Autism Assessment: Social Communication Education Questionnaire Autism Assessment: Social Communication Education Questionnaire Your email address Child's name Child's date of birth Child's address Child's address Child's address Child's address Child's address Child's address Child's address School name Current school year Name of teacher completing this form Today's date Section 1 - Overall concerns Please summarise your main concerns about the child in the education setting. Section 2 - Reciprocal social interaction Please describe the child’s use of eye contact in their interaction with adults and peers. Ability to use facial expression and gesture when communicating. Please tick which applies: Expressive child who uses both facial expression and gesture Rarely uses gesture Limited facial expression Exaggerated/over-dramatic Are they aware of personal boundaries? Yes No Do they invade others’ personal space or get upset if others invade their space? Yes No Have they established appropriate friendships? Yes No Are their friendships truly reciprocal? Yes No Do they dominate interactions? Yes No Are they on the periphery of interactions? Yes No Comments: Can they share with adults and/or their peers about things that are happening in their life and about their experiences, thoughts and opinions with others? Yes No Comments: Do they show interest in others’ experiences, achievements and happiness? Yes No Comments: Do they show sensitivity towards others’ needs and feelings? Yes No Comments: Are they able to cooperate with adults and peers in small group/large class settings? Yes No Comments: Can they share possessions and activity materials easily? Yes No Comments: Are they able to seek help/comfort/reassurance when upset? Yes No Comments: Inappropriate or unexpected displays of emotion. Does the child: Laugh inappropriately Yes No React angrily when corrected Yes No Show extreme anxiety Yes No Other Yes No Comments: Do they know how to modify their behaviour in different situations in school? e.g. in assembly/playground/ with adults Yes No Comments: Section 3 - Communication Please comment on the child’s ability to understand language in the classroom. Are they able to express their needs effectively using verbal and non-verbal communication? Yes No Are they able to express their emotions effectively using verbal and non-verbal communication? Yes No Can they ask for help? Yes No Describe how they cope when there is a problem: Are they able to initiate and engage in a sustained two-way conversation where there is an easy to-and-fro in the conversation… With peers? Yes No With adults? Yes No Does the conversation go off at a tangent? Yes No Are there obsessive topics? Yes No Please describe their conversation ability with peers and adults: Do they have any unusual characteristics in their use of language? Unusual accent Monotonous flat tone Problems with volume or pitch Echolalia (repetition of words) Use of repetitive phrases Formal pedantic style (e.g. sounds like an adult, corrects what others say, is overly polite) Use of unusual words N/A Section 4 - Creativity / Imagination Does the child demonstrate a level of creativity/imagination similar to their peers in the following contexts? Play Yes No Art Yes No Written work Yes No Reasoning and problem solving Yes No Do they display any unusual behaviours/unusual interests or preoccupations in play/free-time activities? Yes No Describe: Section 5 - Restrictive, repetitive or ritualistic behaviour Does the child display any repetitive behaviours? Please tick any which apply: Collecting Hoarding Spinning objects Lining up toys Sorting by colour/shape/size None Do they display any hand flapping/finger flicking or any other unusual movements? Yes No Do they have any strong attachments to objects or carry unusual objects in their bag or pockets? Yes No If yes, please describe: Do they show any unusual interest in the parts of objects rather than the whole object? Dismantles the object Smells the object Feels the object OtherOther Describe how they cope with changes in routine Describe how they cope with changes to the environment Do they insist on particular routines/rituals? Yes No Are you aware of any particular rituals/order that they must perform such as always eating snack in a particular order or following the same routine every morning? Yes No If yes, please describe: Section 6 - Sensory processing Ability to cope with the sensory environment. Please tick any which apply: Distracted by noise or covers ears Slow to respond when you speak to them Reacts emotionally or aggressively to touch Dislikes messy play Seeks out certain textures Seeks movement: fidgets/bounces/jumps/bumps into things Cautious with movement, dislikes swings/slides Avoids certain tastes, textures or smells of food Seeks out certain tastes, textures or smells of food Runs up and down repetitively Walks on tiptoe Section 7 - Academic progress Describe the child’s ability to pay attention in a variety of learning situations. Can they transition from one activity to another without difficulty? Describe any difficulties. Comment on their gross/fine motor skills and handwriting. Section 8 - Other relevant information Are there any safeguarding concerns? Is the child known to Children’s Services (now or in the past)? What level of support is in place in school? E.g. IDP, statement of SEN, ELSA sessions, Eye-to-Eye counselling Has the child been referred to educational psychology? Yes No Has the child been seen by educational psychology? (if yes, please attach report) Yes No File Upload Drop a file here or click to upload Choose File Maximum file size: 268.44MB Submit If you are human, leave this field blank. Δ
