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   Autism Questionnaire

Name
EMail

1. Does your child enjoy being swung, bounced on your knee, etc.? yes   no
2. Does your child take an interest in other children? yes   no
3. Does your child like climbing on things, such as up/on chairs? yes   no
4. Does your child enjoy playing peek-a-boo / hide & seek? yes   no
5. Does your child ever pretend, for example, to make a cup of tea using a toy cup and teapot, or pretend other things (pouring juice)? yes   no
6. Does your child ever use his or her index finger to point, to ask for something? yes   no
7. Does your child ever use his or her index finger to point, to indicate interest in something? yes   no
8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them? yes   no
9. Does your child ever bring objects over to you (parent), to show you something? yes   no
10. Does your child regularly make eye contact with you? yes   no
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