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Pre-School 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. When under stress, child seems to go on autopilot (for example, shows rigid or inflexible patterns of behavior that seem odd).
Not True
Sometimes True
Often True
Almost Always True
3. Doesn't recognize when others are trying to take advantage of him or her
Not True
Sometimes True
Often True
Almost Always True
4. Seems much more fidgety in social situations than when alone.
Not True
Sometimes True
Often True
Almost Always True
5. Seems self-confident when interacting with others.
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. Is able to understand the meaning of other peoples tone of voice and facial expressions.
Not True
Sometimes True
Often True
Almost Always True
10. Clings to adults, seems too dependent on them.
Not True
Sometimes True
Often True
Almost Always True
11. Unable to pick up on any of the meaning of conversations of older children or adults.
Not True
Sometimes True
Often True
Almost Always True
12. Has good self-confidence.
Not True
Sometimes True
Often True
Almost Always True
13. Is able to communicate his or her feelings to others in words or gestures.
Not True
Sometimes True
Often True
Almost Always True
14. Is slow or awkward in turn-taking interactions with peers.
Not True
Sometimes True
Often True
Almost Always True
15. Is not well coordinated in physical activities.
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. When on the playground or in a group with other young children, child does not attempt to interact with other children.
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. Has a strange way of playing with a toy.
Not True
Sometimes True
Often True
Almost Always True
21. Is able to imitate others actions
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 or playmates mood changes from happy to sad)
Not True
Sometimes True
Often True
Almost Always True
25. Plays appropriately with children his or her age.
Not True
Sometimes True
Often True
Almost Always True
26. Does not join group activities unless told to do so
Not True
Sometimes True
Often True
Almost Always True
27. Has more difficulty than other children 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 peers or 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 other children 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. Wants to be changed when diaper or underwear is soiled or wet.
Not True
Sometimes True
Often True
Almost Always True
34. Is socially awkward, even when he or she is 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 normal interaction with other children
Not True
Sometimes True
Often True
Almost Always True
37. Has difficulty relating to adults
Not True
Sometimes True
Often True
Almost Always True
38. Has difficulty relating to peers
Not True
Sometimes True
Often True
Almost Always True
39. Has a restricted (or unusually narrow) range of interests.
Not True
Sometimes True
Often True
Almost Always True
40. Is imaginative, good at pretending (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 are related to one another the way other children his or her age do.
Not True
Sometimes True
Often True
Almost Always True
44. Responds to clear, direct questions in ways that don't seem to make any sense.
Not True
Sometimes True
Often True
Almost Always True
45. Separates easily from caregivers.
Not True
Sometimes True
Often True
Almost Always True
46. Focuses his or her attention to where others are looking or listening.
Not True
Sometimes True
Often True
Almost Always True
47. Has overly serious facial expressions.
Not True
Sometimes True
Often True
Almost Always True
48. Is too silly or laughs inappropriately.
Not True
Sometimes True
Often True
Almost Always True
49. Has a sense of humor, understands jokes.
Not True
Sometimes True
Often True
Almost Always True
50. Does extremely well at a few tasks, but does not do as well at most other tasks.
Not True
Sometimes True
Often True
Almost Always True
51. Has repetitive, odd behaviors such as hand flapping or rocking.
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. Concentrates too much on parts of things rather than seeing the whole picture. For example, spins the wheels of a toy car but doesn't play with it as a car, or plays with dolls hair but not with the whole doll.
Not True
Sometimes True
Often True
Almost Always True
56. Is emotionally distant, doesn't show his or her feelings.
Not True
Sometimes True
Often True
Almost Always True
57. Seems to react to people as if they are objects.
Not True
Sometimes True
Often True
Almost Always True
58. Walks in between two people who are talking.
Not True
Sometimes True
Often True
Almost Always True
59. Other children do not like to play with him or her.
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 others in an unusual way (for example, he or she may touch someone just to make contact and then walk away without saying anything).
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
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