1: Social Initiation and Response
1
.
Do you find it hard to approach others about things you would like or need to discuss with them?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you have difficulty entering into a social group or conversation?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you struggle with knowing when it’s your turn to talk?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you frequently interrupt others in conversations?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Do you frequently leave unusually long pauses in conversations?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you find yourself having one-sided conversations in which you are doing most of the talking? (Monologuing)
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do you get easily bored when someone wants to talk about a subject that does not interest you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Do you find it tedious, confusing, anxiety-provoking, or hard to engage in small talk?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you prefer to have conversations for the primary purpose of exchanging information, rather than for the primary purpose of emotionally connecting?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you find it hard to explain something in a different way, if someone does not understand you the first time?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you find it hard to express excitement when someone else shares news of an exciting or enjoyable experience they had?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Does praise make you uncomfortable because you’re unsure how to respond?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you find that others seem to enjoy social interactions more than you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you have an aversion to intimate physical affection?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
15
.
Do you have an aversion to other types of typically physical contact, such as a handshake or hug?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
16
.
Do you find it difficult to ask others for help?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2: Non-Verbal Communication
1
.
Do you have differences engaging in eye contact during conversation?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you have differences in use of gestures or body language?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Have you been told that your facial expressions are inappropriate for the situation or do not match your feelings?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Have others told you that your facial expressions often look angry, depressed, or blank, even though you don’t feel that way?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Have you been told that you stare at people?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you have difficulty putting on an expected facial expression, such as smiling for photos?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do you find making eye contact uncomfortable, difficult or even painful?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
When talking to others, do you tend to look or face away from them under certain conditions (such as when you’re thinking, or the conversation becomes emotionally intense)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Have you been told that you often speak too loudly, too softly, or too quickly – to be easily understood?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you find yourself imitating the accents or speech patterns of the person you are talking to?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Have you been told that your speech is flat or monotonous?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Have others described you as cold, detached, or bored, when you weren’t feeling that way?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you have difficulty understanding other people’s facial expressions or body language?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you have difficulty recognising sarcasm?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3: Relationships
1
.
Do you find it difficult to judge how another person is feeling about you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you have trouble judging how another person is reacting to your words and actions?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you often miss social cues that others seem to easily understand?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you laugh or smile at the wrong time?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Have you been told you’re aloof, withdrawn, or in your own world?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you have a lower than average need for social interaction?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do you often prefer solitary activities or spending time alone?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Do you find interacting with people who are much younger or older than you easier than interacting with your age peers?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you find it difficult to make new friends?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you struggle with maintaining friendships?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you prefer to have just one or two friends at a time?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Do you wish you had more friends?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you find it difficult to establish relationships?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you have distant or strained relationships with family members, especially for reasons you find hard to understand?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
15
.
Do you find it hard to tell if someone is teasing or mocking you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
16
.
Do you have trouble figuring out when someone wants you to do something, if they don’t especially or directly tell you (e.g., saying they’re cold and wanting you to offer them a blanket or a jumper/sweater)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
17
.
Do you prefer one-on-one interaction over group interaction?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
18
.
Do you sometimes avoid interacting with others, such as not responding to messages?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
19
.
Do you find it hard to understand the unwritten rules of social interaction?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
20
.
Do you rely on scripted speech or imitating others in social interactions?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
21
.
Do you have difficulty in reacting in expected ways to another person’s distress?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
22
.
Do you find it hard to judge when it’s okay to join a group activity or a conversation?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
23
.
Do others tell you that you’re insensitive?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
24
.
Do others tell you that you don’t seem to notice their feelings?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
25
.
Do others call you selfish because you only seem to be thinking of yourself in certain situations?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
26
.
Are you often surprised when another person tells you what they were really thinking, after you’ve had a misunderstanding?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4: Speech or Movements
1
.
Do you repeat words, phrases or longer passages of speech that you’ve heard, such as from a movie or conversational partner (either immediately or along time after hearing the original speech)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you have a larger vocabulary than others you speak with?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you have a strong preference for very exact use of words, regardless of how commonly used those words might be?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you often use unusually formal words or speech structure?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Do you have some phrases that you use frequently, even when they are not exactly appropriate?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you use a lot of metaphors, especially ones that you’ve made up (that might not make sense to others)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do you sometimes feel the need to repeatedly talk about the same subject?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Do you perform soothing repetitive hand movements, like flapping your hands, flicking your fingers, or manipulating an object with your fingers?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you perform whole body movements like rocking, bouncing, walking on your toes, skipping, spinning, or swaying in solitude or in company?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you repeatedly pick at your skin or scalp?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you like to sit, stand or otherwise position yourself in unusual ways, such as curling up in small places, or lying or sitting with certain body parts under you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Have you been told that you make unusual facial expressions (e.g. grimaces, flinching) repeatedly, often without realising it?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you enjoy using objects in ways other than how they were intended (e.g., twirling a piece of string, chewing on objects, repeatedly opening and closing things, lining up or arranging things by colour or category)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5: Rituals and Change
1
.
Do you sometimes feel the need to repeatedly ask the same questions, even after your question has been answered?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you need to say a particular thing in a certain way at certain times?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you find it hard to understand certain types of humour?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you have difficulty understanding non-literal types of speech that you have not been exposed to before, such as irony, sarcasm, symbolism, or allusions?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Do you find it hard to end one activity and begin another?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you struggle to begin or complete self-care tasks, even when you know that a task is essential or overdue?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do other people tell you that you over-react to small changes in plans or your environment (even if you don’t consider the changes small)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Do you have a lot of routines that you rely on to get through the day or to navigate certain situations?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you get upset when someone or something disrupts one of your routines?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you have routines that other people think are unusual?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you have routines for activities that others do not have a routine for?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Have you been told that your style of thinking is “black and white” or “all or nothing”?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you have trouble seeing other people’s point of view in a discussion or an argument?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you find it hard to apologise or admit that you’re wrong after you’ve taken a strong stance in a discussion?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
15
.
