| | According to your experience and assessment for early diagnosis of Autism Spectrum Disorder (ASD) in children up to 5 years of age, evaluate the following: | | Questions | Criteria | Alternatives | | 1. Complete | 2. Severe | 3. Mild/moderate |
| | 1. Regarding the functions of fluency and rhythm of speech (changes in fluency, stuttering, verbiage, dyslalia-tachylalia, and bradylalia, among others), for a definite diagnosis of ASD-b330, you believe that: | A | 6 | 54 | 31 | | B | 5 | 42 | 44 | | C | 6 | 32 | 53 | | 2. For the difficulty of intentionally using the sense of sight (following an object visually, observing people, and watching a sporting event or children playing, among others), for a definite diagnosis of ASD-d110, you believe that: | A | 9 | 44 | 38 | | B | 1 | 43 | 47 | | C | 4 | 36 | 51 | | 3. For the difficulty in acquiring and executing necessary skills (using cutlery and pencils, among others) and complicated skills (games, sports, using tools, and watching, among others), in a way compatible with the age group-d155 from 2 years old, do you believe that: | A | 5 | 43 | 43 | | B | 4 | 42 | 45 | | C | 10 | 28 | 53 | | 4. For sleep functions (start, maintenance, quantity, and quality of sleep), in a way compatible with the age group-b134, do you believe that: | A | 7 | 42 | 42 | | B | 10 | 39 | 42 | | C | 6 | 49 | 36 | | 5. For memory functions (recent, remote, and amnestic memory disorders), in a way compatible with the age group-b144 from 3 years old, you believe that: | A | 12 | 43 | 36 | | B | 7 | 39 | 45 | | C | 7 | 30 | 54 | | 6. For global psychosocial functions (interpersonal skills necessary for the establishment of reciprocal social interactions, in terms of meaning and purpose, adaptability, responsiveness, predictability, persistence, and accessibility, and interpersonal communications, among others), in a manner compatible with the age group-b122 and age group-b125 from 2 years, do you believe that: | A | 22 | 41 | 28 | | B | 19 | 46 | 26 | | C | 8 | 36 | 47 | | 7. For the difficulty of moving using specific equipment or device to facilitate movement (walker, wheelchair, crutches, cane, and others), in a manner compatible with the age group-d465 from 3 years, you believe that: | A | 6 | 50 | 35 | | B | 5 | 54 | 32 | | C | 4 | 39 | 48 | | 8. For the difficulty in walking (moving on foot, for short or long distances, without the aid of people, equipment, or devices), in a way compatible with the age group-d450 from 2 years old and age group-d465 from 3 years, you think that: | A | 10 | 41 | 40 | | B | 6 | 47 | 38 | | C | 23 | 40 | 28 | | 9. For vision functions (quality, accuracy, light and color perception, monocular and binocular vision, myopia, hyperopia, astigmatism, hemianopsia, presbyopia, color blindness, tunnel vision, central and peripheral scotoma, diplopia, night blindness, and adaptability to light, among others), in a way compatible with the age group-b210 and age group-d465 from 3 years old, you think that: | A | 7 | 35 | 49 | | B | 2 | 44 | 45 | | C | 13 | 49 | 29 |
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