Evaluation Team Observation Form & Probe Questions
Student’s Name: Observation Location: Date:
Reciprocal Social Interaction
Communication as it Relates to ASD
• Use eye contact to engage the conversational
partner?
• Use facial expressions to match the situation?
• Gesture to engage and influence?
• Demonstrate consciousness of physical proximity?
Peer Relationships
• Interact with peers in activities appropriate to
developmental level?
• Appear indifferent to peers?
• Engage in developmentally appropriate activities?
• Appear attuned to the subtleties of interactions
with peers?
Spontaneous Sharing
• Approach or seek out another person?
• Approach another person to share something of
interest?
Reciprocity
• Take turns during conversation?
• Show empathy to match the mood of peer?
• Exhibit tolerance of changes of topic?
• Show an awareness of the partner’s interests
during conversation or play?
• Respond to other people? Communicate to request or
protest?
• Gesture or take the hand of an adult to direct the adult
to a wanted item?
• Use eye gaze, vocalizations, facial gestures, signing, or
pictures to indicate wants?
Pragmatics
• Provide sufficient background or reference information to
partner to understand and participate in conversation?
• Use and react to nonverbal cues exhibited by others?
• Use vocabulary and knowledge base to express
emotions/feelings in a variety of situations?
• Understand and use non-literal language (e.g., idioms or
slang)?
• Discuss at length a single topic that is of little or no
interest to others?
Stereotyped/Repetitive Use of Language
• Display atypical communication such as echolalia,
perseveration, and pronoun reversals?
• Speak with flat, emotionless voice or with exaggerated
inflection?
• Repeatedly use a limited number of utterances?
Lack Varied Play
• Play with toys as intended?
• Recognize the play repertoire of peers has changed?
• Participate in age-appropriate play?
Restrictive, Repetitive, and
Stereotypical Behaviors
OTHER Relevant Impacting Factors
• Exhibit an all-consuming, high interest in objects,
topics, or themes beyond typical developmentally
appropriate levels?
• Have a restricted or narrow range of interests,
including unusual interests, as compared to peers?
• Show difficulty letting go of perseverative thoughts,
activities, actions, or behaviors?
Inflexibility
• Use ritualistic actions or behaviors? Rigidity in
routine, difficulty with change and/or transitions?
• Display an insistence on sameness?
Stereotyped or Repetitive Motor Mannerisms
• Display repetitive motor or vocal patterns such as
flapping, rocking, pacing, humming, picking, or
chewing?
• Use self-injurious behavior?
Preoccupation with Parts of Objects
• Twirl, spin, and/or bang objects in a hyper-focused
manner? Fixate on how an object works rather than
Academic:
Cognitive Functioning:
Sensory Including Impact on the Three ASD
domains:
Characteristics Related to Other Disabilities:
The Michigan Autism Council 34 www.michigan.gov/autism