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11 views2 pages

Scoring sheet - One page

Scoring sheet

Uploaded by

iswarya vellaisamy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Department of Clinical Psychology

National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan)


Department of Empowerment of Persons with Disabilities (Divyangjan)
Ministry of Social Justice & Empowerment, Government of India

INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) – Evaluation Sheet

Personal Information of the Child

Name: Age: Gender:


DOB: Reg. No.:
Father's Name: Mother's Name:

INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) (For 2-9 years)

Section – A Section - B
Social Interaction Complete this section (1-5) based on
responses from section A and further
history taking (6-12)
A1a i PI* O Yes No Unsure Item Scoring Key Score
ii PI O* Yes No Unsure 1. A - Section - A1 Score
iii PI* O Yes No Unsure 0 = Less than 2
iv PI O* Yes No Unsure 1 = 2 or more
A1b i PI* O Yes No Unsure 2. A - Section - A2 Score
0 = Nil 1 = 1 or more
ii PI* O Yes No Unsure or NA 3. A - Section – A3 Score
iii PI* O Yes No Unsure or NA 0 = Nil 1 = 1 or more
A1c i PI* O Yes No Unsure 4. Interpretation of
ii PI* O Yes No Unsure or NA Questions 1 – 3
A1d i PI* O Yes No Unsure or NA 0 = No ASD
(2 or more response of 1 to 3 is “0”)
ii PI* O Yes No Unsure
1 = ASD Present
iii PI* O Yes No Unsure or NA
(If response to 1 is “1” and response
iv PI* O Yes No Unsure or NA to either or both of 2 and 3 is “1”)

Communication 5. Total number of criteria


A2a PI* O* Yes No Unsure fulfilled in A1, A2 and A3
Ask A2b only if child is speaking at 2-3 word sentences level 0 = Less than 6
Ask A2c only if the child is speaking at few words level 1 = Six or more
A2b i PI* O Yes No Unsure or NA 6. Does / did your child
ii PI* O Yes No Unsure or NA have any of any of the
A2c i PI O* Yes No Unsure or NA following?
ii PI O* Yes No Unsure or NA 0 = No 1 = Yes
iii PI O* Yes No Unsure or NA A B C D
iv PI O Yes No Unsure or NA 7. 0 = No 1 = Yes/Do not
v PI* O Yes No Unsure or NA know/ Not sure
A2d PI O Yes No Unsure 8. Rett’s Disorder
Note for interviewer: If anyone is positive will be marked as 0 = No 1 = Yes
“Yes”
Restricted Interest 9. CDD 0 = No 1 = Yes
A3a i PI* O Yes No Unsure 10. Asperger’s Disorder
ii PI* O Yes No Unsure 0 = No 1 = Yes
iii PI* O Yes No Unsure 11. Summary
A3b PI O Yes No Unsure 0: No ASD 1: Autism
A3c i PI* O Yes No Unsure 2: Asperger’s Disorder
Note for interviewer: Ask with demonstration and answer 3: PDD-NOS
(A3c(i)) ‘yes’ if any one of above example is positive 4: Rett’s Disorder
ii PI* O Yes No Unsure 5: CDD
A3D PI O* Yes No Unsure 9: Indeterminate
12. Can these symptoms be solely explained by
Intellectual Disability? 0 = No 1 = Yes
13. Additional information /
observation

Assessor Name and Signature

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