Client details

First name *

Last name *

Date of birth *

Please enter the client's legal name so our system can match them correctly...

Your first name *

Your last name *

Relationship to client *

Please indicate whether, as a child, the person in question: *

NoSomewhat Yes

1. Was old-fashioned or precocious

NoSomewhat Yes

2. Was regarded as an ”eccentric professor” by the other children

NoSomewhat Yes

3. Lived somewhat in a world of his/her own with restricted idiosyncratic intellectual interests

NoSomewhat Yes

4. Accumulated facts on certain subjects (good rote memory) but did not really understand the meaning

NoSomewhat Yes

5. Had literal understanding of ambiguous and metaphorical language

NoSomewhat Yes

6. Had an unusual style of communication with a formal, fussy, old-fashioned or “robot-like” language

NoSomewhat Yes

7. Invented idiosyncratic words and expressions

NoSomewhat Yes

8. Had a different voice or speech

NoSomewhat Yes

9. Expressed sounds involuntarily; clears throat, grunts, smacks, cries or screams

NoSomewhat Yes

10. Was surprisingly good at some things and surprisingly poor at others

NoSomewhat Yes

11. Used language freely but failed to make adjustment to fit social contexts or the needs of different listeners

NoSomewhat Yes

12. Lacked empathy

NoSomewhat Yes

13. Made naive and embarrassing remarks

NoSomewhat Yes

14. Had an unusual style of gaze

NoSomewhat Yes

15. Wished to be sociable but failed to make relationships with peers

NoSomewhat Yes

16. Could be with other children but only on his/her terms

NoSomewhat Yes

17. Lacked a best friend

NoSomewhat Yes

18. Lacked common sense

NoSomewhat Yes

19. Was poor at games: no idea of cooperating in a team, scored “own goals”

NoSomewhat Yes

20. Had clumsy, ill-coordinated, ungainly, awkward movements or gestures

NoSomewhat Yes

21. Had involuntary face or body movements

NoSomewhat Yes

22. Had difficulties in completing simple daily activities because of compulsory repetition of certain actions or thoughts

NoSomewhat Yes

23. Had special routines: insisted on no change

NoSomewhat Yes

24. Showed idiosyncratic attachment to objects

NoSomewhat Yes

25. Was bullied by other children

NoSomewhat Yes

26. Had markedly unusual facial expression

NoSomewhat Yes

27. Had markedly unusual posture

NoSomewhat Yes

ASSQ score

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