to the needs of others
 Demonstrates eccentric forms of behavior
 Has preoccupation with specific subjects or objects that is abnormal in intensity or focus
 Requires extensive directions from others
 Expresses feelings of empathy inappropriately
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Displays clumsy or uncoordinated gross motor movements
Exhibits unusual, uncoordinated movements when walking or running
Cognitive Patterns Subscale:
 Talks about a single subject excessively
 Displays superior knowledge or skill in specific subjects or activities
 Uses exceptionally precise or pedantic speech
 Attaches very concrete meanings to words
 Has difficulty understanding jokes or humor
 Shows excellent memory
 Shows an intense, obsessive interest in certain intellectual subjects
Pragmatic Skills Subscale:
 Has difficulty understanding slang expressions
 Has difficulty identifying when someone is teasing
 Has difficulty understanding when he or she is being ridiculed, put down, or made fun of
 Has difficulty understanding what causes people to dislike him or her
 Fails to predict probable consequences in social events
 Has difficulty making believe or pretending
 When confused, doesn’t ask for clarification but switches to a familiar topic
Gilliam Autism Rating Scale (GARS-2)
The Gilliam Autism Rating Scale-2 (GARS-2) is a 42 item norm referenced screening instrument used for the assessment of
individuals ages 3-22 who have severe behavioral problems that may be indicative of autism. Its purpose is to help
professionals identify Autism Spectrum Disorders, but in a school setting, it is used to help educational teams determine
whether a child may meet MN State Educational Criteria for receiving special education services under the Autism Spectrum
Disorder category. It is important to clarify that this is not a medical diagnosis, but rather a category to receive special
education services. The GARS-2 gathers information about specific characteristics typically noted in children with autism
spectrum disorders in three areas (Stereotyped Behaviors, Communication, and Social Interaction) and it contains a
developmental history. The GARS-2 was normed entirely of individuals diagnosed as autistic. Standard scores and percentiles
are provided and the likelihood of autism can be determined.
Educational staff at XXXX School and XXXX’s parents completed the GARS-2.
The results were as follows:
HOME Rating
Rater: XXX Name
Stereotyped Behaviors
Communication
Social Interaction
Sum of Standard Scores
Autism Index
Standard Score
XX
XX
XX
XX
XX
%ile
XX%
XX%
XX%
XX%
Standard Score
XX
XX
XX
XX
XX
%ile
XX%
XX%
XX%
XX%
Probability of Autism is Unlikely, Possibly, Very Likely.
SCHOOL Rating
Rater: XXX Name
Stereotyped Behaviors
Communication
Social Interaction
Standard Score
XX
XX
XX
%ile
XX%
XX%
XX%
Standard Score
XX
XX
XX
%ile
XX%
XX%
XX%
Sum of Standard Scores
Autism Index
XX
XX
XX%
XX
XX
XX%
Probability of Autism is Unlikely, Possibly, Very Likely.
Note: On this tool, if the subject’s Autism Index is 85 or above, the person is very likely autistic, and if the Autism Index is 7084, the person is possibly autistic. Autism Indexes of 69 or less indicate that the person is unlikely to be autistic.
The following items were rated frequently observed in each of the following categories:
Stereotyped Behaviors Identified:
 Avoids establishing eye contact, looks away when eye contact is made
 Stares at hands, objects, or items in the environment for at least 5 seconds
 Rapidly flicks fingers or hands in front of eyes for periods of 5 seconds or more
 Eats specific foods and refuses to eat what most people will usually eat
 Licks, tastes or attempts to eat inedible objects
 Smells or sniffs objects
 Whirls, turns in circles
 Spins objects not designed for spinning
 Rocks back and forth while seated or standing
 Makes rapid lunging, darting movement when moving from place to place
 Prances (walks on tiptoes)
 Flaps hand or fingers in front of face or at sides
 Makes high-pitched sounds or other vocalizations for self-stimulation
 Slaps, hits, or bites self or attempts to injure self in other ways
Communication Behaviors Identified:
 Repeats (echoes) words verbally or with signs
 Repeats words out of context
 Repeats words or phrases over and over
 Speaks or signs with flat tone or with dysrhythmic patterns
 Responds inappropriately to simple commands
 Looks away or avoids looking at speaker when name is called
 Does not ask for things he or she wants
 Does not initiate conversations with peers or adults
 Uses “yes” and “no” inappropriately
 Uses pronouns inappropriately
 Uses the word “I” inappropriately
 Repeats unintelligible sounds over and over
 Uses gestures instead of speech or signs to obtain objects
 Inappropriately answers questions about a statement or brief story
Social Interaction Behaviors Identified:
 Avoids eye contact; looks away when someone looks at him or her
 Stares or looks unhappy or unexcited when praised, humored, or entertained
 Resists physical contact from others
 Does not imitate other people when imitation is required or desirable, such as in games or learning activities
 Withdraws, remains aloof, or acts standoffish in group situations
 Behaves in an unreasonably fearful, frightened manner
 Is unaffectionate; doesn’t give affectionate responses
 Shows no recognition that a person is present (ie: looks through people)
 Laughs, giggles, cries inappropriately
 Uses toys or objects inappropriately
 Does certain things repetitively, ritualistically
 Becomes upset when routines are changed
 Responds negatively or with temper tantrums when given commands, requests, or directions
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Lines up objects in precise, orderly fashion and becomes upset when the order is disturbed
The following delays in development during the first three years of life were reported on the parent interview:
 Social Interaction:
 Didn’t reach out or prepare to be picked up when the parent attempted to lift the child
 Didn’t cry or become upset when left unattended in his or her crib, playpen, or other area
 Didn’t cry or become upset when picked up or held
 Didn’t cry or become upset when handed from one adult to another
 Didn’t attempt to join family members in group activities
 Language Used in Social Communication:
 Didn’t use single words by 16 months of age
 Didn’t use meaningful, communicative phrases by age 2
 Didn’t develop normally in terms of language (i.e:cooing, babbling, and speaking without any interruption or
regression)
 Didn’t follow directions
 Didn’t appear to have normal hearing
The following observations of abnormal functioning during the first three years of life were reported on the parent interview:
 Social Interaction:
 Didn’t smile at parents or siblings when smile at or played with
 Didn’t cry when approached by unfamiliar persons during the first year
 Didn’t engaged in imitative play before age 3
 Seemed to tune people out and be in his/her own world
 Spent a great deal of time alone when he/she could have been with others
 Language used in Social Communication:
 Didn’t respond to his/her name when called
 Didn’t ask for things or use gestures to communicate what was wanted
 Didn’t follow simple directions
 Didn’t appear to understand what to do when told to do something
 Didn’t indicate (show facial concern) when a parent or sibling cried or was distressed
 Symbolic or Imaginative Play:
 Didn’t engage in pretend play
 Didn’t pretend he or she was someone else
 Didn’t pretend that an object was something else
 Didn’t pretend that he or she had an imaginary friend or animal
 Didn’t play with dolls pretending that they were real persons
In summary, according to the results of the GARS-2, XXXX is in the unlikely, possibly, very likely probability of having an
autism spectrum disorder.
Short Sensory Profile
The Short Sensory Profile was completed by parent on and interpreted by in order to gather further information related to his
sensory processing and modulation in the school setting. The Short Sensory Profile was designed as a screening tool. Children
who exhibit difficulties in any of the areas are very likely to have sensory processing issues that affect performance and should
have further assessment of sensory processing by an occupational therapist.
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XXXX shows a definite difference (-2SD) in the following categories:
 Tactile Sensitivity
 Taste/Smell Sensitivity
 Movement Sensitivity
 Underresponsive/Seeks Sensation
 Auditory Filtering
 Low Energy/Weak
 Visual/Auditory Sensitivity
 Total
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XXXX exhibits a probable difference (-1SD) in the following categories:
 Tactile Sensitivity
 Taste/Smell Sensitivity
 Movement Sensitivity
 Underresponsive/Seeks Sensation
 Auditory Filtering
 Low Energy/Weak
 Visual/Auditory Sensitivity
 Total
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Due to the above results on the Short Sensory Profile screening, further assessment of sensory processing was
indicated. The results of that assessment are as follows:
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XXXX’s results on the Short Sensory Profile screening indicate typical performance and no further evaluation of
sensory processing appears necessary.
The Autism Social Assessment for School Planning
The Autism Social Assessment for School Planning highlights areas of social dysfunction for purposes of assessing educational
need. Individuals completing the scale rate the student from 0 (does not apply) to 3 (observed often and impacts progress)
regarding 25 separate items. No standardized score is obtained, rather it is use to describe a students pattern of skills.
