Home
About
Background
Mission and Vision
Our Commitment
Understand
Dyslexia
Dysgraphia
Dyscalculia
Dyspraxia
Attention Deficit Hyperactivity Disorder (ADHD)
Visual Processing Deficit
Transition planning
Gifted Students
Advocacy
Inclusive Education
Rights and Protection
Legislative Agenda
Research
Join Us
News & Media
News & Updates
Upcoming Events
Photo & Video Gallery
Downloads
Assessments
Contact
Appointment
Adult Autism Social Responsiveness Assessment (SRS 2)
Assessment 1 of 68
Form Instructions & Things to Know
How to fill this form:
Read each question carefully before selecting an answer.
Select the most accurate option based on your observations.
Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins
Estimated completion time.
Secure
Your data is fully encrypted.
Note:
This is a screening and assessment tool, not clinical (medical).
First, please provide your contact information.
Your Full Name
Email Address
Phone Number
Information about the individual being assessed.
Who are you filing for?
Choose relationship...
Self
Child
Partner
Family Member
Friend
Caretaker
Guardian
Teacher/Tutor
Name of Individual Being Assessed
Date of Birth
Age
Gender
*
Select Gender
Male
Female
School Grade (Optional)
Assessment Reasons / Reason for Assessment
1. Expressions on his or her face don't match what he or she is saying
Not True
Sometimes True
Often True
Almost Always True
2. Doesn't recognize when others are trying to take advantage of him or her
Not True
Sometimes True
Often True
Almost Always True
3. Seems much more uncomfortable in social situations than when alone.
Not True
Sometimes True
Often True
Almost Always True
4. Seems self-confident when interacting with others
Not True
Sometimes True
Often True
Almost Always True
5. When under stress, he or she shows rigid or inflexible patterns of behavior that seem odd.
Not True
Sometimes True
Often True
Almost Always True
6. Would rather be alone than with others.
Not True
Sometimes True
Often True
Almost Always True
7. Is aware of what others are thinking or feeling
Not True
Sometimes True
Often True
Almost Always True
8. Behaves in ways that seem strange or bizarre.
Not True
Sometimes True
Often True
Almost Always True
9. Takes things too literally and doesn't get the real meaning of a conversation.
Not True
Sometimes True
Often True
Almost Always True
10. Is awkward in turn-taking interactions with others (for example, doesn't seem to understand the give-and-take of conversations).
Not True
Sometimes True
Often True
Almost Always True
11. Recognizes and appropriately responds to changes in other peoples tone of voice and facial expressions.
Not True
Sometimes True
Often True
Almost Always True
12. Seems too dependent on others for help with meeting basic needs.
Not True
Sometimes True
Often True
Almost Always True
13. Has good self-confidence
Not True
Sometimes True
Often True
Almost Always True
14. Is able to communicate his or her feelings to others.
Not True
Sometimes True
Often True
Almost Always True
15. Is not well coordinated.
Not True
Sometimes True
Often True
Almost Always True
16. Avoids eye contact or has unusual eye contact.
Not True
Sometimes True
Often True
Almost Always True
17. Recognizes when something is unfair.
Not True
Sometimes True
Often True
Almost Always True
18. Has difficulty making friends, even when trying his or her best.
Not True
Sometimes True
Often True
Almost Always True
19. Gets frustrated trying to get ideas across in conversations
Not True
Sometimes True
Often True
Almost Always True
20. Shows unusual sensory interests (for example, smelling his or her fingers frequently) or strange, repetitive ways of handling or manipulating small items within reach.
