Neurodevelopmental Assessment Social-Communication Questionnaire

This questionnaire is designed to gather information about the social-communication skills and behaviour of children and young people aged 3 to 18 years. Please answer relevant to the individual’s age and learning context.  If you are unsure regarding any items (i.e. you cannot provide a definitive yes/no response), you can note this as  “DK” – don’t know. 

The SCQ is an essential part of the autism assessment.  We understand that young person can present differently across settings.  Your observations are important to us in understanding the young person’s presentation and possible support needs across contexts.  Even if you have few or no concerns, please complete the form stating this (see back page) so as to inform next steps in the assessment.

Neurodevelopmental Assessment Social-Communication Questionnaire

Child's Details:

Child's Name
Child's Name
Name
Surname

Attendance

Is the child/young person following a reduced or restricted timetable?
If school attendance is irregular, has the Education Welfare Service been informed?

School Supports

What supports, if any, does he/she receive:

Language Skills:

Functional Communication:

tick which applies and describe further where necessary

Social Communication and Interaction

Social Initiation and Responses: tick which applies and describe further where necessary
Conversation: tick which applies and describe further where necessary

Non Verbal Communication tick which applies and describe further where necessary

Eye Contact
Facial Expression
Gesture
Body Language
Tone of Voice
Integration of Verbal and Non-Verbal Communication

Developing and Maintaining Relationships and Sharing in Imaginative Play tick which applies and describe further where necessary

Friendships: tick which applies and describe further where necessary
Interaction Style: tick which applies and describe further where necessary
Understanding of Social Situations / Rules & Boundaries: tick which applies & describe further where necessary

Restricted, Repetitive Patterns of Behavior, Interests or Activities

Stereotyped or Repetitive Speech: tick which applies and describe further where necessary
Stereotyped or Repetitive Motor Movements: tick which applies and describe further where necessary
Stereotyped or Repetitive use of Objects: tick which applies and describe further where necessary
Adherence to Routines, Ritualised Patterns of Behaviour, and Resistance to Change: tick which applies and describe further where necessary
Imagination and Creativity: tick which applies and describe further where necessary

Restricted and or Intense Interests

Preoccupations: tick which applies and describe further where necessary

Sensory Processing: tick which applies and describe further where necessary

Response to Noise: tick which applies and describe further where necessary
Response to Touch: tick which applies and describe further where necessary
Response to Movement: tick which applies and describe further where necessary
Response to Taste/ Smell: tick which applies and describe further where necessary
Response to Visual Stimulation: tick which applies and describe further where necessary

Academic Attainments / Supports

Organisation & Attention/Concentration Skills: tick which applies and describe further where necessary
Homework
Mood / Behavioural and Emotional Wellbeing

Completed By:

Name
Name
Name
Surname

Neurodevelopmental Assessment Social-Communication Questionnaire

This questionnaire is designed to gather information about the social-communication skills and behaviour of children and young people aged 3 to 18 years. Please answer relevant to the individual’s age and learning context.  If you are unsure regarding any items (i.e. you cannot provide a definitive yes/no response), you can note this as  “DK” – don’t know. 

The SCQ is an essential part of the autism assessment.  We understand that young person can present differently across settings.  Your observations are important to us in understanding the young person’s presentation and possible support needs across contexts.  Even if you have few or no concerns, please complete the form stating this (see back page) so as to inform next steps in the assessment.

Neurodevelopmental Assessment Social-Communication Questionnaire

Child’s Details:

Child’s Name

Child's Name

Name

Name

Surname

Surname

DOB:

Class:

School:

Teachers Name:

SCQ Completed by:

Date

Attendance

Is the child/young person following a reduced or restricted timetable?

Yes

No

If yes, please state days and times:

If school attendance is irregular, has the Education Welfare Service been informed?

Yes

No

Name of EWO:

School Supports

What supports, if any, does he/she receive:

Learning support within school

Outreach learning support teachers

ASD support teachers

SBEW support teachers

Statement of SEN

Referred to Educational Psychologist

Classroom Assistant

Counselling

Other (please specify):Other (please specify):

Language Skills:

Comment on his/her ability to understand language in the classroom:

Does he/she experience periods of being mute? If yes, please elaborate:

Functional Communication:

tick which applies and describe further where necessary

Is able to express his/her needs

Is able to express emotions verbally

Can seek help

Can seek reassurance when upset

Describe how he/she seeks reassurance:

Describe how he/she copes when there is a problem:

Social Communication and Interaction

Social Initiation and Responses: tick which applies and describe further where necessary

Responds when his / her name is called

Initiates interaction with others

Only initiates interactions with others to seek help or have their needs met

Responds appropriately to the initiations of others

Clumsy, awkward or delayed social responses

Seeks comfort from others when upset / comforts others

Responds to or initiates social smiles

Brings objects or completed work to show you

Is interested in your response about what he/she’s brought you

Seeks peer’s attention to show them something

Looks to share a play/leisure activity with classmates

Responds to others who try to draw their attention to something

Shows enjoyment in activities with others

Shows interest in others’ experiences and achievements

Is happy for others who win a prize

Responds appropriately to praise

Can share possessions and materials (e.g. snack, toys, rubber, pens)

