Trinity Medical Centre

1 Goldstone Villas, Hove, BN3 3AT

Telephone: 01273 736030

sxicb-bh.thetrinitymedicalcentre@nhs.net

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Adolescent (12-15 yrs) Autism Screening Questionnaire

Adolescent (12-15 yrs) Autism Screening Questionnaire 

This questionnaire is suitable for patients aged 12-15 years old. Please answer the questions below, rating the patient on each of the criteria.

Name(Required)
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Part A

1. S/he notices patterns in things all the time
2. S/he usually concentrates more on the whole picture, rather than the small details
3. In a social group, s/he can easily keep track of several different people's conversations
4. If there is an interruption, s/he can switch back to what s/he was doing very quickly
5. S/he frequently finds that s/he doesn't know how to keep a conversation going
6. S/he is good at social chit-chat
7. When s/he was younger, s/he used to enjoy playing games involving pretending with other children
8. S/he finds it difficult to imagine what it would be like to be someone else
9. S/he finds social situations easy
10. S/he find it hard to make new friends

Thank you for completing the questionnaire.

Please ensure you have sent details of your chosen Right to Choose provider along with your statement to sxicb-bh.trinity-adhd.autismreferrals@nhs.net