Mr./Mrs. XXX a teacher at XXX School completed the Autism Social Assessment for School Planning in order to gather
information, which would be beneficial when planning for XXX’s education. Based on this scale the team reported the
following characteristics often described (rated 3):
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Does not imitate others at play or during leisure
Laughs, giggles or cries inappropriately or to an unreasonable degree
Behaves in a highly anxious or fearful way
Becomes upset when routines are changed
Responds negatively to commands, requests or directions
In a group, at lunch or in a social situation, student remains aloof
Will watch others play or interact, but resists joining without prompts
An absences of facial responsiveness or reciprocal eye contact
Lack of friendships
Has problems initiating or maintaining social interaction
Exhibits explosive behavior
Seems to lack fear or understanding of real danger
Engages in rituals
Gets stuck in negative interactive patterns with particular people or in specific situations
Exhibits self-aggressive behavior
Behaves aggressively towards others
Engages in odd play behavior for long periods of time
Unreasonable dependence on a particular object
Seems to be dependent on staff cues or prompts
Spinning, flipping or twirling self or objects
Has high levels of stress associated with obsessive activities or talking about obsessive interests
Spends an unreasonable amount of time engaging in obsessive thinking
Misinterprets other’s words or actions as threatening
Makes rude comments to others
Seems to expect others to know his/her thoughts and feelings without explanation
School Assessment Rating Scale for Asperger’s Syndrome
Mr./Mrs. XXX, XXX’s teacher at XXX School completed the School Assessment Rating Scale for Asperger’s Syndrome in
order to gather information, which would be beneficial when planning for the student’s education. This scale measures
abilities in four areas including social-emotional, communication, cognitive, and movement abilities. Individuals completing
the scale rate the student from 1 (rarely) to 6 (frequently) regarding 24 separate items. No standardized score is obtained,
rather it is use to describe a students pattern of skills. Based on this scale the team reported the following characteristics
frequently described (rated 4, 5 or 6):
Social Emotional Skills:
 Lacks understanding of how to play or interact with other students
 Appears unaware of social conventions or codes of conduct and makes inappropriate comments
 Misinterpret other peoples actions or words as threatening
 Lacks an intuitive understanding of another person’s feelings
 Seems to expect other people to know their thoughts, experiences and opinions
 Needs an excessive amount of reassurance, especially if things are changes or go wrong
 Lacks subtlety in their expression of emotion
 Is not interested in participating in sports, games or team activities
 Indifferent to peer pressure
 Takes comments literally
 Has an unusual tone of voice
 When talking to the student he appears to be uninterested in your side of the conversation
 When in conversation, the student tends to use less eye contact than you would expect
 Overly precise or pedantic speech
 Have trouble asking for clarification when confused
Cognitive Skills:
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Primarily reads books for information rather than fiction
Has an exceptional long term memory for events or facts
Lacks social imaginative play
Preoccupied or fascinated by a particular topic and/or avidly collects information
Becomes unreasonably upset by changes in routine or expectations
Develops elaborate routines or rituals that must be completed
Movement Skills:
 Has poor motor coordination
 Has an odd gait when running
Other indicators:
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Unusual fear or anxiety due to: XXX
A tendency to flap his arms or rock body when excited or upset
A lack of sensitivity to low levels of pain
Late in acquiring speech
Unusual facial grimaces or tics
Autism Spectrum Structured Student Interview
The Autism Spectrum Structured Interview is a non standardized measure developed by Kari Dunn Buron to help understand
the students' understanding of the social world. The questionnaire includes eighteen questions regarding social understanding.
The following information was obtained during this interview conducted by XXXX, a XXXX for XXXX.
XXX accompanied the examiner to a quiet setting. XXX appeared comfortable with the examiner. He/She easily engaged in
conversation. XXX was asked questions about friends, rules, and others’ behavior.
School Function Assessment
The School Function Assessment (SFA) was completed by ,case manager, classroom teacher, pupil support assistant, SLP,
and , OTR/L in order to accurately record XXXX’s current level of independent functioning in numerous areas in the school
environment. The SFA is a criterion referenced test which is used to measure a student’s performance in functional tasks that
support their participation in the academic and social aspects of an elementary school program. It is a judgment-based
assessment whose items have been written in measurable, behavioral terms that can be used directly in the development of a
student’s Individual Education Plan (IEP).
The SFA is composed of three parts:
1.
Participation-examines the student’s level of participation in six major school activity settings including
the classroom, playground/recess, transportation, bathroom/toileting skills and meals/snacks.
2.
Task supports-examines the supports that are currently provided to the student when the functional tasks
are being performed. Two types of tasks support are examined separately: assistance (adult help) and
adaptations (modifications to the environment/program).
3.
Activity Performance-is used to examine the student’s performance in specific school-related functional
activities. Each set of activities is used to examine in detail one of the functional tasks addressed globally
in Part. 2.
Summary and Interpretation of XXXX’s SFA scores:
Part 1-Participation-XXXX’s was rated in the regular classroom/special education setting.
Part 2-Task Supports
The Physical Tasks supports that are in place include:
The Cognitive/Behavioral Tasks supports that are in place include:
Part 3-Activity Performance includes 292 common school tasks in the following categories:
Physical Tasks:
 Travel
 Maintaining and Changing Positions
 Recreational Movement
 Manipulation with Movement
 Using Materials
 Setup and Cleanup
 Up/Down Stairs
 Written Work
 Computer and Equipment Use
Cognitive/Behavioral Tasks:
 Functional Communication
 Memory and Understanding
 Following Social Conventions
 Compliance with Adult Directives and School Rules
 Task Behavior/Completion
 Positive Interaction
 Behavior Regulation
 Personal Care Awareness
 Safety
In summary, XXXX’s scores on the School Function Assessment are recorded on the attached SFA summary score form.
