ACIA

General Info

Family Background

Question	Your notes
Family Background
History of Autism / ADHD in family

Past Events

Question	Your notes
Traumatic events / ACES

Current Circumstance

Question	Your notes
Current circumstance / work

Reason for Referral

Question	Your notes
Reason for referral

Medical History

Question	Your notes
Medical History

Strengths

Question	Your notes
Strengths

Education

Question	Your notes
Education

Employment

Question	Your notes
Employment

Early Development

Question	Your notes
Pregnancy and Birth
Motor Milestons
Language Milestones (age of first words and phrases)
Toileting
Any loss of language or other skills
Information about infancy
Any additional information

Social-emotional Reciprocity

Question	Your notes
Pragmatics of Language
Interest in Social chat
Reciprocal conversation
Emotional Cues and Responsiveness
Social Responsiveness

Non-verbal Communication

Question	Your notes
Prosodic speech patterns
Literal understanding / misunderstanding
Eye contact
Facial expression
Use of gesture
Affection

Peer Relationships

Question	Your notes
Social Shared play and imagination in Childhood
Friendships
Reciprocal Quality of Friendships
Reciprocal Intimate Relationships
Emotional Closeness
Aloof - Social Motivation / Interest
Social Behaviour

Stereotyped or repetitive speech, motor movements, or use of objects

Question	Your notes
Stereotyped or repetitive motor patterns
Speech Patterns
Use of Objects

Insistence on sameness, Routines and Rituals

Question	Your notes
Rigidity / Insistence of Sameness
Perfectionism
Rituals and Routines / Compulsions

Restricted Interests

Question	Your notes
Activites, Hobbies and Circumscribed / Special Interests

Sensory Sensitivities and Interests

Question	Your notes
Sensory Interests
Sensory Aversions

Co-occurring Conditions

Question	Your notes
Co-occurring Conditions

Generating Report