Click Here to download the questionnaire
his questionnaire is based on GARS-2, the Gilliam Autism Rating Scale – Second Edition, given to students in California who are suspected of having a condition on the Autism Spectrum, including Asperger’s Syndrome.
This is informal, and a high score does not necessarily mean that you have a condition on the Autism Spectrum. Keep in mind that this survey is laid out in a self-reporting way, instead of in a third-person, observational format, so answers may not be entirely accurate. It may be helpful to have a spouse or loved one present as you answer the questions as they may have noticed something that you have not.
The original GARS-2 is given to parents of a child suspected of having ASD. It has been adapted here to be given to adults who have had years to develop social skills and learn “appropriate” behaviors. When answering this survey, please take into account the urge to do things, whether or not you act upon them. Also, try to remember back to childhood and see if any of these questions applied to you back then, and answer accordingly.
This survey is not meant to diagnose you or anybody else with an Autism Spectrum Disorder. Only a Psychologist can officially diagnose somebody with ASD.
Answers should use the following format…
1. 0
2. 2
3. 1
4. 3
Section Raw Score: 6
You can email your answers to tleland1980(at)gmail(dot)com.
Name
Age
Sex
Degree and/or Field of Study
Section 1: Stereotyped Behaviors
Directions: Rate the following items according to the frequency of occurrence. Use the following guidelines for your ratings:
0 Never – You never behave in this manner.
1 Seldom – Individual behaves in this manner 1-2 times in a 6 hour period.
2 Sometimes – Individual behaves in this manner 3-4 times in a 6 hour period.
3 Frequent – Individual behaves in this manner at least 5-6 times in a 6 hour period.
Give the number that best describes your typical behavior under ordinary circumstances (i.e., in most places, with familiar people, and in usual daily activities). EVERY ITEM SHOULD RECEIVE A SCORE.
1. Avoids establishing eye contact; looks away when eye contact is made.
2. Stares at hands, objects, or items in the environment for at least 5 seconds.
3. Flicks fingers rapidly in front of eyes for periods of 5 seconds or more.
4. Eats specific foods and refuses to eat what most people will usually eat.
5. Licks, tastes, or attempts to eat inedible objects (e.g. person’s hand, books, etc.).
6. Smells or sniffs objects (e.g. hair, hands, books, etc.).
7. Whirls/turns in circles.
8. Spins objects not intended for spinning (e.g. saucers, cups, glasses, etc.).
9. Rocks back and forth while seated or standing.
10. Makes rapid lunging, darting movements when moving from place to place.
11. Walks on tiptoes/Prances.
12. Flaps hands or fingers in front of face or at sides.
13. Makes repeated sounds or repeats words, phrases or vocalizations for self-stimulation/calming.
14. Slaps, hits or bites self or attempts to injure self in other ways.
Stereotyped Behaviors Raw Score ____________
Section 2: Communication
Directions: Rate the following items according to the frequency of occurrence. Use the following guidelines for your ratings:
0 Never – You never behave in this manner.
1 Seldom – Individual behaves in this manner 1-2 times in a 6 hour period.
2 Sometimes – Individual behaves in this manner 3-4 times in a 6 hour period.
3 Frequent – Individual behaves in this manner at least 5-6 times in a 6 hour period.
Give the number that best describes your typical behavior under ordinary circumstances (i.e., in most places, with familiar people, and in usual daily activities). EVERY ITEM SHOULD RECEIVE A SCORE.
15. Repeats or echoes words.
16. Repeats words out of context (i.e., repeats words heard at an earlier time; e.g. repeats words heard more than 1 minute earlier.
17. Repeats words or phrases over and over.
18. Speaks with flat tone, affect, or dysrhythmic patterns.
19. Responds inappropriately to simple commands.
20. Looks away or avoids looking at speaker when name is called.
21. Does not ask for things he or she wants.
22. Does not initiate conversations with peers or superiors.
23. Uses “yes” and “no” inappropriately. Says “yes” when asked if he or she wants an aversive stimulus, or says “no” when offered a pleasant option.
24. Uses pronouns inappropriately (e.g., refers to self as “he,””she,” “you”).
25. Uses the word “I” inappropriately (e.g., does not use “I” to refer to self).
26. Repeats unintelligible sounds (babbles) over and over.
27. Uses gestures instead of speech or signs to obtain objects.
28. Inappropriately answers questions about a statement or brief story.
Communication Raw Score _________________
Section 3: Social Interaction
Directions: Rate the following items according to the frequency of occurrence. Use the following guidelines for your ratings:
0 Never – You never behave in this manner.
1 Seldom – Individual behaves in this manner 1-2 times in a 6 hour period.
2 Sometimes – Individual behaves in this manner 3-4 times in a 6 hour period.
3 Frequent – Individual behaves in this manner at least 5-6 times in a 6 hour period.
Give the number that best describes your typical behavior under ordinary circumstances (i.e., in most places, with familiar people, and in usual daily activities). EVERY ITEM SHOULD RECEIVE A SCORE.
29. Avoids eye contact; looks away when someone looks at you.
30. Stares or looks unhappy or unexcited when praised, humored or entertained.
31. Resists physical contact with others (e.g., hugs, pats, being held affectionately).
32. Does not imitate other people when imitation is required or desirable, such as in games or learning activities.
33. Withdraws, remains aloof, or acts standoffish in group situations.
34. Behaves in an unreasonably fearful, frightened manner.
35. Is unaffectionate; does not give affectionate responses (e.g., hugs and kisses, holding hands).
36. Shows no recognition that a person is present (i.e., looks through people).
37. Laughs, cries, etc. inappropriately.
38. Uses objects inappropriately (e.g., spins stapler, takes electronics apart).
39. Does certain things repetitively, ritualistically.
40. Becomes upset or agitated when routines are changed.
41. Responds negatively or with anger when given commands, requests or directions.
42. Lines up objects in precise, orderly fashion and becomes upset when the order is disturbed.
Social Interaction Raw Score _______________
Click Here to download the questionnaire
his questionnaire is based on GARS-2, the Gilliam Autism Rating Scale – Second Edition, given to students in California who are suspected of having a condition on the Autism Spectrum, including Asperger’s Syndrome.