They demonstrate that XXXX has clear strengths in
Physical Tasks of:
 Travel
 Maintaining and Changing Positions
 Recreational Movement
 Manipulation with Movement
 Using Materials
 Setup and Cleanup
 Up/Down Stairs
 Written Work
 Computer and Equipment Use
Cognitive/Behavioral Tasks of:
 Functional Communication
 Memory and Understanding
 Following Social Conventions
 Compliance with Adult Directives and School Rules
 Task Behavior/Completion
 Positive Interaction
 Behavior Regulation
 Personal Care Awareness
 Safety
Additionally, they document areas of concern in:
Physical Tasks of:
 Travel
 Maintaining and Changing Positions
 Recreational Movement
 Manipulation with Movement
 Using Materials
 Setup and Cleanup
 Up/Down Stairs
 Written Work
 Computer and Equipment Use
Cognitive/Behavioral Tasks of:
 Functional Communication
 Memory and Understanding
 Following Social Conventions
 Compliance with Adult Directives and School Rules
 Task Behavior/Completion
 Positive Interaction
 Behavior Regulation
 Personal Care Awareness
 Safety
Systematic Classroom Observation
XXX, an Autism Specialist for XXX, observed XXX on two occasions at XXX School during
As the first observation began XXX was
Autism Spectrum Criteria
The multidisciplinary team shall determine that a pupil is eligible and in need of special education, instruction and related
services if the pupil demonstrates patterns of behavior consistent with those in item A and fulfills the requirements in item B.
In order to qualify for services, students must fulfill requirements in both A and B.
A. An educational evaluation must address all three-core features listed below. For eligibility purposes, a student must
meet criteria in Core Feature 1 and either Core Feature 2 or 3. They may meet criteria in all three Core Features.
Core Feature 1: Qualitative Impairment of Reciprocal Social Interactions as documented by 2 or more behavioral
indicators such as:
Limited joint attention and limited use of facial expressions directed toward others
Does not show or bring things to others to indicate an interest in the activity
Difficulty relating to people, objects, and events
Gross impairment in the ability to make and keep friends
Significant vulnerability and safety issues due to social naiveté
Appears to prefer isolated or solitary activities
Misinterprets others’ behaviors and social cues
Other
Core Feature 2: Qualitative Impairment in Communication as documented by 1 or more behavioral indicators such as:
Not using finger to point or request
Using others’ hand or body as a tool
Showing lack of spontaneous imitation or lack of varied imaginative play
Absence or delay of spoken language
Limited understanding & use of nonverbal communication skills such as gestures, facial expressions, or
voice tone
Odd production of speech, including intonation, volume, rhythm or rate
Repetitive or idiosyncratic language or inability to initiate
Inability to initiate or maintain a conversation
Other
Core Feature 3: Restricted, Repetitive or Stereotyped Patterns of Behavior, Interests, and Activities as documented by 1
or more behavioral indicators such as:
Insistence on following routines or rituals
Demonstrating distress or resistance to change
Repetitive hand or finger mannerisms
Lack of true imaginative play versus reenactment
Over-reaction or under-reaction to sensory stimuli
Rigid or rule-bound thinking
An intense, focused preoccupation with a limited range of play, interests, or conversation topics
Other
AND
B. Verification that Autism Spectrum Disorders adversely affects the pupil’s present level
of performance.
1. Identification of the student’s present level of performance and educational needs in each core feature.
CORE FEATURE 1: Social Interaction
Present Level of Performance: XXX
Current Educational Needs:
XXX
CORE FEATURE 2: Communication
Present Level of Performance: XXX
Current Educational Needs:
XXX
CORE FEATURE 3: Behavior, Interests and Activities
Present Level of Performance: XXX
Current Educational Needs:
XXX
And
2. Observation in two different settings on two different days. An observation was completed by XXX, ASD Specialist,
and XXX, Education Psychologist. (see in report)
And
3. A developmental history is included which summarizes developmental information and behavior patterns.
XXX’s difficulties and subsequent disability identification are not primarily caused by a lack of instruction in reading or math
or by limited English proficiency.
EDUCATIONAL EVALUATION METHODS
Documentation of Behavioral Indicators for the identification of Autism Spectrum Disorders must include the use of at least
two of the following:
Parent Input Collected
Communication and Developmental Rating Scales
Functional Behavior Assessments
Informal and Standardized Evaluation Instruments
Intellectual testing
Autism Rating Scales or Checklist(s)
Application of DSM-IV Diagnostic Criteria
Intellectual Testing
XXX DOES / DOES NOT qualify for Autism Spectrum services.