Appendix B — Scales
APPENDIX B
SCREENING SCALES FOR NEURODEVELOPMENTAL DISORDERS
Usage guidelines: These scales are not diagnostic — they are screening tools. A positive result is an indication for specialized clinical assessment, not a diagnosis. A definitive diagnosis is established through clinical interview, comprehensive assessment, and (when necessary) standardized diagnostic tools (ADOS-2, ADI-R, WISC-V, etc.).
License status and disclaimer. The screening scales reproduced in full in this appendix (M-CHAT-R, AQ-10, ASRS v1.1, SNAP-IV) are instruments that their developers have made freely available for research and clinical use. This volume is a clinical guide, not a compendium of diagnostic tests. Licensed instruments referenced elsewhere in the text (WISC-V, ADOS-2, Vineland-3, and others; see Appendix B.5) are not reproduced here. Obtaining and administering them requires a valid license from the rights holder (Pearson, WPS, MHS, or equivalent) and appropriate professional qualification.
B.1. M-CHAT-R: Modified Checklist for Autism in Toddlers, Revised (16–30 months)
Original authors: Diana L. Robins, Deborah Fein, Marianne Barton, 2009.
Original reference: Robins DL, Fein D, Barton M. M-CHAT-R/F. Self-published, 2009; Pediatrics, 2014; 133: 37–45.
Instruction
This questionnaire consists of 20 questions about your child’s daily behavior. To be completed by parent or primary caregiver. Answer each question YES or NO — based on how your child typically behaves. If you have seen the behavior once or twice, but the child generally does not do it, answer NO.
Questions
| № | Question | YES | NO |
|---|---|---|---|
| 1 | If you point at something on the other side of the room, does your child look there? (For example, at a flying plane, a large animal, or a toy) | ||
| 2 | Have you ever thought your child might be deaf? | ||
| 3 | Does your child play pretend games? (For example, drinking from an empty cup, talking on a phone, feeding a doll) | ||
| 4 | Does your child like climbing on objects? (Furniture, stairs, tree) | ||
| 5 | Does your child make unusual movements with fingers in front of his or her eyes? | ||
| 6 | Does your child point to something they want? (For example, a toy out of reach on a shelf) | ||
| 7 | Does your child point to attract your attention to something interesting? (For example, an airplane in the sky or a big car) | ||
| 8 | Does your child show interest in other children? (For example, looks at children in playground, tries to join them) | ||
| 9 | Does your child share with you by showing or placing something before you (not for help, but for sharing)? | ||
| 10 | Does your child respond when their name is called? | ||
| 11 | When you smile at your child, do they smile back at you? | ||
| 12 | Does your child get bothered by everyday sounds? (For example, vacuum cleaner, loud music) | ||
| 13 | Does your child walk? | ||
| 14 | Does your child look into your eyes when you are with them, dressing them or playing? | ||
| 15 | Does your child imitate what you do? (For example, if you make a face, they copy it) | ||
| 16 | When you turn your head to look at something, does your child also look there? | ||
| 17 | Does your child try to get your attention? (e.g., by looking at you, asking for praise, or saying ‘look!’) | ||
| 18 | Does your child respond to words they understand? (e.g., ‘give me the ball’ or ‘take the book’) | ||
| 19 | If something new or strange happens, does your child look at your face to see your reaction? | ||
| 20 | Does your child enjoy active games? (For example, being swung in the air or bounced on your knee) |
Scoring
Risk score = number of risk responses: for items 2, 5, 12 YES is a risk indicator, for the remaining items NO is a risk indicator.
That is:
- For items 1, 3, 4, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18, 19 and 20, a NO response counts as a risk indicator.
- For items 2, 5 and 12, a YES response counts as a risk indicator.
Interpretation of results
| Score | Risk level | Recommendation |
|---|---|---|
| 0–2 | Low risk | Additional assessment is not required (if no other risk factors); rescreening recommended up to 24 months |
| 3–7 | Moderate risk | M-CHAT-R/F (Follow-up) required — structured follow-up interview; conducted by medical staff |
| 8–20 | High risk | Urgent ASD diagnostic assessment and referral to an early intervention program are required |
Note: M-CHAT-R — used in various clinics in Azerbaijan, but official validation in the Azerbaijani population is limited. The above translation is for clinical practice; original official translation should be used in scientific research (for official translations: https://mchatscreen.com).
