Autism Research Institute

Autism Treatment Evaluation Checklist (ATEC)
Internet Scoring Program for Non-Autistic Control Group

Although the Autism Treatment Evaluation Checklist (ATEC) was designed to assess changes in autistic children, we are also collecting normative data for other non-autistic populations. This data will allow researchers and families to make comparisons with respect to the severity of the autistic person's behaviors. We appreciate your time and effort in completing this checklist.

This simple Internet scoring procedure that will calculate subscale scores and a summary score from the ATEC. The scores are weighted according to the response and the corresponding subscale. The higher the subscale and total scores, the more impaired the subject.

The ATEC subscale and summary scores will be displayed immediately after you input each checklist. A copy of the data will also be sent to the ARI's database to help us develop norms. Information regarding the identity of each person will be kept confidential. If you wish, you can input an identification number for each person rather than entering his/her name, and/or use a code name rather than entering the intervention.

A. Information About Researcher and Project

Last Name / First Name of Researcher:
/

Name of data entry person [if different from above]:

Address1:
Address2:
City: , State: Zipcode:
Country [if outside U.S.]:

Telephone: Fax:
E-mail: <==Please enter your e-mail address


Intervention, if any, Being Evaluated [optional]:

B. Information Specific to Each ATEC/Person (Research Subject)

Assessment Period [e.g., baseline, 1 week post, 1 month post, etc.]:

Diagnosis or Probable Diagnosis: You may check more than one diagnosis.

Normal AD/HD Dyslexia Mental Retardation Epilepsy Learning Disability Other

If you checked 'Other,' please specify:

Is he/she related to an autistic individual? Sibling Cousin Not a blood relative Other
If you checked 'Other,' please specify:

ATEC

Last Name / First Name of Child [or identification code]:
/

Sex of Child: Male Female
Age:
Date of Birth [format: mo/da/yr; e.g., 09/25/98]:
Today's Date [same format as above]:
Form Completed By: [first and last name]
Relationship: [e.g., mother, teacher]

Please Click the Appropriate 'Radio Button'

I. Speech/Language/Communication

N = Not true S=Somewhat true V=Very true

1. Knows own name N S V
2. Responds to ‘No’ or ‘Stop’ N S V
3. Can follow some commands N S V
4. Can use one word at a time N S V
5. Can use 2 words at a time N S V
6. Can use 3 words at a time N S V
7. Knows 10 or more words N S V
8. Can use sentences with 4 or more words N S V
9. Explains what he/she wants N S V
10. Asks meaningful questions N S V
11. Speech tends to be meaningful/relevant N S V
12. Often uses several successive sentences N S V
13. Carries on fairly good conversation N S V
14. Has normal ability to commmunicate for his/her age N S V

II. Sociability

N = Not descriptive S=Somewhat descriptive V=Very descriptive

1. Seems to be in a shell - you cannot reach him/her N S V
2. Ignores other people N S V
3. Pays little or no attention when addressed N S V
4. Uncooperative and resistant N S V
5. No eye contact N S V
6. Prefers to be left alone N S V
7. Shows no affection N S V
8. Fails to greet parents N S V
9. Avoids contact with others N S V
10. Does not imitate N S V
11. Dislikes being held/cuddled N S V
12. Does not share or show N S V
13. Does not wave ‘bye bye’ N S V
14. Disagreeable/not compliant N S V
15. Temper tantrums N S V
16. Lacks friends/companions N S V
17. Rarely smiles N S V
18. Insensitive to other's feelings N S V
19. Indifferent to being liked N S V
20. Indifferent if parent(s) leave N S V

III. Sensory/Cognitive Awareness

N = Not descriptive S=Somewhat descriptive V=Very descriptive

1. Responds to own name N S V
2. Responds to praise N S V
3. Looks at people and animals N S V
4. Looks at pictures (and T.V.) N S V
5. Does drawing, coloring, art N S V
6. Plays with toys appropriately N S V
7. Appropriate facial expression N S V
8. Understands stories on T.V. N S V
9. Understands explanations N S V
10. Aware of environment N S V
11. Aware of danger N S V
12. Shows imagination N S V
13. Initiates activities N S V
14. Dresses self N S V
15. Curious, interested N S V
16. Venturesome - explores N S V
17. “Tuned in” - Not spacey N S V
18. Looks where others are looking N S V

IV. Health/Physical/Behavior

N = Not a Problem MI=Minor Problem MO=Moderate Problem S=Serious Problem

1. Bed-wetting N MI MO S
2. Wets pants/diapers N MI MO S
3. Soils pants/diapers N MI MO S
4. Diarrhea N MI MO S
5. Constipation N MI MO S
6. Sleep problems N MI MO S
7. Eats too much/too little N MI MO S
8. Extremely limited diet N MI MO S
9. Hyperactive N MI MO S
10. Lethargic N MI MO S
11. Hits or injures self N MI MO S
12. Hits or injures others N MI MO S
13. Destructive N MI MO S
14. Sound-sensitive N MI MO S
15. Anxious/fearful N MI MO S
16. Unhappy/crying N MI MO S
17. Seizures N MI MO S
18. Obsessive speech N MI MO S
19. Rigid routines N MI MO S
20. Shouts or screams N MI MO S
21. Demands sameness N MI MO S
22. Often agitated N MI MO S
23. Not sensitive to pain N MI MO S
24. “Hooked” or fixated on certain objects/topics N MI MO S
25. Repetitive movements N MI MO S

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