Chie's Name Dae of Bit Age Cil's Adress Phone “Tote used by GP's or Heath Visors during he 18 mont developmental checkap, SECTION A: — Ask Parent _— 1. Does your eid enjoy being swung bounced on your knee, .? 2, Does your child take an interest ino hen? 2. Does your child ke lining on things, such sup tas? 4. Does your cil exjoy plying pck-r-boofhideand-aeek? +5. oes your child ever pretend for example to make a cup of tea ting toy cup and tempt or pretend he things pouring juice? 6, Does your child ever us hisher index finger to point to as for senehing? 7, oes your child ever use hisher index finger to point to indiste interest in someting? Cam your bil pay propery wit small tos (6: crs or blocks) ‘without just mowing, Gling dropping thw? SECTION: GP or HV Observation i: Dering the appointment, ha the ld made eye contact with you? (Getchi's tetion, then pont ros the oom aan interesting ‘object and say, "Oh look! There's (2am of oy)" Watch the ‘hid’ face, Does the child lok srs ose what you are Pointing (Get the cis tention, hen pve cil miniature toy eup and teapot and say, "Can you make a up ea7" Does the child retend to pour out tea, ink ite __ “iv. Say tothe ei, "Where's the ight” oF “Show me the light” ‘Dees the child point with ihe index finger at the ight? ___¥. Canthe child build atower ofbocs? (Is, how many) (Number of boc...) * tadiates critica questions that are most indicative of autistic sharacteratic. 1 (Fo record yes on this em, ensure the cil has not simpy looked at your tad, buch eoaly Iooked tthe object you are poating at) 2 ry can elicit an example of pretending in some other game, score ayes entice) > Repeat this wih, “Where's the Today?” or ome other unreachable object; Sed doesnot understand the word"ight” To record ayes on his ite, the cild must have loked up a your face sound the time of pointing) ‘The British Journal of Pech (1996), 168. pp. 158-163. ‘The British Journal of Paychcry (192), 161, pp. 839-843