APPENDIX B
SCREENING SCALES FOR NEURODEVELOPMENTAL DISORDERS
> Usage patterns: These scales diagnostic not, screening tools. Positive result – indication for specialized clinical assessment, is not a diagnosis. A definitive diagnosis is established through clinical observation, comprehensive assessment, and (when necessary) standardized diagnostic tools (ADOS-2, ADI-R, WISC-V, etc.).
>
> Licence status: All scales presented in this appendix are instruments openly provided by their developers for scientific research and clinical use.
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. To each question YES or NO Answer like — your child’s Typically Based on how they behaved. If you've seen the behavior once or twice, but generally the child does not do it, NO Respond.
Questions
| № | Question | YES | No |
|---|---|---|---|
| 1 | If you look at something on the other side of the room, does your child also 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 empty cup, talking on phone, feeding doll) | ||
| 4 | Does your child like climbing objects? (Furniture, stairs, tree) | ||
| 5 | Does your child make unusual movements with palms, fingers or other parts of body in front of eyes? | ||
| 6 | Does your child point to something they want? (For example, a toy far away in buffet) | ||
| 7 | Does your child point to attract your attention to something interesting? (For example, airplane in sky or 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 to your child, do they smile back to 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, when you make activity on your face, they do same) | ||
| 16 | Does your child look at you when they hear something to see what happened? | ||
| 17 | Does your child try to get your attention? (e.g., looking at you, for praise, saying ‘look!’) | ||
| 18 | Does your child respond to understood words? (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, bouncing in air, hopping on knees) |
Scoring
Risk score = number of YES responses, exception: for items 2, 5, and 12 answer NO — risk indicator (YES answer on these three items considered risk).
That is:
- 1, 3, 4, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18, 19, 20-ci suallarda NO response considered a risk indicator.
- 2, 5, 12-ci suallarda YES answer considered 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 is required |
> Note: M-CHAT-R – used in various clinics in Azerbaijani, 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 Strongly agree, Somewhat agree, Somewhat disagree, Strongly disagree select one of the variants.
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 | “Absolutely agree / Partially agree” – 1 point | “Absolutely not agree / Partially not agree” – 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 ~77%, specificity 36–41%. 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 HDHD symptoms in adults. The following 6 questions – within the last 6 months Answer based on how you felt. For each question Never, Rarely, Sometimes, Often, Very often select one of the variants.
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 — a positive sign.
| 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. By Kessler et al. worldwide ASRS-5 (APA, 2013 — according to DSM-5 criteria, 2017) Processed — a shorter 5-question version. 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/APA, 1994 criteria, DSM-IV/APA, 2013 – DSM-5 criteria. To be completed by parent or teacher. How is each symptom observed in your child over the past 1 month: None (0), Mild (1), Moderate (2), Severe (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 inattentiveness subscale positive;
- Primarily hyperactive-impulsive: Only hyperactivity subscale positive;
- Combined: Both subscales positive.
A positive result on the oppositional-defiant subscale indicates the likelihood of comorbid oppositional-defiant disorder (ODD, ICD-11 6C91).
> 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 the official website of Prof. Swanson: 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 licensed psychological instruments and cannot be fully provided within the text. Clinical psychologist or specialized expert required for their acquisition and use.
B.5.1. Intellectual Assessment
| Instrument | Age group | Publisher | Typical time |
|---|---|---|---|
| WPPSI-IV (Wechsler Preschool and Primary Scale of Intelligence) | 2 il 6 ay – 7 il 7 ay | 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 group | Publisher | Type of assessment |
|---|---|---|---|
| Vineland-3 (Vineland Adaptive Behavior Scales) | From birth to 90+ years | Pearson | Parent/teacher interview |
| ABAS-3 (Adaptive Behavior Assessment System) | From birth to 89 years | WPS | Parent/teacher interview |
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 direct use in clinical work. To the authors of these scales and their institutions – WHO, Harvard Medical School, Baron-Cohen and colleagues, Robins, Fein, Barton and Swanson — we thank for major contributions to modern psychiatry.
Licensed diagnostic tools (ADOS-2, WISC-V, Vineland-3, etc.) cannot be fully presented in this book – their use requires specialized training and an officially obtained copy. Clinical psychologists must obtain these tools through official publishers such as Pearson, WPS, MHS.
Issue of official and validated translation into Azerbaijani language: The Azerbaijani translations provided above are a working version for clinical use. For scientific publications and validation studies, contact with official publishers is required. Developing standardized norms for the Azerbaijani population is an important future task.