B.2. AQ-10: Short Autism Spectrum Quotient (16 years+)
Original authors: Carrie Allison, Bonnie Auyeung, Simon Baron-Cohen, 2012.
Original reference: Allison C, Auyeung B, Baron-Cohen S. Toward brief “red flags” for autism screening: the short Autism Spectrum Quotient (AQ-10). J Am Acad Child Adolesc Psychiatry, 2012; 51: 202–212.
Instruction
What do you think about the following 10 statements? For each statement, select one of the following: Strongly agree, Somewhat agree, Somewhat disagree, Strongly disagree.
Questions
| № | Statement |
|---|---|
| 1 | I often notice small sounds that others do not notice |
| 2 | I usually pay more attention to the overall picture rather than small details |
| 3 | I have difficulty following a conversation among several people in a social situation |
| 4 | I often focus so much on one topic or activity that I lose track of other things |
| 5 | I easily understand what someone is thinking or feeling when they say something |
| 6 | I am good at reading people’s intentions |
| 7 | I have difficulty understanding what characters are thinking when reading a story |
| 8 | I like to collect detailed information about activities I have done before (e.g., car models, birds, trains) |
| 9 | I have difficulty understanding what a person is thinking or feeling when I look at them |
| 10 | I have difficulty knowing how to behave in social situations |
Scoring
| Question | “Strongly agree / Somewhat agree” – 1 point | “Strongly disagree / Somewhat disagree” – 1 point |
|---|---|---|
| 1 | ✓ | |
| 2 | ✓ | |
| 3 | ✓ | |
| 4 | ✓ | |
| 5 | ✓ | |
| 6 | ✓ | |
| 7 | ✓ | |
| 8 | ✓ | |
| 9 | ✓ | |
| 10 | ✓ |
Total score = ___ out of 10
Interpretation of results
| Score | Recommendation |
|---|---|
| 0–5 | ASD diagnostic assessment probability is low |
| ≥6 | Detailed ASD clinical assessment is recommended |
Note: AQ-10 is a short version of the classic AQ-50. It is officially recommended by NICE CG142 (UK) for adult ASD screening in primary care. Sensitivity/specificity 0.88/0.91 (Allison 2012). AQ-10 is particularly reliable in self-screening and should be used together with clinician’s initial interview.
B.3. ASRS v1.1: Adult ADHD Self-Report Scale
Original authors: WHO, Ronald C. Kessler and colleagues, Harvard Medical School, 2005.
Original reference: Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS). Psychological Medicine, 2005; 35: 245–256.
Instruction
This scale is for screening ADHD symptoms in adults. For the following 6 questions, answer based on how you have felt within the last 6 months. For each question, select one of the options: Never, Rarely, Sometimes, Often, Very often.
Part A — Primary screening (6 questions)
| № | Question | Never | Rarely | Sometimes | Often | Very often |
|---|---|---|---|---|---|---|
| 1 | How often do you have difficulty finishing the final details after a difficult part of a project is completed? | |||||
| 2 | How often do you have difficulty prioritizing tasks when organizing a demanding job? | |||||
| 3 | How often do you have trouble remembering appointments or obligations? | |||||
| 4 | When you have a task that requires a lot of thinking, how often do you hesitate to start or procrastinate? | |||||
| 5 | How often do you move or fidget your hands and feet when you have to sit for a long time? | |||||
| 6 | How often do you feel ‘motor-driven’ hyperactive or compelled to do something? |
Calculation (for Part A)
Responses in the bold cells of the table are considered positive.
