This item must be based on your OBSERVATION. Ask younger patients to show you something in your office. If they cannot, then point to something to see if they look at the object you pointed to. For adults who do not spontaneously point, observe for the presence of hand gestures that mediate nonverbal communication.
This item is based equally on reported and observed data. So, if a parent REPORTS that her child uses full, complex sentences--even if the child does not exhibit such skills during the exam--you should score a "0".
Recent data suggests that there may be an articulation deficit in a subgroup of ASD patients. But "articulation problem" does not contribute to the score--it is just there for your clinical use.
5. Pragmatics of Language
This item is not applicable if the previous item is scored 1 or 2. For verbal patients: if you OBSERVE any of the signs/symptoms on the right (e.g. monopolizes, pedantic, can't make small talk, can't answer clearly; or, unvaried/odd intonation) then the item automatically gets score of 2. If you don't observe such signs/symptoms but they are REPORTED then the item gets score of 1.
6. Repetitive Behaviors & Stereotypy
This item is based equally on reported and observed data. So, if a mother reports that her child has overly-formal (stereotyped) speech--even if you don't observe it--mark it and score the item: 2.
Compulsive-like behaviors can include: lining up, spinning or moving objects back and forth; repetitive requests/demands, hoarding, pacing, jumping, etc.
Motor stereotypy: arm flapping, finger flicking; Vocal stereotypy: forced exhalations/vocalizations; Echolalia: delayed or immediate recitation of words or phrases usually without communicative intent; Stereotyped speech: overly formal/atypical usually with communicative intent.
7. Unusual or Encompassing Preoccupations
Encompassing preoccupations typically "take over" one's life, supplant other interests/hobbies and cause impairment in numerous domains. They can change over time and for the purpose of this exam must occur within the past 2 weeks. To be scored a 2 the preoccupation must spontaneously emerge during your exam. An unusual preoccupation may take the form of an interest that is atypical and very specific, such as kitchen appliance model numbers or calendar dates. For the purpose of this exam, an unusual preoccupation need not "take over" one's life but may simply be present. In younger or lower functioning patients preoccupations may take the following forms: 1) particular attachment to an unusual object or 2) particular interest in nonfunctional aspects of toys or other objects through stimulation of touch, taste, visual and vestibular modalities. Examples: staring at spinning wheel, blinking light, or TV screen; feeling textures; moving objects back and forth in peripheral visual field.
8. Unusual Sensitivities
Heightened sensitivity to noise, touch, smell or taste OR High pain threshold. For example, a child may cover his or her ears in response to a noise. A patient may report extreme sensitivity to clothing labels or textures of clothing fabrics. The examiner may notice that an impulsive child bangs into a piece of furniture and appears to have a high pain threshold.