John Doe
Patient Age: 90
Test Name: Coolidge Autistic Symptoms Survey
Gender: Male
Test Date: Jun 23, 2016
Data Provided By: Self

Note: This is a Sample Report

Profile Validity - Answer Frequency (response pattern)
Raw Scores: Patient Norm Frequency (SD)
2 = More False Than True (MF) 3 22.8 (9.4)
3 = More True Than False (MT) 76 11.3 (6.8)
4 = Strongly True (ST) 5 2.9 (3.8)
Data:
1. Inappropriate body language/gestures 3 29. Difficulty with common expressions 3 57. Dislikes transition/changes 3
2. Talks less than other children 3 30. Moves fingers in front of face 2 58. Inappropriate facial expressions 3
3. Emotionally cold/detached 2 31. Doesn't interact well with children 3 59. Play with certain toys 3
4. Unable to give eye messages 3 32. Difficulty with eye contact 4 60. Trouble with conversations 3
5. Misuses pronouns 3 33. Misinterprets what others say 3 61. Talks only about self-interests 3
6. Repeats what is said 4 34. Trouble understanding feelings of others 3 62. Different sense of humor 3
7. Doesn't laugh at jokes 3 35. Strange/unusual speech rhythm/inflection 3 63. Sensitive to lights/sounds/tastes/touch/smells 3
8. No close friends. 4 36. Limited interests 3 64. Insensitive to lights/sounds/tastes/touch/smells 3
9. Stops thoughts if interrupted 3 37. Limited gestures 3 65. Sounds like dictionary/encyclopedia 3
10. Potty trained late 3 38. Difficulty approaching children 3 66. Rocks back/forth 3
11. Laughs for unknown reasons 3 39. Trouble hugging/kissing 3 67. Comes too close when talking 3
12. Trouble playing like other children 4 40. Won't look if I point 3 68. Talks too much only specific topics 3
13. Prefers things same old way 3 41. Difficult starting friendships 3 69. Trouble following conversations 3
14. Trouble reading facial expressions 3 42. Doesn't respond to own name 3 70. Neither speaks/communicates/points 3
15. Intense dislike of change. 3 43. Misinterprets body language/gestures 3 71. Sensitive to bright light 3
16. Repeats words/phrases 3 44. Uncoordinated/clumsy 3 72. No response to flashing lights 3
17. Tries to engage with children but fails 3 45. Intense interest in a single subject 3 73. Sensitive to loud noises 3
18. Trouble using hands for expression 3 46. Preoccupied with object parts 3 74. No respond to loud noises 3
19. Loner 3 47. Tolerates only little physical contact 3 75. Constant need to touch certain things 3
20. Strange/weird or no handshake 3 48. Fascination with fans/spinning objects 3 76. Cannot be touched 3
21. Unaware of body language 3 49. Brings me things that interested in 3 77. Indifferent to smells 3
22. Doesn't look at others when talking 3 50. Difficult to read child's feelings 3 78. Interest with smelling certain things 3
23. Drags toes when walking 3 51. Limited facial expressions 3 79. Only eats certain foods 3
24. Doesn't notice people 3 52. Delayed speech 3 80. Unresponsive to food tastes 3
25. Only points out things that interested in 3 53. Approaches only when needs 3 81. Sensitive to extreme temperatures 3
26. Flaps arms/hands 4 54. Socially clumsy or awkward 3 82. Not sensitive to extreme temperatures 3
27. Trouble expressing self 3 55. Avoid activities involving children 3 83. Wanders away without permission 3
28. Physically inappropriate with children 2 56. Fixed routine/rules, angry/upset at change 3 84. Overly fearful or lacks fear 3
Scale %tile TScore
Overall ASD 99% 84
84
A: Persistent Deficits in Social Communication/Interaction (PDSCI) 99% 81
81
A1: Deficits in Social-Emotional Reciprocity (DSER) 99% 70
70
A2: Deficits in Nonverbal Communication (DNVC) 99% 77
77
A3: Deficits in Relationships (DR) 99% 80
80
B. Restricted, Repetitive Patterns of Behavior (RRPB) 99% 87
87
B1: Stereotyped/Repetitive Motor Movements 99% 81
81
B2: Insistence on Sameness (IS) 99% 74
74
B3: Restricted/Fixated Interests (RFI) 99% 75
75
B4: Hyper-Hypo Reactivity to Environment (HHRE) 99% 91
91
A. Persistent Deficits in Social Communication/Interaction (PDSCI):
A1: Deficits in Social-Emotional Reciprocity (DSER)
mostly true 2.My child talks less than other children his/her age.
mostly true 9.My child stops her/his train of thought if interrupted.
mostly true 17.My child tries to engage with other children, but doesn't seem to know how.
mostly true 27.My child acts physically inappropriately with other children (e.g., too much hugging, never wants to hug, too aggressive, etc.).
mostly true 33.My child misinterprets what other people say (e.g., doesn't understand, interprets what people say narrowly or inappropriately).
mostly true 34.My child has trouble understanding the feelings of others.
mostly true 39.My child has trouble hugging or kissing people.
mostly true 40.If I point at something excitedly, my child will often not look.
mostly true 42.My child often does not respond to his/her name.
mostly true 47.My child can only stand little physical contact with others (as in hugging).
mostly true 53.My child approaches others only when he/she needs something for himself/herself.
mostly true 60.My child has trouble starting or maintaining conversations with others.
mostly true 61.My child has no trouble starting conversations, but only about things he or she wishes to talk about.
mostly true 67.When talking to others, my child comes up too close to other people.
mostly true 68.My child talks too much, but only on specific topics.
mostly true 69.My child has trouble following conversations.
mostly true 70.My child neither speaks, nor tries to communicate through other means (for examples, pointing).
mostly true 76.My child cannot be touched without being uncomfortable.
