Q-CHAT

1. What age is your child (in months)?

2. What is your child's gender?

3. Does your Child have an Autism diagnosis?

4. Has your child been diagnosed with any of the following?

5. Do any of your child’s immediate family members (siblings or parents) have a diagnosis of autism?

6. Does your child look at you when you call his/her name?

7. How easy is it for you to get eye contact with your child?

8. When your child is playing alone, does s/he line objects up?

9. Can other people easily understand your child’s speech?

10. Does your child point to indicate that s/he wants something (e.g a toy that is out of reach)?

11. Does your child point to share interest with you (e.g pointing at an interesting sight)?

12. How long can your child’s interest be maintained by a spinning object (e.g washing machine, electric fan, toy car wheels)?

13. How many words can your child say?

14. Does your child pretend (e.g. care for dolls, talk on a toy phone)?

15. Does your child follow where you’re looking?

16. How often does your child sniff or lick unusual objects?

17. Does your child place your hand on an object when s/he wants you to use it (e.g on a door handle when s/he wants you to open the door, on a toy when s/he wants you to activate it)?

18. Does your child walk on tiptoe?

19. How easy is it for your child to adapt when his/her routine changes or when things are out of their usual place?

20. If you or someone else in the family is visibly upset, does your child show signs of wanting to comfort them (e.g stroking their hair, hugging them)?

21. Does your child do the same thing over and over again (e.g running the tap, turning the light switch on and off, opening and closing doors)?

22. Would you describe your child’s first words as:

23. Does your child echo things s/he hears (e.g things that you say, lines from songs or movies, sounds)?

24. Does your child use simple gestures (e.g wave goodbye)?

25. Does your child make unusual finger movements near his/her eyes?

26. Does your child spontaneously look at your face to check your reaction when faced with something unfamiliar?

27. How long can your child’s interest be maintained by just one or two objects?

28. Does your child twiddle objects repetitively (e.g pieces of string)

29. Does your child seem oversensitive to noise?

30. Does your child stare at nothing with no apparent purpose?