AUTISM SCREENING - MGM Behavioral

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8040 NW 155 St

Miami Lakes, FL 33016, US

Monday - Friday: 9:00 - 5:00

Saturday - Sunday: Closed

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AUTISM SCREENING

Parent Name *

First

Last

Child Name *

First

Last

Child's age *

Phone

Email *

Social interaction difficulties with same age peer *

Phone

Poor eye contact, or staring from unusual angle *

Ignores when called, pervasive ignoring, not turning head to voice *

Excessive fear of noises (vacuum cleaner); covers ears frequently *

In his/her own world (aloof) *

Lack of curiosity about the environment *

Daydreams too much *

Facial expressions don’t fit situations *

Inappropriate crying or laughing *

Temper tantrums, overreacting when not getting his/her way *

Ignores pain (bumps head accidentally without reacting) *

Doesn’t like to be touched or held (body, head) *

Does not understand other people’s feelings *

Hates crowds, difficulties in restaurants and supermarkets *

Inappropriate emotional response (not reaching to be picked up) *

Abnormal joy expression when seeing parents *

Lack of ability to imitate *

SPEECH AND LANGUAGE DELAY *

Produces unusual noises or infantile squeals *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Voice louder than required *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Difficulty understanding basic things (“just can’t get it”) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Pulls parents around when wants something *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Difficulty expressing needs or desires, using gestures *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

No spontaneous initiation of speech and communication *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Repeats heard words, parts of words or TV commercials *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Repetitive language (same word or phrase over and over) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Can’t sustain conversation *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Monotonous speech, wrong pausing *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Speaks same to kids, adults, objects (can’t differentiate) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Uses language inappropriately (wrong words or phrases) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

ABNORMAL SYMBOLIC OR IMAGINARY PLAY *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Hand or finer flapping; self stimulation *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Head banging *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Self mutilation, inflicting pain or injury *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Arranging toys in rows *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Smelling, banging, licking or other inappropriate use of toys *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Obsessed with objects or topics (trains, weather, numbers, dates) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Spinning objects, self, or fascination with spinning objects *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Restricted interest, (watching the same video over and over) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Attachment to unusual objects, (sticks, stones, strings, or hair) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Stubborn about rituals and routines; resists to change *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

Restricted taste by consistency, shape or form (refuses solids) *

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

BEHAVIORAL DIFFICULTIES *

Any other information the therapists must know

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.

We aim to create a substantial and long-lasting impact on every family, improving their overall well-being.

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8040 NW 155 Street, Miami Lakes, FL

Mon-Fri: 9:00 am – 4:00 pm
Saturday: By Appointment
Sunday: Closed

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