A2: Deficits in Nonverbal Communication (DNVC)
mostly true 1.My child uses inappropriate body language or gestures (e.g., turns away when spoken to, etc.).
mostly true 4.My child is unable to give messages with his or her eyes (e.g., rolls her/his eyes in annoyance).
mostly true 14.My child has trouble reading other people's facial expressions.
mostly true 18.My child has trouble using his or her hands to express himself or herself (e.g., doesn't use hands when talking, doesn't give high fives or does so inappropriately, doesn't fist-bump or does so inappropriately).
mostly true 20.My child has a strange or weird handshake (or doesn't shake hands at all).
mostly true 21.My child is unaware of what he/she is communicating to others with his/her body language.
mostly true 22.I have to remind my child to look at me or other people when talking to them.
strongly true 32.My child has difficulty making or maintaining eye contact.
mostly true 35.My child has a strange or unusual rhythm or inflection when he/she speaks.
mostly true 37.My child has limited use of gestures compared to other children.
mostly true 43.My child misunderstands certain body language or gestures.
mostly true 44.My child is uncoordinated or clumsy (e.g., riding a bike or running).
mostly true 50.It is difficult to tell what my child is feeling.
mostly true 51.My child has a limited number of facial expressions compared to other children.
mostly true 58.My child has inappropriate or exaggerated facial expressions (e.g., blank stares, little emotion, grimaces).
A3: Deficits in Relationships (DR)
mostly true 7.My child doesn't seem to laugh at jokes others his/her age find funny.
strongly true 8.My child has no close friends.
mostly true 11.My child laughs for reasons I don't understand.
strongly true 12.My child has trouble playing like other children his or her age (for example, pretending or make-believe).
mostly true 19.My child is a loner.
mostly true 24.My child seems to not notice other people, even if they are in the same room.
mostly true 29.My child has difficulty understanding common expressions or takes phrases too literally, such as "If looks could kill," "I'm history," or "Has the cat got your tongue?"
mostly true 31.My child doesn't interact well with other children his/her own age.
mostly true 38.Even when my child tries to approach other children, he/she finds it difficult.
mostly true 41.My child finds it difficult to start a friendship.
mostly true 49.My child brings me things that he/she is interested in
mostly true 54.My child is socially clumsy or awkward.
mostly true 55.My child tends to avoid activities involving other children.
mostly true 62.My child has a different sense of humor from other kids (e.g. only laughs at puns, only when people get hurt).
mostly true 83.My child wanders away from home or school without permission.
B. Restricted, Repetitive Patterns of Behavior (RRPB):
B1: Stereotyped/Repetitive Motor Movements
mostly true 5.My child misuses pronouns like substituting "I" for "you," "him" for "me," or "her" for "me."
strongly true 6.My child repeats over and over exactly what is said to him or her.
mostly true 16.My child repeats the same word or phrase a lot.
mostly true 23.My child drags his/her toes often when walking.
strongly true 26.My child often flaps her/his arms (as if flying like a bird).
mostly true 66.My child rocks back and forth.
B2: Insistence on Sameness (IS)
mostly true 10.My child potty trained later than most children her/his age.
mostly true 13.My child prefers things to be the way she/he originally found them.
mostly true 15.My child has an intense dislike of change.
mostly true 56.My child has to stick to some routine or rule and gets angry or upset if it is changed.
mostly true 57.My child dislikes transition or changes (e.g. beginning of the new school year).
B3: Restricted/Fixated Interests (RFI)
mostly true 25.My child only points out things to me that he/she is interested in or obsessed with.
strongly true 26.My child often flaps her/his arms (as if flying like a bird).
mostly true 45.My child gets intensely interested or preoccupied with a single subject and doesn't seem to want to do anything else (e.g., trains, vacuum cleaners, firetrucks, planes, details of plane wrecks, details of major accidents or natural disasters, Anime [Japanese cartoons] or other cartoon figures, and the Titanic).
mostly true 46.My child gets preoccupied or interested with parts of objects or just one aspect of a toy (for example, how it feels or a noise that it might make).
mostly true 48.My child is overly fascinated by fans or other spinning objects.
mostly true 59.My child has a strong preference to only play with certain toys.
mostly true 65.My child sounds like a "walking dictionary" or encyclopedia.
B4: Hyper-Hypo Reactivity to Environment (HHRE)
mostly true 63.My child is overly sensitive to lights, sounds, tastes, touch, or smells.
mostly true 64.My child has reduced sensitivities to lights, sounds, tastes, touch, or smells.
mostly true 71.My child is extremely sensitive to bright light.
mostly true 72.My child does not seem to respond to flashing lights.
mostly true 73.My child is very sensitive to loud noises.
mostly true 74.My child does not seem to respond to loud noises as he/she should.
mostly true 75.My child seems to have a constant need to touch certain things.
mostly true 76.My child cannot be touched without being uncomfortable.
mostly true 77.My child seems indifferent to smells (good or bad).
mostly true 78.My child has an intense interest with smelling certain objects.
mostly true 79.My child will only eat certain foods because of the taste.
mostly true 80.My child seems unresponsive to tastes of food.
mostly true 81.My child seems excessively sensitive to extreme temperatures outside.
mostly true 82.My child is not sensitive to extreme hot or cold temperatures.