SOCIAL COMMUNICATION PRIMARY AND SECONDARY QUESTIONNAIRE TO BE COMPLETED

SENSORY

Y

N

Any other comments or examples

Is hypersensitive to (loud) sounds, tastes, textures and smells - please state which

Appears to have a high pain threshold

Demonstrates unusual, repetitive or obsessive behaviours e.g. hand movements

Makes sudden or strange sounds/noises

Has poor gross motor skills e.g. balance, ball skills, getting dressed etc…

Walks on tip-toes

Has an odd gait when running

Has poor fine motor skills e.g. handwriting, scissors, fastening buttons etc…

PLAY & IMAGINATION

Y

N

Any other comments or examples

Has limited pretend play or other imaginative skills

Prefers to be alone when playing or doing other activities

Has difficulty with unexpected changes to routine- upset, anxious

Has special and repetitive interests/rituals

Has difficulty with imaginative writing

SOCIAL INTERACTION

Y

N

Any other comments or examples

Finds the unstructured parts of the school day difficult e.g. lunchtime, tidy away

Tends to be alone on the playground or around school

Interacts with others, but has difficulty doing so appropriately

Does not join in games with his/her peers

Lacks awareness of personal space and gets too close or stands too far away

Has a limited understanding of social skills e.g. waiting, turn taking, etc

Does not respond to social comments, e.g. “How are you?”

Has limited understanding of body language, facial expressions and emotions

Finds it difficult to see another person’s point of view

Resists trying new experiences

Resists sitting down in group situations

Has difficulty sustaining attention e.g. class work

Does not respond to group instructions (but may respond to his/her name)

Has difficulty understanding "unwritten rules"

Is naïve in responses to situations

Appears to lack 'common sense'

BEHAVIOUR FOR LEARNING

Y

N

Any other comments or examples

Has difficulty organising themselves e.g. late to lessons, incorrect books etc

Forgets equipment

Has difficulty following verbal instructions

Has difficulties settling to work

Has difficulty knowing how to begin or end a task

Has difficulties problem solving

Has difficulties generalising skills from one context to another

Sees things in very 'black and white' terms

Once learned applies rules rigidly

COMMUNICATION

Y

N

Any other comments or examples

Has difficulty understanding language

Prefers to follow written or visual instructions

Has difficulties with comprehension of text, but good reader

Appears not to be listening or paying attention/silently refuses

Finds eye contact difficult

Not able to appreciate jokes or sarcasm

Has difficulty understanding abstract concepts or non literal language

Takes a long time to respond to comments or questions

Has difficulty using language

Has a monotone or flat, unusually loud or quiet voice

Tends to use immediate or delayed echolalia (ie, repeats what has been said)

Finds it hard to ask for help

Tendency to talk on one topic

Tendency to interrupt when others are talking

Tendency to make irrelevant comments

EMOTIONS & FEELINGS

Y

N

Any other comments or examples

Has low self esteem

Is prone to anxiety or easily stressed

Has difficulty coping with the social and emotional demands of school

Has difficulty tolerating making mistakes

Displays outbursts without apparent cause

Does not understand general emotions

Has a limited range of facial expressions

Has difficulty empathising with peers

Is targeted by children, picked on or taunted