Retrospective Australian scale

This form involves retrospective completion for when the adult was a child.

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This form is for use by parents or relatives of patients. In the absence of a parent or relative, it can be completed by the patient.

Social and emotional abilities

Each item has a scale rated 0 - 6, where 0 is 'not at all' and 6 is 'totally'.

Communication skills

Cognitive skills

Specific interests

Movement skills

Other characteristics

For this section, tick whether the child showed any of the following characteristics:
Unusual fear or distress due to: *
A tendency to flap or rock when excited or distressed *
A lack of sensitivity to low levels of pain *
Late in acquiring speech *
Unusual facial grimaces or tics *

The information from this questionnaire will be used qualitatively to inform the overall assessment process

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Screening forms