Not True
Sometimes True
Often True
Almost Always True
21. Is able to imitate others actions and demeanor when it is socially appropriate to do so.
Not True
Sometimes True
Often True
Almost Always True
22. Doesn't seem to mind being out of step with or not on the same wavelength as others.
Not True
Sometimes True
Often True
Almost Always True
23. Can't get his or her mind off something once he or she starts thinking about it.
Not True
Sometimes True
Often True
Almost Always True
24. Responds appropriately to mood changes in others (for example, when a friends mood changes from happy to sad).
Not True
Sometimes True
Often True
Almost Always True
25. Interacts appropriately with other adults
Not True
Sometimes True
Often True
Almost Always True
26. Does not join group activities or social events unless forced to do so.
Not True
Sometimes True
Often True
Almost Always True
27. Has more difficulty than others with changes in his or her routine
Not True
Sometimes True
Often True
Almost Always True
28. Offers comfort to others when they are sad.
Not True
Sometimes True
Often True
Almost Always True
29. Avoids starting social interactions with other adults.
Not True
Sometimes True
Often True
Almost Always True
30. Thinks or talks about the same thing over and over.
Not True
Sometimes True
Often True
Almost Always True
31. Is regarded by others as odd or weird.
Not True
Sometimes True
Often True
Almost Always True
32. Becomes upset in a situation with lots of things going on.
Not True
Sometimes True
Often True
Almost Always True
33. Has good personal hygiene.
Not True
Sometimes True
Often True
Almost Always True
34. Is socially awkward, even when trying to be polite
Not True
Sometimes True
Often True
Almost Always True
35. Avoids people who want to be emotionally close to him or her.
Not True
Sometimes True
Often True
Almost Always True
36. Has trouble keeping up with the flow of a normal conversation.
Not True
Sometimes True
Often True
Almost Always True
37. Has difficulty relating to family members.
Not True
Sometimes True
Often True
Almost Always True
38. Has difficulty relating to other adults.
Not True
Sometimes True
Often True
Almost Always True
39. Has an unusually narrow range of interests
Not True
Sometimes True
Often True
Almost Always True
40. Is imaginative without losing touch with reality.
Not True
Sometimes True
Often True
Almost Always True
41. Wanders aimlessly from one activity to another
Not True
Sometimes True
Often True
Almost Always True
42. Seems overly sensitive to sounds, textures, or smells.
Not True
Sometimes True
Often True
Almost Always True
43. Doesn't understand how events relate to one another (cause and effect) the way other adults do.
Not True
Sometimes True
Often True
Almost Always True
44. Enjoys and is competent with small talk (casual conversation with others).
Not True
Sometimes True
Often True
Almost Always True
45. Generally gets interested in what others nearby are paying attention to.
Not True
Sometimes True
Often True
Almost Always True
46. Has overly serious facial expressions.
Not True
Sometimes True
Often True
Almost Always True
47. Laughs at inappropriate times.
Not True
Sometimes True
Often True
Almost Always True
48. Has a sense of humor, understands jokes.
Not True
Sometimes True
Often True
Almost Always True
49. Does extremely well at a few intellectual or computational tasks, but does not do as well at most other tasks.
Not True
Sometimes True
Often True
Almost Always True
50. Has repetitive, odd behaviors
Not True
Sometimes True
Often True
Almost Always True
51. Has difficulty answering questions directly and ends up talking around the subject
Not True
Sometimes True
Often True
Almost Always True
52. Knows when he or she is talking too loud or making too much noise.
Not True
Sometimes True
Often True
Almost Always True
53. Talks to people with an unusual tone of voice (for example, talks like a robot or like he or she is giving a lecture).
Not True
Sometimes True
Often True
Almost Always True
54. Knows when he or she is too close to someone or is invading someones space.
Not True
Sometimes True
Often True
Almost Always True
55. Is emotionally distant, doesn't show his or her feelings.
Not True
Sometimes True
Often True
Almost Always True
56. Seems to react to people as if they are objects.
Not True
Sometimes True
Often True
Almost Always True
57. Walks in between two people who are talking.
Not True
Sometimes True
Often True
Almost Always True
58. Isolative; tends not to leave his or her home.
Not True
Sometimes True
Often True
Almost Always True
59. Concentrates too much on parts of things rather than seeing the whole picture.
Not True
Sometimes True
Often True
Almost Always True
60. Is overly suspicious.
Not True
Sometimes True
Often True
Almost Always True
61. Is inflexible, has a hard time changing his or her mind.
Not True
Sometimes True
Often True
Almost Always True
62. Gives unusual or illogical reasons for doing things.
Not True
Sometimes True
Often True
Almost Always True
63. Touches or greets others in an unusual way
Not True
Sometimes True
Often True
Almost Always True
64. Is too tense in social settings.
Not True
Sometimes True
Often True
Almost Always True
65. Stares or gazes off into space.
Not True
Sometimes True
Often True
Almost Always True
Previous
Next
File Preview
Loading...