Do you have a lot of rules that you like to follow?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
16
.
Do you become upset when others break your personal rules? For example, this can include moving your belongings or sitting in your preferred seat?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
17
.
Do other people tell you that you’re controlling or bossy?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
18
.
Do you get frustrated by things that are not clearly defined (e.g., when people say “it depends”) or where there are no clear answers to a problem or question?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
19
.
Do you find open ended questions hard to answer?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
20
.
Do you often have trouble changing your mind or adjusting your plans, if you’re presented with new information, or a situation suddenly changes?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6: Interests
1
.
Do you tend to become passionate about certain topics, sometimes for reasons you can’t explain?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
When you are interested in a topic, does it seem to take over many aspects of your life (e.g., you find yourself talking, thinking, or reading about it, or collecting and making things related to it)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you have an object that you like to have with you at all times because it is soothing?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you find that you naturally focus more on details of things, rather than the whole?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Do you have interests that are unusually intense compared to your peers?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you have highly niche interests?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Do you have a narrow range of interests?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Does your leisure time always focus on just one or two activities or topics?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you have a passion for numbers, letters, words, or symbols, including specimens/items such as the number 3, or categories?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you consider yourself, or have you been told, that you are a perfectionist?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you like to collect?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Do you like to categorize items?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Do you have large collections of factual knowledge?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you see patterns and systems in things?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7: Sensory Experiences
1
.
Are their certain textures you particularly enjoy touching?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Do you find certain textures hard to tolerate?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Do you find that textures, features or styles of clothing (e.g. tags, seams, high/tight collars or waists) that don’t seem to bother other people, are irritating or even upsetting to you?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Do you find showers, haircuts or other common selfcare tasks, physically uncomfortable or painful?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Are you unusually sensitive to any light touch on your skin?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Do you notice physical sensations that others don’t seem to notice?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Are you unusually sensitive or insensitive to heat or cold?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Are you easily startled by loud sounds, or do you find certain sounds painful?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Do you have unusually sensitive hearing?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Do you often hear sounds that others don’t notice?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Do you have difficulty following conversations when there is a lot of background noise?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Do you find a certain type of intensity of light painful or otherwise hard to tolerate?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Are you unusually sensitive to specific smells, often to the point that if you can’t escape them, you’ll become physically ill?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Do you find it impossible to eat certain types of foods due to their unpleasant taste or texture?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
15
.
Do you sometimes become physically ill (e.g., nauseous, dizzy, severe headache) around certain types of sensory input (e.g., fluorescent lights, sirens, strobes, machinery)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
16
.
Do you have an unusually high tolerance for pain?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
17
.
Do you enjoy watching moving objects for extended periods of time?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
18
.
Are you strongly drawn to certain smells or visual patterns?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
19
.
Do you seek out certain types of movement like swing, bouncing, speed or flight?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
20
.
Do you seek out deep pressure such as tight hugs, heavy blankets, or tight spaces?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8: Traits Present in Childhood
1
.
Have most of your (above) traits, to which you’ve answered 'Sometimes' or 'Often', been present since early childhood (8 or younger)?
Yes
No
2
.
Have most of your (above) traits, to which you’ve answered 'Sometimes' or 'Often', been present since early adolescence (age 16 or younger)?
Yes
No
3
.
Are there some questions above that you answered 'Sometimes' or 'Often' to when thinking about your childhood, which were present then, but no longer present in adulthood?
Yes
No
9: Other
1
.
Insomnia or poor sleeping patterns?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
2
.
Persistent anxiety?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
3
.
Impaired fine motor coordination (tying shoelaces or holding a pencil)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
4
.
Impaired gross motor coordination (PE and games, bumps into things)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
5
.
Difficulty in recognising your own emotions?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
6
.
Difficulty in talking about your own emotions and difficulties?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
7
.
Difficulty in differentiating between physical sensations and emotions?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
8
.
Difficulty in recognising the emotions of others?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
9
.
Dyslexia?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
10
.
Severe difficulty in making arithmetical calculations (as a result of brain disorder)?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
11
.
Problems in recognising familiar people out of context?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
12
.
Meltdowns or shutdowns: periods of intense emotional upset, physical withdrawal from environment, fit like episodes, reduction in verbal skills followed by intense fatigue?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
13
.
Auditory processing issues – problems in processing and understanding spoken language?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
14
.
Tics – involuntary movements of face or body?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
15
.
What main challenges are you currently experiencing (related to autism or otherwise)?
16
.
Do you camouflage/mask? Do you change your behaviour to fit in with others and ensure that social interactions go smoothly?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
17
.
Have you experienced meltdowns, shutdowns, or overwhelm?
No / Nil / NA – Does not apply to me at all
Rarely, applies to me to a small degree
Sometimes, applies to me to a moderate/medium degree
Often, applies to me to a high degree
18
.
What makes you suspect that you are autistic?
19
.
Are any of your relatives autistic?
Yes
No
20
.
Do you have a previous diagnosis for any of the following conditions:
Attention deficit hyperactivity disorder (ADHD)
Bipolar disorder
Dyslexia
Dyspraxia
Eating disorders
Epilepsy
Generalized anxiety disorder (GAD)
Hypermobility spectrum disorders
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Seizures
Sleep disorders
Social anxiety disorder
Tourette’s syndrome
Trauma and stressor-related disorder
Score