Pervasive Developmental Disorder (PDD) Screening AssessmentPervasive Developmental Disorder (PDD) Screening Assessment Pervasive developmental disorders (PDD) now known as autism spectrum disorder (ASD) refers to a group of conditions that affect average development. It may appear as a delay in development of social and communication skills. Signs of this condition usually become noticeable around the age of 3 years, but can appear from early infancy.NameDate of EvaluationNameDate of EvaluationSocial and1. Little interest or pleasure in doing things1. Little interest or pleasure in doing things Not True Rarely True Sometimes True Often True2. Feeling down, depressed, or hopeless2. Feeling down, depressed, or hopeless Not True Rarely True Sometimes True Often True3. Trouble falling or staying asleep, or sleeping too much3. Trouble falling or staying asleep, or sleeping too much Not True Rarely True Sometimes True Often True4. Feeling tired or having little energy4. Feeling tired or having little energy Not True Rarely True Sometimes True Often True5. Poor appetite or overeating5. Poor appetite or overeating Not True Rarely True Sometimes True Often True6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down Not True Rarely True Sometimes True Often True7. Trouble concentrating on things, such as reading the newspaper or watching television7. Trouble concentrating on things, such as reading the newspaper or watching television Not True Rarely True Sometimes True Often True8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual Not True Rarely True Sometimes True Often True9. Thoughts that you would be better off dead or of hurting yourself in some way9. Thoughts that you would be better off dead or of hurting yourself in some way Not True Rarely True Sometimes True Often TrueIf you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not True Rarely True Sometimes True Often TrueBehavioral1. Little interest or pleasure in doing things1. Little interest or pleasure in doing things Not True Rarely True Sometimes True Often True2. The child displays an obsessive interest in narrow or atypical topics (is ritualistic)2. The child displays an obsessive interest in narrow or atypical topics (is ritualistic) Not True Rarely True Sometimes True Often True3. The child is rule bound (sees things in black and white)3. The child is rule bound (sees things in black and white) Not True Rarely True Sometimes True Often True4. The child displays unusual eating habits4. The child displays unusual eating habits Not True Rarely True Sometimes True Often True5. The child engages in perseverative behaviors5. The child engages in perseverative behaviors Not True Rarely True Sometimes True Often True6. The child’s behavior is rigid (has difficulty with changes and transitions, needs sameness, needs order)6. The child’s behavior is rigid (has difficulty with changes and transitions, needs sameness, needs order) Not True Rarely True Sometimes True Often True7. The child is a perfectionist (cannot tolerate mistakes, resists learning new tasks)7. The child is a perfectionist (cannot tolerate mistakes, resists learning new tasks) Not True Rarely True Sometimes True Often True8. The child appears anxious8. The child appears anxious Not True Rarely True Sometimes True Often TrueSpeech and Language1. The child uses words in a peculiar manner1. The child uses words in a peculiar manner Not True Rarely True Sometimes True Often True2. The child does not ask for the meaning of words2. The child does not ask for the meaning of words Not True Rarely True Sometimes True Often True3. The child does not ask for help3. The child does not ask for help Not True Rarely True Sometimes True Often True4. The child does not make jokes and has difficulty understanding joking and teasing4. The child does not make jokes and has difficulty understanding joking and teasing Not True Rarely True Sometimes True Often True5. The child does not initiate conversation5. The child does not initiate conversation Not True Rarely True Sometimes True Often True6. The child has difficulty maintaining conversation in a reciprocal format (conversational give-and-take)6. The child has difficulty maintaining conversation in a reciprocal format (conversational give-and-take) Not True Rarely True Sometimes True Often True7. The child does not inquire about others7. The child does not inquire about others Not True Rarely True Sometimes True Often True8. The child “sounds” like an adult8. The child “sounds” like an adult Not True Rarely True Sometimes True Often True9. The child says things that embarrasses others (comments on physical characteristics, asks probing questions)9. The child says things that embarrasses others (comments on physical characteristics, asks probing questions) Not True Rarely True Sometimes True Often True10. The