Peterborough County, ON

Screening Tool: Social challenges including autism spectrum disorder (ASD)

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Does your child have troubles getting along with others?

If so, consider filling out this survey, which is designed to see whether or not your child might have signs and symptoms related to conditions such as autism spectrum disorder (ASD). If the test is positive, it does not necessarily mean that your child has a condition such as ASD. It simply means that your child should be seen by a health professional for further assessment.

This survey is the Social Challenges Screening Questionnaire (SCSQ) version 3.1, developed by Dr. Christopher Smith, Southwest Autism Research & Resource Centre. Special thanks to Dr. Smith permission to use this questionnaire!

Have difficulty with fine or gross motor coordination (handwriting, throwing or catching balls, riding a bike, etc.)?

	Yes
	No

Have unusual speech at times (too slow or loud, formal or "little professor-like", monotone, robotic etc.)?

	Yes
	No

Have difficulty playing with others (disrupts play, controls the activity, etc.)?

	Yes
	No

Have trouble making or keeping friends?

	Yes
	No

Seem socially awkward at times (rude, inappropriate comments, unaware of social cues)?

	Yes
	No

Have interests that seem overly intense and are expressed in conversation, play, and thoughts?

	Yes
	No

Have trouble organizing or completing school work?

	Yes
	No

Find jokes or sarcasm difficult to understand?

	Yes
	No

Have few or unusual facial expressions?

	Yes
	No

10.

Often act without thinking (interrupts often, takes things from others without asking, etc.)?

	Yes
	No

11.

Have difficulty following instructions or the flow of simple conversations?

	Yes
	No

12.

Become overly distressed when routines are changed at home or school?

	Yes
	No

13.

Have trouble following rules of personal space and boundaries (excessive touching, stands too close, etc.)?

	Yes
	No

14.

Have poor eye contact?

	Yes
	No

15.

Have exceptional skills (advanced language development, early letter or number recognition, memorization of facts, etc.)?

	Yes
	No

For more information

Christopher J. Smith, Elena Pollard, Alexander J. Stein, Sharman Ober-Reynolds,

Janet Kirwan, Amanda Malligo, Nicole L. Matthews, Daniel Openden & Raun D. Melmed (2015)

A Method for Universal Screening of Elementary School Students: Development of the Social

Challenges Screening Questionnaire, Journal of Applied School Psychology, 31:2, 115-140, DOI:

10.1080/15377903.2014.995391