| Never | Rarely | Sometimes | Often | Always | |
|---|---|---|---|---|---|
| a) Does your child avoid eye contact when he/she talks to you? | 0 | 1 | 2 | 3 | 4 |
| b) Does your child avoid eye contact when he/she talks to friends and family? | 0 | 1 | 2 | 3 | 4 |
| c) Does your child avoid eye contact when he/she talks to unfamiliar people? | 0 | 1 | 2 | 3 | 4 |