HTML Preview Autism Child Behavior Checklist page number 1.
Autism Behavior Checklist From Krug, Arick, and Almond (1978)
Patient _____________________________ Birth Date: ______________________
Examiner___________________________ Test Date______________________
Page 1
Circle the number for those items most accurately describing the child:
1 Whirls self for long periods of time 4
2 Learns a simple task but “forgets” quickly 2
3 Frequently does not attend to social/environmental cues 4
4 Does not follow simple commands (sit down, come here, stand up) given once 1
5 Does not use toys appropriately (spins wheels, etc.) 2
6 Poor use of visual discrimination when learning (fixates on parts of objects such as
size, color, position…)
2
7 Lacks a social smile (may smile out-of-context) 2
8 Exhibits pronoun reversal (you for I…) 3
9 Insists on keeping certain objects with him/herself 3
10
Seems not to hear (despite normal hearing tests) 3
11
Speech is atonal and arrhythmic 4
12
Rocks self for long periods of time 4
13
Does not (or did not as a baby) reach out when reached for 2
14
Strong reactions to minor changes in routine/environment 3
15
Does not respond to own name when called out among two or more other names 2
16
Lunges and darts about, interrupted by spinning, toe walking, hand flapping… 4
17
Not responsive to other people’s facial expressions or feelings 3
18
Seldom uses “yes” or “I” 2
19
Has special abilities in one area – seems to rule out mental retardation 4
20
Does not follow simple prepositional commands (e.g., “put the ball in the box”) 1
21
Sometimes shows no “startle response” to a loud noise 3
22
Flaps hands (or other self-stimulating behavior) 4
23
Severe temper tantrums and/or frequent minor tantrums 3
24
Actively avoids eye contact 4
25
Resists being touched or held 4
26
Sometimes, painful stimuli (cuts, injections, bruises) evoke no reaction 3
27
Is (or was as a baby) stiff and hard to hold 3
28
Is flaccid (doesn’t cling) when held in arms 2
29
Gets desired objects by gesturing 2
30
Walks on toes 2
31
Hurts others by biting, hitting, kicking… 2
32
Repeats phrases over and over again 3
33
Does not imitate other children at play 3
34
Often will not blink when a bright light is directed toward eyes 1
35
Hurts self by biting hand, banging head… 2
36
Does not wait for needs to be met (wants things immediately) 2
37
Cannot point to more than five named objects 1