child engages in obsessive questioning10. The child engages in obsessive questioning Not True Rarely True Sometimes True Often True11. The child engages in obsessive talking about specific topics11. The child engages in obsessive talking about specific topics Not True Rarely True Sometimes True Often True12. The child does not maintain another’s topic when it does not pertain to his or her own special interest12. The child does not maintain another’s topic when it does not pertain to his or her own special interest Not True Rarely True Sometimes True Often True13. The child has a large vocabulary consisting primarily of nouns and verbs13. The child has a large vocabulary consisting primarily of nouns and verbs Not True Rarely True Sometimes True Often True14. The child does not use language socially (focuses conversations on facts or special interests)14. The child does not use language socially (focuses conversations on facts or special interests) Not True Rarely True Sometimes True Often True15. The child confuses “he” and “she”15. The child confuses “he” and “she” Not True Rarely True Sometimes True Often True16. The child displays unusual intonation, pitch, and/or loudness16. The child displays unusual intonation, pitch, and/or loudness Not True Rarely True Sometimes True Often True17. The child uses “language scripts” when conversing (language consists of scripts or parts of scripts from movies/TV/books)17. The child uses “language scripts” when conversing (language consists of scripts or parts of scripts from movies/TV/books) Not True Rarely True Sometimes True Often True18. The child interprets language on a literal level18. The child interprets language on a literal level Not True Rarely True Sometimes True Often True19. The child misses the point or main idea of a conversation19. The child misses the point or main idea of a conversation Not True Rarely True Sometimes True Often True20. The child insists upon verbal rituals (repeats scripts from movies/TV/books, shares too many details)20. The child insists upon verbal rituals (repeats scripts from movies/TV/books, shares too many details) Not True Rarely True Sometimes True Often True21. The child does not exhibit gestural communication21. The child does not exhibit gestural communication Not True Rarely True Sometimes True Often True22. The child has difficulty maintaining the topic in a conversation22. The child has difficulty maintaining the topic in a conversation Not True Rarely True Sometimes True Often TrueCognition1. The child has difficulty understanding abstract concepts (such as guessing, wishing, time sequence)1. The child has difficulty understanding abstract concepts (such as guessing, wishing, time sequence) Not True Rarely True Sometimes True Often True2. The child displays strong memory skills2. The child displays strong memory skills Not True Rarely True Sometimes True Often True3. The child has difficulty with fine motor skills3. The child has difficulty with fine motor skills Not True Rarely True Sometimes True Often True4. The child interprets the behavior of others on a literal level4. The child interprets the behavior of others on a literal level Not True Rarely True Sometimes True Often True5. The child does not generalize learning from one situation to another5. The child does not generalize learning from one situation to another Not True Rarely True Sometimes True Often True6. The child is easily distracted6. The child is easily distracted Not True Rarely True Sometimes True Often True7. The child has difficulty sustaining attention7. The child has difficulty sustaining attention Not True Rarely True Sometimes True Often TrueSensory1. The child displays unusual sensitivity to noises1. The child displays unusual sensitivity to noises Not True Rarely True Sometimes True Often True2. The child displays unusual sensitivity to smells2. The child displays unusual sensitivity to smells Not True Rarely True Sometimes True Often True3. The child displays unusual sensitivity to tastes3. The child displays unusual sensitivity to tastes Not True Rarely True Sometimes True Often True4. The child displays unusual sensitivity to textures4. The child displays unusual sensitivity to textures Not True Rarely True Sometimes True Often True5. The child displays unusual sensitivity to being touched5. The child displays unusual sensitivity to being touched Not True Rarely True Sometimes True Often True6. The child engages in repetitive or stereotypic movements6. The child engages in repetitive or stereotypic movements Not True Rarely True Sometimes True Often True7. The child displays difficulty with motor functioning/planning (tying shoes, riding a bike)7. The child displays difficulty with motor functioning/planning (tying shoes, riding a bike) Not True Rarely True Sometimes True Often TrueSubmit Form
