Relative Questionnaire

Please complete this questionnaire in relation to when the person being assessed was in Infant/Junior School ie age 4 -11 years old

Relatives Questionnaire

Client Name(Required)
Completed by(Required)
1. Does s/he join in playing games with other children easily?(Required)
2. Does s/he come up to you spontaneously for a chat?(Required)
3. Was s/he speaking by 2 years old?(Required)
4. Does s/he enjoy sports?(Required)
5. Is it important to him/her to fit in with the peer group?(Required)
6. Does s/he appear to notice unusual details that others miss?(Required)
7. Does s/he tend to take things literally?(Required)
8. When s/he was 3 years old, did s/he spend a lot of time pretending (e.g., play-acting being a superhero, or holding teddy’s tea parties)?(Required)
9. Does s/he like to do things over and over again, in the same way all the time?(Required)
10. Does s/he find it easy to interact with other children?(Required)
11. Can s/he keep a two-way conversation going?(Required)
12. Can s/he read appropriately for his/her age?(Required)
13. Does s/he mostly have the same interests as his/her peers?(Required)
14. Does s/he have an interest which takes up so much time that s/he does little else?(Required)
15. Does s/he have friends, rather than just acquaintances?(Required)
16. Does s/he often bring you things s/he is interested in to show you?(Required)
17. Does s/he enjoy joking around?(Required)
18. Does s/he have difficulty understanding the rules for polite behaviour?(Required)
19. Does s/he appear to have an unusual memory for details?(Required)
20. Is his/her voice unusual (e.g., overly adult, flat, or very monotonous)?(Required)
21. Are people important to him/her?(Required)
22. Can s/he dress him/herself?(Required)
23. Is s/he good at turn-taking in conversation?(Required)
24. Does s/he play imaginatively with other children, and engage in role-play?(Required)
25. Does s/he often do or say things that are tactless or socially inappropriate?(Required)
26. Can s/he count to 50 without leaving out any numbers?(Required)
27. Does s/he make normal eye-contact(Required)
28. Does s/he have any unusual and repetitive movements?(Required)
29. Is his/her social behaviour very one-sided and always on his/her own terms?(Required)
30. Does s/he sometimes say “you” or “s/he” when s/he means “I”?(Required)
31. Does s/he prefer imaginative activities such as play-acting or story-telling, rather than numbers or lists of facts?(Required)
32. Does s/he sometimes lose the listener because of not explaining what s/he is talking about?(Required)
33. Can s/he ride a bicycle (even if with stabilisers)?(Required)
34. Does s/he try to impose routines on him/herself, or on others, in such a way that it causes problems?(Required)
35. Does s/he care how s/he is perceived by the rest of the group?(Required)
36. Does s/he often turn conversations to his/her favourite subject rather than following what the other person wants to talk about?(Required)
37. Does s/he have odd or unusual phrases?(Required)