Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
How many words and gestures does he use?	Y □	N □
Does he use words or gestures to indicate his wants (e.g. does he point to indicate wants)?	Y □	N □
How does he usually let you know what he wants or when he needs something?	Y □	N □
In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others
Can you have a conversation with _____? For example, if you make a comment but don’t ask a question, will he say something in response?	Y □	N □
Will he start a conversation with you just to talk or chat, not to ask for something?	Y □	N □
Can he take turns in a conversation or is it usually one-sided, e.g. does he always want to talk about his favorite subject?	Y □	N □
Does he notice when you’ve lost interest in talking or does he talk on and on?	Y □	N □
Does he interpret what you say literally or concretely, e.g. ‘what’s up’ (what are you doing) or ‘you must have springs in your shoes’ (to jump that high) or’hop to it’ (hurry)?	Y □	N □
Stereotyped and repetitive use of language or idiosyncratic language
What word or name does _____ use to refer to himself/herself?	Y □	N □
Does he sometimes mix up pronouns, e.g. you for I, he or she for I?	Y □	N □
Does he say what you say right after (immediate echolalia)?	Y □	N □
Does he repeat the same phrase over and over?	Y □	N □
Does he use pat or set phrases, e.g. things you may have said or that s/he heard someone else say, such as from a TV show or movie (delayed echolalia)?	Y □	N □
Talk to himself during play, or make nonsense noises or words to himself/herself during play (words that he made up)?	Y □	N □
Does he seem to talk too loudly or too softly?	Y □	N □
Does he use the same tone of voice each time or have a sing-song pattern to his/her voice?	Y □	N □
Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
Will he play games such as pat-a-cake or peek-a-boo; make hand gestures to familiar songs such as’itsy-bitsy-spider’; fill in a word in a familiar song like ‘wheels on the bus’?	Y □	N □
Does _____ like to ‘pretend’ or ‘make-believe’ when playing. For example, will he pretend to talk on a toy phone or pretend to feed or take care of a doll or stuffed animal, will he dress up and ‘make believe’ he is someone else?	Y □	N □
Does he pretend a toy is something else, e.g. a toy banana is a phone, or a block is a sandwich?	Y □	N □