Has difficulty sharing special items

Conversation: tick which applies and describe further where necessary

Converses easily with adults

Converses easily with peers

Talks about his/her life e.g. birthdays, outings, holidays

Has unusual conversation topics

Does not initiate communication with others

Is interested in other’s responses to his/her topics

Is interested in other people’s conversation topics

Difficulties with back and forth conversation

Does not ask socially interested questions (e.g. enquiring about another person’s thoughts, feelings or experiences)

Dominates the speaking turn

Interrupts others

Conversation goes off at a tangent

Needs prompted continually to support conversation

Doesn’t provide listener with enough background information

Finds it difficult to get to the point

Provides excessive details in conversation

Please provide any additional information below:

Non Verbal Communication tick which applies and describe further where necessary

Eye Contact

Rarely uses eye contact

Looks for a fleeting moment

Stares intensely

Uses a wide-eyed gaze often

Can make eye contact when he/she has initiated the communication

Looks at the speaker when spoken to

Varies eye contact according to person/situation

Facial Expression

Uses small/subtle changes in facial expression when telling you or others something

Only shows extremes of expression e.g. big smiles, laughs, frowns

Uses exaggerated/over-dramatic expressions

Limited facial expression

Makes facial expressions but does not direct his/her expression to an intended listener

Lack of warm, joyful expressions directed at others

Facial expression may be inappropriate to the situation. If yes, Give example: Facial expression may be inappropriate to the situation. If yes, Give example:

Facial expression does not match the words spoken. If yes, Give example: Facial expression does not match the words spoken. If yes, Give example:

Has difficulties reading and responding appropriately to the facial expressions used by others

Gesture

Uses basic gestures well (e.g. nodding, pointing, shrugging, waving, clapping)

Uses gestures to describe something i.e. size, shape, amount, action

Uses gestures alongside spoken words

Uses gestures instead of speaking when he/she can speak

Body Language

Typical of peers

Overly-dramatic

Tense

Rigid/Stiff

Limited

Finds it difficult to recognise or respond to other people’s body language

Tone of Voice

Unusually loud/quiet – please specify:Unusually loud/quiet – please specify:

Unusually low/high pitch – please specify:Unusually low/high pitch – please specify:

Monotone/sing song intonation – please specify:Monotone/sing song intonation – please specify:

Stresses unusual parts of words

Speaks at slow/fast rate – please specify:Speaks at slow/fast rate – please specify:

Struggles to accurately interpret other people’s tone of voice

Integration of Verbal and Non-Verbal Communication

Uses eye contact and gesture effectively together?

Copies other people’s non-verbal communication e.g. gestures or facial expressions?

Difficulties conveying a range of emotions via words, expression, tone of voice and gestures

Please provide any additional information below:

Developing and Maintaining Relationships and Sharing in Imaginative Play tick which applies and describe further where necessary

Friendships: tick which applies and describe further where necessary

Shows an interest in engaging with others

Struggles to understand the thoughts and feelings of others

Saves a seat for a friend or look to sit beside a friend in class

Difficulties developing peer relationships

Difficulties maintaining friendships

Falls out frequently with friends

Repairs friendships easily

Is liked by classmates

Has an identified friendship or group of friends

Has strong attachment to one particular friend

Finds it difficult to share friends with others

Has no preferred friends

Preference to interact with much younger or older children

Strongly prefers one to one interactions

Is alone at break and lunch-times

Prefers to stay in class/club at lunch

Has an imaginary friend

Cannot cope with peers’ behaviour

Difficulties managing with group interactions/games

Tolerates losing in games

Notices and responds to social cues, e.g., notices when others are not interested in play

Difficulties understanding the impact of communication and interactions on others

Misinterprets gentle teasing / banter from peers (i.e. doesn’t notice or reacts excessively to it)

Difficulties engaging in joint imaginative play with others

Interaction Style: tick which applies and describe further where necessary

Dominates play/interactions

On the periphery of play and interactions (i.e. follows and intermittently engages in moments of interaction but never fully involved)

Passively observes play and interactions

Imitates other’s play/social interactions

Understanding of Social Situations / Rules & Boundaries: tick which applies & describe further where necessary

Makes socially inappropriate statements/ask inappropriate questions

Thinks he/she is the adult

Challenges authority

Can appear rude or argumentative

Corrects other’s behaviour

Cannot cope with being corrected

Is aware of personal boundaries

Invades others’ personal space

Leans on others often

Gets upset/irritated if others invade his/her space

Please provide any additional information below:

Restricted, Repetitive Patterns of Behavior, Interests or Activities

Stereotyped or Repetitive Speech: tick which applies and describe further where necessary

Unusual accent – If yes, please describe:Unusual accent – If yes, please describe:

Echolalia (i.e. repetition of words spoken by others)

Unusual words/makes up words

Americanised vocabulary

Repetitive phrases

Repetitive conversation topics

Engages in listing facts

Formal pedantic style (e.g. sounds like an adult, corrects what others say, is overly polite)

