Autism Spectrum Parent Screener Child's First Name *Child's Last Name *Date of Birth *Parent/Guardian Name *Date of Screening *Email Address *Phone * Autism Screener (parent version): ages 4–17 Instructions: Please rate how often you notice these behaviors in your child: 0 = Never/Rarely 1 = Sometimes 2 = Often/Always Q1. Has difficulty understanding social cues (tone of voice, facial expressions, gestures) *Never/RarelySometimesOften/AlwaysQ2. Struggles to make or keep friends *Never/RarelySometimesOften/AlwaysQ3. Has very intense or narrowly focused interests *Never/RarelySometimesOften/AlwaysQ4. Gets very upset by unexpected changes in routine *Never/RarelySometimesOften/AlwaysQ5. Repeats movements or phrases (e.g., rocking, hand-flapping, repeating certain words) *Never/RarelySometimesOften/AlwaysTotal ScoreSubmit