| Question | Responses counted as positive signs |
|---|---|
| 1 | Sometimes, Often, Very often |
| 2 | Sometimes, Often, Very often |
| 3 | Sometimes, Often, Very often |
| 4 | Often, Very often |
| 5 | Often, Very often |
| 6 | Often, Very often |
Total positive symptom count = _____ / 6
Interpretation of results
| Number of positive signs | Comment |
|---|---|
| 0–3 | Symptoms not typical for adult ADHD |
| ≥4 | Symptoms highly consistent with adult ADHD. Medical evaluation recommended. |
Part B — Extended questionnaire (12 additional questions)
When Part A is positive, Part B questions (12 additional questions) are used in conjunction with clinical assessment. The full version of Part B can be obtained from the developers’ official website: https://www.hcp.med.harvard.edu/ncs/asrs.php
Note: ASRS v1.1 – Developed by WHO, the most widely used adult ADHD screening scale in the world. Later, the world-renowned Ustun, Kessler et al. (2017) developed ASRS-5 — a 6-question version according to DSM-5. Both versions are suitable for screening; ASRS v1.1 remains widely used.
B.4. SNAP-IV: Swanson, Nolan, and Pelham Rating Scale (child ADHD)
Original authors: James M. Swanson, 1983.
Original reference: Swanson JM. School-based assessments and interventions for ADD students. Irvine, CA: KC Publishing, 1992.
Instruction
SNAP-IV — the assessment of ADHD symptoms in children based on DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, APA, 1994; the ADHD symptoms are retained in DSM-5). To be completed by parent or teacher. How is each symptom observed in your child over the past month: Not at all (0), Just a little (1), Quite a bit (2), Very much (3).
Questions (SNAP-IV short version – 26 questions)
Inattention subscale (Items 1–9):
| № | Statement | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|
| 1 | Often makes careless mistakes in schoolwork or other activities | ||||
| 2 | Often has difficulty sustaining attention in tasks or play | ||||
| 3 | Often appears not to listen when spoken to directly | ||||
| 4 | Often fails to follow instructions and to finish schoolwork or daily chores | ||||
| 5 | Often has difficulty organizing tasks and activities | ||||
| 6 | Often avoids, dislikes, or reluctantly performs tasks requiring sustained mental effort | ||||
| 7 | Often loses necessary items for tasks or activities (school materials, pencils, books) | ||||
| 8 | Often easily distracted by extraneous stimuli | ||||
| 9 | Often forgetful in daily activities |
Hyperactivity-Impulsivity Subscale (Items 10–18):
| № | Statement | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|
| 10 | Often fidgets with hands or feet or squirms in seat | ||||
| 11 | Often leaves seat in room when remaining seated is required | ||||
| 12 | Often runs about or climbs excessively in inappropriate situations | ||||
| 13 | Often has difficulty playing quietly | ||||
| 14 | Often behaves as ‘motor-driven’ or ‘hyperactive’ | ||||
| 15 | Often talks excessively | ||||
| 16 | Often blurts out answers before questions are completed | ||||
| 17 | Often unable to wait for his/her turn | ||||
| 18 | Often interrupts others’ activities (conversation, game) |
Oppositional-defiant behavior subscale (Items 19–26):
| № | Statement | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|
| 19 | Often loses temper | ||||
| 20 | Often argues with adults | ||||
| 21 | Often defies adult requests or rules | ||||
| 22 | Often deliberately annoys others | ||||
| 23 | Often blames others for his/her mistakes or misbehavior | ||||
| 24 | Often easily irritated by others | ||||
| 25 | Often irritable and quick-tempered | ||||
| 26 | Often behaves vindictively or spitefully |
Scoring
Mean of each subscale:
- Inattention subscale (1–9): sum ÷ 9 = ____
- Hyperactivity-Impulsivity subscale (10–18): sum ÷ 9 = _____
- Oppositional-defiant subscale (19–26): sum ÷ 8 = _______
Interpretation of results (moderate levels)
| Subscale | Parent: positive boundary | Teacher: positive boundary |
|---|---|---|
| Inattention | ≥1.78 | ≥2.56 |
| Hyperactivity-impulsivity | ≥1.44 | ≥1.78 |
| Oppositional-defiant | ≥1.88 | ≥2.00 |
These cutoffs are based on data from Bussing et al., 2008 and are for the US population. No specific validation has been conducted in the Azerbaijani population — results should be interpreted in a clinical context.