Confuses pronouns such as he and she

Refers to themselves using their own name

Repetitive vocalisations

Stereotyped or Repetitive Motor Movements: tick which applies and describe further where necessary

Finger flicking

Hand-flapping

Holds fingers in flexed position

Keeps fingers crossed

Teeth grinding

Facial grimacing

Tip-toe walks

Runs up and down in a line

Spins self

Body tensing / posturing. If yes, please describe:Body tensing / posturing. If yes, please describe:

Whole body movements, for example, foot to foot rocking, swaying

Skin picking

Stereotyped or Repetitive use of Objects: tick which applies and describe further where necessary

Non-functional play with objects

Lines up toys or objects

Repetitively opens and closes doors or items

Repetitively turns lights on and off

Repetitively sorts by colour/shape/size

Please provide any additional information below:

Adherence to Routines, Ritualised Patterns of Behaviour, and Resistance to Change: tick which applies and describe further where necessary

Imposes set routines

Asks repetitive questions

Engages in verbal or non-verbal rituals

Difficulty coping with change

Needs prepared for change

Unsettled with new teacher

Difficulties coping with non-routine school events

Can transition from one activity to another without difficulty

Difficulties transition into school, between classes, or times of the day

Needs reminders/countdowns to leave activities

Difficulties understanding humour or gentle teasing

Literal understanding; not typical for his/her age

Rigid or rule bound responses

Imagination and Creativity: tick which applies and describe further where necessary

Limited interest in play

Needs shown how to play

Plays predominantly with construction play or puzzles

Avoids certain play areas / less likely to play in imaginative play areas e.g. house corner

Small world play is limited to repetitive themes e.g. placing/arranging items or fighting/crashing

Can generate and follow own ideas in activities or play

Can generate ideas for sentences and stories appropriate for age and ability

Can understand / write a story from someone else’s perspective

Please provide any additional information below:

Restricted and or Intense Interests

Preoccupations: tick which applies and describe further where necessary

Has unusual interests If yes, please describe:Has unusual interests If yes, please describe:

Has intense interests If yes, please describe:Has intense interests If yes, please describe:

Has a fascination with a particular object, colour, sensory element, topic

Brings things to school each day

Often has an item in hand or pocket

Distressed by imperfections

Collects / hoards items If yes, please describe:Collects / hoards items If yes, please describe:

Spins objects

Takes objects apart

Please provide any additional information below:

Sensory Processing: tick which applies and describe further where necessary

Response to Noise: tick which applies and describe further where necessary

Distracted by noise

Upset by loud and / or unexpected noise

Covers ears in response to noise

Slow to respond when spoken to

Struggles to cope with assembly

Response to Touch: tick which applies and describe further where necessary

Uncomfortable sitting in close proximity to others

Reacts emotionally or aggressively to touch

Difficulties tolerating items of clothing /uniform

Dislikes messy play

Crashes and collides in to people or objects

Enjoys touching certain items / materials

Response to Movement: tick which applies and describe further where necessary

Seeks movement: fidgets/bounces/jumps/bumps into things

Cautious with movement, dislikes swing/slides

Response to Taste/ Smell: tick which applies and describe further where necessary

Avoid certain tastes, textures or smells of food

Seeks out smells

Seeks certain textures / tastes of food (e.g. crunchy / spicy)

Notices smells others are not aware of

Gags in response to particular tastes or smells

Response to Visual Stimulation: tick which applies and describe further where necessary

Peers at objects, lines, angles in unusual way

Sensitive to light

Academic Attainments / Supports

Comment on his/her ability to access the curriculum (include standardized scores where relevant):

Organisation & Attention/Concentration Skills: tick which applies and describe further where necessary

Can pay attention easily in all settings

Attends better when seated away from peers/distractions

Daydreams

Loses focus easily/distractible

Attention is better for subjects of specific interest

Loses items

Is forgetful

Rarely prepared for lessons

Difficulty getting work started

Difficulty getting work finished within set time

Fine/Gross Motor Skills and Handwriting: Describe any difficulties

Homework

Needs prompting to write homework into homework diary

Homework is differentiated due to learning needs

Homework is differentiated due to difficulties with completion e.g. fewer tasks given

Parent/carer reports difficulties in completing homework due to learning needs

Parent/carer reports difficulties in completing homework due to behavioural/emotional needs or reduced motivation

Homework rarely completed

Homework completed; high level of parent support evident

Homework always completed, independently

Mood / Behavioural and Emotional Wellbeing

Appears content, happy and confident in school

Generally anxious

Only anxious in certain subjects / times of the day (please specify):Only anxious in certain subjects / times of the day (please specify):

Emotionally dysregulated (e.g. angers quicker than peers, easily upset or irritated)

Low mood or depression, seems sad often

Thoughts of life not worth living or evidence/talk of self-harm

Tired / lethargic

Aggression toward others (e.g. staff members, peers)

Aggression toward self

Please note your main concerns or any other concerns

What strengths or positive qualities do you see in this young person? (e.g. Personal, academic, social etc)

Completed By:

Name

Name

Name

Name

Surname

Surname

Role:

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