Pre-Assessment Screening

Our Pre-Assessment Screening is an informal screening tool. Unlike the M-CHAT, which is a formalized, clinically-validated tool which can screen toddlers (16 – 30 months of age) for risk of autism, our Pre-Assessment is just a questionnaire.

Our tool doesn’t give an answer to the question of whether your child has autism, or is at risk of autism. It’s simply a casual set of questions that will help us determine whether a more formal in-person assessment, called the ADOS (published by WPS), may be appropriate.
The ADOS is the Autism Diagnostic Observation Schedule – a leading diagnostic assessment used to determine the level of concern or severity of symptoms associated with autism spectrum disorder. This is a 45-60 minute long in-person assessment done at our office.
The below questions help us determine whether or not an ADOS may be appropriate. If you’ve been referred to Action Behavior Centers by a physician or psychologist, we’ll be happy to serve you. The below information will help us have some good information before your visit.


Please answer these questions about your child. Keep in mind how your child usually behaves. If you have seen your child engage in a behavior a few times, but he or she does not usually do it, then please answer no. Please check yes or no for every question. Thank you very much.

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Name of Child for Services
MM slash DD slash YYYY
Name of Parent/Insured*