Diagnostic interpretation
- Presentation type of ADHD according to DSM criteria:
- Primarily inattentive: Only the inattentiveness subscale is positive;
- Primarily hyperactive-impulsive: Only the hyperactivity subscale is positive;
- Combined: Both subscales are positive.
A positive result on the oppositional-defiant subscale indicates the likelihood of comorbid oppositional-defiant disorder (ODD, ICD-11 6C90).
Note: SNAP-IV is freely available for research and clinical use. The full 90-item version, the short 26-item version, and teacher versions can be downloaded from this site: http://www.shared-care.ca/files/Scoring_for_SNAP_IV_Guide_26-item.pdf
B.5. Key instruments for intellectual and adaptive assessment (data table)
The following tools are licensed psychological instruments and cannot be fully provided within the text. A clinical psychologist or other specialist is required to obtain and use them.
B.5.1. Intellectual assessment
| Instrument | Age group | Publisher | Typical time |
|---|---|---|---|
| WPPSI-IV (Wechsler Preschool and Primary Scale of Intelligence) | 2 years 6 months – 7 years 7 months | Pearson | 60–90 min |
| WISC-V (Wechsler Intelligence Scale for Children) | 6–16 years | Pearson | 60–90 min |
| WAIS-IV/V (Wechsler Adult Intelligence Scale) | 16–90 years | Pearson | 60–90 min |
| Stanford-Binet 5 | 2 years+ | Riverside Insights | 45–75 min |
| Leiter-3 (non-verbal) | 3–75+ years | Stoelting | 25–40 min |
| Raven’s Progressive Matrices | 5 years+ | Pearson | 20–40 min |
B.5.2. Adaptive behavior
| Instrument | Age range | Publisher | Format |
|---|---|---|---|
| Vineland-3 (Vineland Adaptive Behavior Scales) | Birth to 90+ years | Pearson | Semi-structured parent/caregiver interview |
| ABAS-3 (Adaptive Behavior Assessment System) | Birth to 89 years | WPS | Parent/teacher rating form |
B.5.3. Autism diagnostic tools
| Instrument | Age group | Publisher | Typical time |
|---|---|---|---|
| ADOS-2 (Autism Diagnostic Observation Schedule) | 12 months — adult | WPS | 40–60 min (5 modules) |
| ADI-R (Autism Diagnostic Interview — Revised) | 2 years — adult | WPS | 90–150 min |
| CARS-2 (Childhood Autism Rating Scale) | 2 years+ | WPS | 15–30 min |
| SRS-2 (Social Responsiveness Scale) | 2.5 years+ | WPS | 15–20 min |
B.5.4. Detailed assessment of ADHD
| Instrument | Age group | Publisher |
|---|---|---|
| Conners-3 (Conners Rating Scales) | 6–18 years | MHS |
| Conners CBRS | 6–18 years | MHS |
| CAARS (Conners Adult ADHD Rating Scales) | 18+ years | MHS |
| BRIEF-2 (Behavior Rating Inventory of Executive Function) | 5–18 years | PAR |
| CPT-3 (Conners Continuous Performance Test) | Age 8+ | MHS |
Author’s note
The screening scales presented in Appendix B (M-CHAT-R, AQ-10, ASRS v1.1, SNAP-IV) are ready for immediate use in clinical practice. The authors and their affiliated institutions — the World Health Organization, Harvard Medical School, Professor Simon Baron-Cohen and colleagues, Diana Robins, Deborah Fein, Marianne Barton, and James Swanson — are gratefully acknowledged for their substantial contributions to modern psychiatry.
Licensed diagnostic instruments (ADOS-2, WISC-V, Vineland-3, and others) cannot be reproduced in full within this volume. Their administration requires specialized training and an officially purchased license. Clinicians should obtain these instruments directly through the authorized publishers (Pearson, WPS, MHS, or equivalent distributors in their jurisdiction).
Note on translation and local validation. The Azerbaijani-language translations provided in this volume represent a working clinical version. They have not yet undergone formal psychometric validation for the Azerbaijani population. For use in scientific publications or validation research, clinicians should consult the official publishers to obtain authorized translations. The development of population-specific normative data for Azerbaijan remains an important priority for future work.