1.
Do you:
Like to arrange items in rows or patterns?
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
2. Repetitively fiddle with items? (e.g. spin, twiddle, bang, tap, twist, or flick anything repeatedly?)
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
3. Spin yourself around and around?
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
4. Rock backwards and forwards, or side to side, either when sitting or when standing?
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
5. Pace or move around repetitively? (e.g. walk to and fro across a room, or around the same path outside?)
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
6. Make repetitive hand and/or finger movements? (e.g. flap, wave, or flick hands or fingers repeatedly?)
15 or more times daily (or at least once an hour)
30 or more times daily (or at least twice an hour)
7. Have a fascination with specific objects? (e.g. trains, road signs or other things?)
8. Like to look at objects from particular or unusual angles?
9. Have a special interest in the smell of people or objects?
10. Have a special interest in the feel of different surfaces?
11. Have any special objects you like to carry around?
12. Collect or hoard items of any sort?
13. Insist on things at home remaining the same? (e.g. furniture staying in the same place, things being kept in certain places, or arranged in certain ways?)
Mild or occasional (does not affect others)
Marked or notable (occasionally affects others)
Serious or severe (affects others on a regular basis)
14. Get upset about minor changes to objects? (e.g. flecks of dirt on clothes, minor scratches on objects?)
Mild or occasional (does not affect others)
Marked or notable (occasionally affects others)
Serious or severe (affects others on a regular basis)
15. Insist that aspects of daily routine must remain the same?
Mild or occasional (does not affect others)
Marked or notable (occasionally affects others)
Serious or severe (affects others on a regular basis)
16. Insist on doing things in a certain way or re-doing things until they are “just right”?
Mild or occasional (does not affect others)
Marked or notable (occasionally affects others)
Serious or severe (affects others on a regular basis)
17. Play the same music, game or video, or read the same book repeatedly?
Mild or occasional (not entirely resistant to change or new things)
Marked or notable (will tolerate changes when necessary)
Serious or severe (will not tolerate any changes)
18. Insist on wearing the same clothes or refuse to wear new clothes?
Mild or occasional (not entirely resistant to change or new things)
Marked or notable (will tolerate changes when necessary)
Serious or severe (will not tolerate any changes)
19. Insist on eating the same foods, or a very small range of foods, at every meal?
Mild or occasional (not entirely resistant to change or new things)
Marked or notable (will tolerate changes when necessary)
Serious or severe (will not tolerate any changes)
20. What sort of activity will you choose if left to occupy yourself?
A range of different and flexible self-chosen activities
Some varied and flexible interests but commonly chooses the same activities
Almost always chooses from a restricted range of repetitive activities