James Adams, Ph.D. - Arizona State University

Autism Treatment Evaluation Checklist (ATEC)
Research Study

If you have not been asked by Dr. Adams to participate in this study,
please do not complete this ATEC form. You can complete the ATEC at
www.ari-atec.com.


The Autism Treatment Evaluation Checklist (ATEC) was designed to assist parents, physicians and researchers to evaluate virtually any treatment for autism. The Autism Research Institute (ARI) has developed this convenient Internet scoring procedure that will calculate four subscale scores and a total score from the ATEC. The scores are weighted according to the response and the corresponding subscale. The higher the subscale and total scores, the more impaired the subject.

The four ATEC subscale scores and the total score will be displayed immediately after you input each checklist. A copy of the data will also be sent to Dr. Adams' database for analysis. Information regarding the identity of each person will be kept confidential. If you wish, you may input an identification number for each person rather than entering his/her name, and/or use a code name rather than entering the name of the intervention being evaluated.

A. Information About ATEC User and Project

ATEC User:
Parent Practitioner Researcher Other:

Last Name / First Name of ATEC User:
/

Name of person entering data [if different from above]:

Address1:
Address2:
City: , State: Zipcode:
Country [if outside U.S.]:

Telephone: Fax:
E-mail: <==Please enter your e-mail address


Diagnosis: You may check more than one diagnosis.

Autism Asperger Syndrome PDD-NOS Landau-Kleffner Syndrome Other

If you checked 'Other,' please specify:

Autism Treatment Evaluation Checklist (ATEC)

Last Name / First Name of Child [or identification code]:
/

Sex of Child: Male Female
Age -- Years: Months:
Date of Birth [format: mo/da/yr; e.g., 09/25/98]:
Form Completed By: [first and last name]
Relationship: [e.g., mother, teacher]

*****

Assessment: First time; Second time (one week later)

Please Click the Appropriate 'Radio Button'

I. Speech/Language/Communication

N = Not true S=Somewhat true V=Very true

1. Knows own name N S V
2. Responds to ‘No’ or ‘Stop’ N S V
3. Can follow some commands N S V
4. Can use one word at a time N S V
5. Can use 2 words at a time N S V
6. Can use 3 words at a time N S V
7. Knows 10 or more words N S V
8. Can use sentences with 4 or more words N S V
9. Explains what he/she wants N S V
10. Asks meaningful questions N S V
11. Speech tends to be meaningful/relevant N S V
12. Often uses several successive sentences N S V
13. Carries on fairly good conversation N S V
14. Has normal ability to commmunicate for his/her age N S V

II. Sociability

N = Not descriptive S=Somewhat descriptive V=Very descriptive

1. Seems to be in a shell - you cannot reach him/her N S V
2. Ignores other people N S V
3. Pays little or no attention when addressed N S V
4. Uncooperative and resistant N S V
5. No eye contact N S V
6. Prefers to be left alone N S V
7. Shows no affection N S V
8. Fails to greet parents N S V
9. Avoids contact with others N S V
10. Does not imitate N S V
11. Dislikes being held/cuddled N S V
12. Does not share or show N S V
13. Does not wave ‘bye bye’ N S V
14. Disagreeable/not compliant N S V
15. Temper tantrums N S V
16. Lacks friends/companions N S V
17. Rarely smiles N S V
18. Insensitive to other's feelings N S V
19. Indifferent to being liked N S V
20. Indifferent if parent(s) leave N S V

III. Sensory/Cognitive Awareness

N = Not descriptive S=Somewhat descriptive V=Very descriptive

1. Responds to own name N S V
2. Responds to praise N S V
3. Looks at people and animals N S V
4. Looks at pictures (and T.V.) N S V
5. Does drawing, coloring, art N S V
6. Plays with toys appropriately N S V
7. Appropriate facial expression N S V
8. Understands stories on T.V. N S V
9. Understands explanations N S V
10. Aware of environment N S V
11. Aware of danger N S V
12. Shows imagination N S V
13. Initiates activities N S V
14. Dresses self N S V
15. Curious, interested N S V
16. Venturesome - explores N S V
17. “Tuned in” - Not spacey N S V
18. Looks where others are looking N S V

IV. Health/Physical/Behavior

N = Not a Problem MI=Minor Problem MO=Moderate Problem S=Serious Problem

1. Bed-wetting N MI MO S
2. Wets pants/diapers N MI MO S
3. Soils pants/diapers N MI MO S
4. Diarrhea N MI MO S
5. Constipation N MI MO S
6. Sleep problems N MI MO S
7. Eats too much/too little N MI MO S
8. Extremely limited diet N MI MO S
9. Hyperactive N MI MO S
10. Lethargic N MI MO S
11. Hits or injures self N MI MO S
12. Hits or injures others N MI MO S
13. Destructive N MI MO S
14. Sound-sensitive N MI MO S
15. Anxious/fearful N MI MO S
16. Unhappy/crying N MI MO S
17. Seizures N MI MO S
18. Obsessive speech N MI MO S
19. Rigid routines N MI MO S
20. Shouts or screams N MI MO S
21. Demands sameness N MI MO S
22. Often agitated N MI MO S
23. Not sensitive to pain N MI MO S
24. “Hooked” or fixated on certain objects/topics N MI MO S
25. Repetitive movements N MI MO S