Yes   No   Documentation supports the existence of a developmental disability that was
                 generally evident before the student was three years of age, and

Yes   No   The student has a communication disability in verbal or nonverbal communication
                 and social interaction. Assessments shall document the presence of at least six
                 items from (a), (b) and (c), to include one from (a)(ii) and one from (a)(iii):
 

(a) Qualitative impairment in social interaction, as manifested by at least two of
      the following:

Yes   No   (i) marked impairment in the use of multiple nonverbal
                 behaviors such as eye-to-eye gaze facial expression, body
                 postures and gestures to regulate social interaction;

Yes   No   (ii) failure to develop peer relationships appropriate to
                 developmental level;

Yes   No   (iii) a lack of spontaneous seeking to share enjoyment,
                 interests or achievements with other people (e.g., a lack of
                 showing, bringing or pointing out objects of interest);

Yes   No   (iv) lack of social or emotional reciprocity.

(b) Qualitative impairments in communication as manifested by at least one of the
      following:

Yes  No   (i) delay in, or total lack of, the development of spoken
                language (not accompanied by an attempt to compensate
                through alternative modes of communication such as gesture
                or  mime);

Yes   No  (ii) in individuals with adequate speech, marked impairment in
                the ability to initiate or sustain a conversation with others;

Yes   No  (iii) lack of varied, spontaneous, make-believe play or social
                imitative play appropriate to developmental level.

(c) Restricted, repetitive and stereotyped patterns of behavior, interests
     and activities, as manifested by at least one of the following:

Yes   No   (i) encompassing preoccupation with one or more stereotyped
                and restricted patterns of interest that is abnormal either in
                intensity or focus;

Yes   No  (ii) apparently inflexible adherence to specific nonfunctional
               routines or rituals;

Yes   No  (iii) stereotyped and repetitive motor mannerisms (e.g., hand or
                finger flapping or twisting, or complex whole-body
                movements);

Yes   No  (iv) persistent preoccupation with parts of objects.

(d) Delays or abnormal functioning in at least one of the following areas, with
      onset prior to age 3 years:

Yes  No  (i) social interaction;

Yes  No  (ii) language as used in social communication;

Yes  No  (iii) symbolic or imaginative play.

EXCLUSIONARY FACTORS:

The student may not be identified as having autism if the student has a hearing
impairment, emotional disturbance or global cognitive defects in which the
student exhibits "autistic-like" behavior, such as Rett's disorder, Asperger's
disorder, or childhood disintegrative disorder.

Student Name: _________________ CST Date: __________