Marked impairment in the use of multiple non-verbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
In general, will he look you/others in the eye, e.g. when he wants something?	Y □	N □
Will _____ nod his head for ‘yes’, shake his head for ‘no’, wave ‘bye-bye’ at appropriate times, point to indicate his wants, use other gestures?	Y □	N □
Does _____ look at you when you start talking to him or doing things with him? Will he turn his head to look at you when you call his name?	Y □	N □
Will he look where you point when you point to show him a toy or a picture in a book?	Y □	N □
Does he point to a toy or object to show you he is interested in it?	Y □	N □
Does he smile, frown, raise his eyebrows, show a variety of facial expressions (can you tell how he’s feeling or what he’s thinking by his facial expressions)?	Y □	N □
Does he gesture with his hands when he’s talking?	Y □	N □
Failure to develop peer relationships appropriate to developmental level
Is he interested in other children?	Y □	N □
Does he talk to or try to join other children in their play (e.g. at the park, school or daycare, how does he join another child or a group, for example, start playing next to them)?	Y □	N □
How does he respond if other children talk to or try to play with him?	Y □	N □
How many friends does _____ have (children he plays with regularly)?	Y □	N □
Does he invite friends over to play and is he invited to play at other children’s houses (ask about play’dates’ set up by parent)?	Y □	N □
What do they do when they play together, e.g. parallel play only, chase, video games, make-believe play?	Y □	N □
Are his relationships based primarily on his special interests?	Y □	N □
Does he have trouble participating in groups, following cooperative rules of games?	Y □	N □
A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest)
Does he try to involve you in his play, in his favorite activities, or does he prefer to play by himself?	Y □	N □
How does he try to engage you?	Y □	N □
Does he bring a toy or book to show you what he is doing?	Y □	N □
How does he respond to praise	Y □	N □
Does he offer to share things (toys or food) with you; and will he offer to share things with other children?	Y □	N □
At different times, does he frown and pout, act embarrassed, look surprised or look happy and excited (show a range of emotions)?	Y □	N □
How does he share his feelings with you, e.g. his excitement after drawing a picture that he really likes, and how does he respond to praise?	Y □	N □
Does he like to be held or cuddled, does he give hugs and kisses (does he imitate you or does he spontaneously give a hug)?	Y □	N □
Lack of social or emotional reciprocity
Will he play ball by rolling or throwing it back and forth?	Y □	N □
Does he play other games that require turn taking?	Y □	N □
Is he interested in what game you want to play or what you want to do?	Y □	N □
Does he recognize how you are feeling, e.g. when you’re happy, angry or sad? When you’re sad or ill, will he try to comfort you?	Y □	N □
Does he notice when others are upset or hurt?	Y □	N □
Does _____ realize certain things he does bother others?	Y □	N □