Observation For ASD Assessment

Observer ______Date ______

Child’s Name ______Grade ______Age ______

School Name ______Teacher Name ______

Description of Setting ______

Description of Activity ______

Description of Child ______

  1. Qualitative Impairment in Social Interaction

Limited Joint Attention ______

Limited Use of Facial Expressions Directed Toward Others ______

Absence of Bringing This to Others to Indicate an Interest in the Activity ______

Demonstrates difficulties in relating to people, objects, and events ______

Gross Impairment in Ability to Make and Keep Friends ______

Significant Vulnerability and Safety Issues Due to Social Naivete ______

May Appear to Prefer Isolated or Solitary Activities ______

Misinterprets Others’ Behaviors and Social Cues ______

  1. Qualitative Impairment in Communication

Not Using finger to Point or Request ______

Using Others’ Hand or Body As a Tool ______

Showing Lack of Spontaneous Imitation or Lack of Varied Imaginative Play ______

Absence or Delay of Spoken Language ______

Limited Understanding and Use of Nonverbal Communication Skills such as Gestures, Facial Expressions, or Voice Tone ______

Odd Production of Speech Including Intonation, Volume, Rhythm, or Rate ______

Repetitive or Idiosyncratic Language or Inability to Initiate or Maintain a Conversation When Speech is Present ______

  1. Restricted, Repetitive, or Stereotyped Patterns of Behavior, Interest, and Activities

Insistence on Following Routines or Rituals ______

Demonstrating Distress or Resistance to Changes in Activity ______

Repetitive Hand or Finger Mannerism ______

Lack of True Imaginative Play Versus Reenactment ______

Overreaction or Under-Reaction to Sensory Stimuli ______

Rigid or Rule-bound Thinking ______

Intense, Focused Preoccupation with a Limited Range of Play, Interests, or Conversation Topics ______

Summary:

Minnesota Eligibility Criteria for Special Education states that “The team shall verify than an ASD adversely affects a pupil’s present level of performance and that the student is in need of special education instruction and related services.”

Identify observational areas in which the child exhibits a pattern of behaviors that indicates eligibility for an ASD identification--

  1. Qualitative Impairment in Social Interaction

______Limited Joint Attention

______Limited Use of Facial Expressions Directed Toward Others

______Absence of Bringing This to Others to Indicate an Interest in the Activity

______Demonstrates difficulties in relating to people, objects, and events Gross

Impairment in Ability to Make and Keep Friends

______Significant Vulnerability and Safety Issues Due to Social Naivete

______May Appear to Prefer Isolated or Solitary Activities

______Misinterprets Others’ Behaviors and Social Cues

2. Qualitative Impairment in Communication

______Not Using finger to Point or Request

______Using Others’ Hand or Body As a Tool

______Showing Lack of Spontaneous Imitation or Lack of Varied Imaginative Play

______Absence or Delay of Spoken Language

______Limited Understanding and Use of Nonverbal Communication Skills such

as Gestures, Facial Expressions, or Voice Tone

______Odd Production of Speech Including Intonation, Volume, Rhythm, or Rate

______Repetitive or Idiosyncratic Language or Inability to Initiate or Maintain a

Conversation When Speech is Present

3. Restricted, Repetitive, or Stereotyped Patterns of Behavior, Interest, and Activities

______Insistence on Following Routines or Rituals

______Demonstrating Distress or Resistance to Changes in Activity

______Repetitive Hand or Finger Mannerism

______Lack of True Imaginative Play Versus Reenactment

______Overreaction or Under-Reaction to Sensory Stimuli

______Rigid or Rule-bound Thinking

______Intense, Focused Preoccupation with a Limited Range of Play, Interests, or

Conversation Topics