Symptom Checklist Page 3
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4Evidenced By
(For Office Use Only)
Runs away
Cruelty to animals
Fire setting
School suspensions
Change in school performance
Other
Does not make eye contact with others
Has problems communicating
Uses same movements over and over, i.e. wringing hands,
rocking back and forth, clapping fingers
Does not notice when others are trying to speak or play with
him/her
Not interested in making friends or playing with others
Is not easily soothed when upset
Did not start talking until after 12 months old
Does not play make believe
Child has moved many times with different care givers
Unchangeable false beliefs or ideas e.g. really believes that
he/she has special powers or abilities
Hears voices when no one is there
Sees things when nothing is there
Voices tell him/her to harm self
Voices tell him/her to harm others
Talks with words that do not make sense
Symptom Check List
Page 3 of 4
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Parent category: Life