CARS2-Parent

INSTRUCTIONS

This form asks about behaviors in several areas where people may have difficulty. The person you are rating may or may not have ever shown these behaviors.

For each behavior listed, please check the description that best describes the person you are rating. Check the box Don't Know if you do not have enough information about a behavior to give a rating. It is important to provide an answer for every behavior. After each section, there is space for you to give one or more brief, specific examples that relate to your ratings in that section. The final section of this questionnaire provides space where you can describe any other behaviors that you would like us to know about.

Sections 1: How does the person you are rating communicate? *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Imitates sounds, words, and movements of others
Responds to facial expressions, gestures, and different tones of voice used by others
Responds to his or her name being called by turning and making eye contact with the person calling his or her name
Directs facial expressions to others to show the emotions he or she is feeling
Uses a variety of gestures (pointing, nodding the head, showing the size of something) that are coordinated with words or used to explain things when he or she doesn't have the words to do so

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Uses made-up words or repeats specific words or phrases
Has an unusual tone, rhythm, loudness, or rate of speech
Speech is overly formal; for example, uses vocabulary that seems more sophisticated than usual for a person of his or her age for the situation
Carries on a conversation with another person that flows back and forth, at a level you would expect for someone of his or her age
Can talk with another person about that person's interests

Examples: Give one or more brief but specific examples of the problem behaviors rated above.

Section 2: How does the person you are rating relate to others and show emotion? *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Makes eye contact when speaking with or listening to another person
Points to and shares things of interest with others
Follows another person's gaze or points toward an object that is out of reach
Is responsive to social initiations from others
Initiates social interactions with adults and peers (not just to get a basic need met)
Sustains an interaction with others in an easy, flowing, back-and-forth manner
Makes and maintains friendships with peers of same developmental level
Shows a range of emotional expressions that match the situation (for example, smiles frowns, conveys different emotions through eyes and facial expressions, etc.)
Understands and responds to how another person may be thinking or feeling (for example, tries to comfort someone in distress, does something because he or she thinks the other person will like it)

Example: Give one or more brief but specific examples of the problem behaviors rated above.

Section 3: How does the person you are rating move his or her body? *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Has unusual ways of moving fingers, hands, arms, legs; or spins or rocks body
Does things that might result in self-injury, like scratching, head banging, picking at his or her skin
Is clumsly, stumbles, or has an awkward walk or run
For school-aged children or adults: has difficulty tying shoes or difficulty with handwriting or other tasks that require fine motor coordination

Section 4: How does the person you are rating play? (For an older individual , how did he or she paly as a child?) *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Uses only parts of toys instead of whole toys, or plays with objects (e.g., opens and closes toy barn doors, spins wheels on cars, wobbles or spins household objects
Plays with same things in the same way over and over
Uses toys or other materials to represent something they are not (e.g., uses a banana as a phone or microphone)
Endgages in make-believe play, taking on a role (not based on scripts from movies or TV shows)

Examples: Give one or more brief but specific examples of the problem behaviors rated above.

Section 5: How does the person you are rating react to new experience and changes in routine? *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
May show anxiety or worry in facial expression or body movement, or by becoming overly impatient
May show worry about the same thing over and over again
Copes with changes in routine or the environment (for example, moving furniture)
Has specific routines or specific ways things must be done by self or others
Has special interests or topics (for example, dinosaurs, trains, clocks, weather, license plates)

Section 6: How does the person you are rating use his or her senses of vision, hearing, touch, and smell? *

	Not a problem (does very well)	Mild-to-Moderate Problem (Sometimes a problem)	Severe Problem (Often or always a problem)	Not a problem now, but was in the past	Don't Know
Tends to look at objects from unusual angles or out of the corner of his or her eyes
Is overly interested in light from mirrors or light reflecting off objects
Is overly sensitive to sounds, smells, or textures; seeks some out, actively avoids others
Has unusual response to touch; may overreact to touch or pain or may not respond to things that others would find uncomfortable or painful

Examples: Give one or more brief but specific examples of the problem behaviors rated above.

Section 7: Does the individual have any extremely unusual mathematical, reading, or artistic abilities? If yes, please explain below. *

Yes No
Explain:
Are there other unusual behaviors you have noticed that you would like to tell us about? Please list the specific behavior, and give an example or two.
Additional Behavior Examples or Comments:
Should be Empty:

Questionnaire for Parents or Caregivers