Screening tools and guidline for CBR workers_Autism_English.pdf

Empowering CBR workers with a simple Autism Screening Tool to spot early signs in children, especially where specialized support is not available. Adapted from WHO, M-CHAT, and CBR guidelines for the Bangladesh context, it ensures timely support, therapy, and inclusive growth for every child. Written by Nusrat Zerin, Disability Inclusion and Development Professional.

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Community-Level Autism Screening Tool
for
Community Based Rehabilitation (CBR) Workers
(Adapted from WHO CBR Guidelines, M-CHAT Screening Tool, and local field experience
– Bangladesh context)





Nusrat Zerin
Disability Inclusion and Development Professional

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Community-Level Autism Screening Tool for CBR Workers
Autism or Autism Spectrum Disorder (ASD) often appears in early childhood, but due to a lack of
awareness, it frequently goes unrecognized. Trained Community-Based Rehabilitation (CBR)
workers need to use a simple screening tool at the community level. Using this tool, they can
observe early signs in a child’s behavior, communication, and social interaction, and make timely
referrals. This helps the child receive therapy, education, and family support at the right time,
ensuring inclusive development within the community.

Purpose: To identify children who may have Autism Spectrum Disorder (ASD) for early referral
and intervention.
Target Users: Community-Based Rehabilitation (CBR) field workers.
Age Range: 18 months – 10 years
Reference:
(Adapted from WHO CBR Guidelines, M-CHAT Screening Tool, and local field experience –
Bangladesh context)

Key reasons why CBR workers will use this Autism Screening Tool:
1. Early Detection: Helps CBR workers identify signs of autism at an early stage for timely
referral and support.
2. Simple and Practical: The tool uses easy language and observation-based questions that
even low-literate field workers can use confidently.
3. Community-Level Use: Designed for rural and low-resource settings where professional
diagnosis may not be available.
4. Guides Action: Provides clear steps for scoring, decision-making, and referral, ensuring
appropriate follow-up.
5. Promotes Inclusion: Early identification supports families in accessing education,
therapy, and community participation for children with autism.

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Preliminary Screening Table for Identifying Children with Autism Spectrum Disorder
(ASD)
Preliminary Screening Table for Identifying Children with Autism Spectrum Disorder (ASD) is
designed for Community-Based Rehabilitation (CBR) workers to use easily at the community level,
using observation and caregiver reports.

Age
(Years)
Social Interaction
Communication /
Language
Behavior and
Interests
Warning Signs (Referral
Needed)
1–2
years
Makes eye
contact, responds
to familiar people
Uses few simple
words or gestures
(e.g., bye-bye, come)
Plays simple
games like peek-
a-boo, claps or
waves
Does not respond to
name, avoids eye contact,
no gestures, no interest
in people
3–4
years
Starts to play
with other
children, shares
toys
Can use short
sentences, expresses
needs
Plays different
games, uses
imagination (e.g.,
feeding doll)
Prefers to play alone,
repeats words/sounds,
no pretend play, limited
speech
5–6
years
Engages in group
play, understands
others’ feelings
Can hold short
conversations
Shows interest in
different toys or
activities
Avoids group play,
repeats same actions
(spinning, lining toys),
gets upset with change
7–10
years
Maintains
friendships,
shows empathy
Can talk about
experiences, answer
simple questions
Can shift between
activities
Difficulty making friends,
speaks oddly or off-topic,
obsessed with specific
topics
11–15
years
Understands
social rules and
emotions
Communicates
clearly, understands
humor
Adapts to new
situations
Very fixed routines, poor
understanding of jokes,
lacks emotional
understanding, avoids
peers

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Scoring and Referral Guidelines:
• 0–2 “Yes” responses: Low concern - Continue observation and encourage the child’s
development.
• 3–4 “Yes” responses: Moderate concern - Provide guidance to parents, continue
monitoring, and repeat screening after 3 months.
• 5 or more “Yes” responses: High concern - Refer promptly to a pediatrician, psychologist,
or special education center.

Notes for CBR Workers
• Observe the child in natural settings (home, school, play).
• Ask caregivers about the child’s communication, play, and reactions.
• Use simple yes/no questions and examples from local life.
• If 3 or more warning signs are present - refer the child to a specialist (pediatrician,
psychologist, or special educator).
• Follow scoring and referral guidance below.
• This is a screening tool, not a diagnostic tool - used for early identification and referral.

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Child Screening Form
(Age-based Questions for Autism)
Child’s Name: ___________
Parent’s Name: ___________
Age (months/years): ___________
Village: ___________
Date: ___________

Age 18–24 months (1.5–2 years):
Question Yes / No Notes
1. Does your child make eye contact when you talk to them?
2. Does your child respond to their name?
3. Does your child point to show things to others?
4. Does your child enjoy playing simple interactive games (peek-a-
boo, clapping)?

5. Does your child use gestures like waving or shaking head?
6. Does your child use at least a few meaningful words?
7. Does your child follow simple instructions (“come here”, “give me
the toy”)?


Age 2–4 years:
Question Yes / No Notes
1. Does your child have trouble making friends or playing with other
children?

2. Does your child repeat words, phrases, or sounds often?

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Question Yes / No Notes
3. Does your child show strong interest in only one activity or toy?
4. Does your child have difficulty understanding other people’s
feelings?

5. Does your child avoid eye contact or interaction?
6. Does your child have unusual body movements (hand flapping,
rocking)?


Age 5–10 years:
Question Yes / No Notes
1. Does your child struggle to speak clearly or hold a conversation?
2. Does your child have difficulty following multi-step instructions?
3. Does your child show very strong routines and get upset if disrupted?
4. Does your child have trouble understanding jokes or social cues?
5. Does your child prefer to play alone most of the time?

Scoring and Referral Guidance:
• 0–2 “Yes” responses: Low concern - continue observation and encourage development.
• 3–4 “Yes” responses: Medium concern - provide parent guidance, monitor closely,
repeat screening in 3 months.
• 5 or more “Yes” responses: High concern - refer immediately to a pediatrician,
psychologist, or special education service.

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Notes for Fieldworkers:
• Observe the child in their natural environment; ask caregivers simple questions.
• Do not attempt to diagnose; this tool is for screening and early referral only.
• Use simple language and local examples when explaining to parents.
Reference for Use:
(WHO, 2010. Community-Based Rehabilitation Guidelines; Robins et al., 2001. M-CHAT:
Modified Checklist for Autism in Toddlers; Adapted for rural Bangladesh field use)