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The Communication Questionnaire form, designed with user-friendliness in mind, serves as a valuable tool for assessing social communication in individuals, particularly children. This insightful instrument helps caregivers and professionals identify various aspects of communication, from the ability to engage in conversations to the use of appropriate facial expressions. By requesting straightforward yes or no responses, the form encourages respondents to reflect on the individual’s behaviors over the past three months. It prompts parents or guardians to consider whether the subject can use phrases and engage in reciprocal interactions with others. Furthermore, it explores the use of language and social nuances, including peculiar phrasing or repetitive language patterns, which could indicate deeper communication challenges. The form also examines behaviors such as engagement with peers, imaginative play, and responsiveness to social cues. By incorporating questions about interests and mannerisms, the questionnaire provides a well-rounded view of the individual’s social communication landscape, aiding in the detection of potential developmental disorders and enhancing understanding for tailored support.

Communication Questionnaire Example

SOCIAL COMMUNICATION QUESTIONNAIRE (SCQ) – CURRENT

PC ANSWER SHEET

Michael Rutter, M.D., F.R.S., Anthony Bailey, M.D., Sibel Kazak Berument, Ph.D.,

Catherine Lord, Ph.D., and Andrew Pickles, Ph.D.

Name of Subject: _______________________ D.O.B. _________ Interview Date ________ Age: ____

Gender: F M Name of Respondent: ______________________ Relation to Subject: __________

DIRECTIONS: Thank you for taking the time to complete this questionnaire. Please answer each question by selecting yes or no. A few questions ask about several related types of behavior; please select yes if any of these behaviors were present during the past 3 months. Although you may be uncertain about whether some behaviors were present or not, please answer yes or no to every question on the basis of what you think.

ITEM

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

1.

Is she/he now able to talk using short phrases or sentences? If no, skip to question 8.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Do you have a to and fro “conversation” with her/him that involves taking turns or building on

 

 

 

what you have said?

 

 

 

 

 

 

 

3.

Does she/he ever use odd phrases or say the same thing over and over in almost exactly the

 

 

 

 

 

 

 

 

 

 

 

 

same way (either phases that she/he hears other people use or ones that she/he makes up?

 

 

 

 

 

 

 

 

 

 

 

4.

Does she/he ever use socially inappropriate questions or statements? For example, does

 

 

 

she/he ever regularly ask personal questions or make personal comments at awkward times?

 

 

 

 

 

 

 

 

5.

Does she/he ever get his/her pronouns mixed up (e.g., saying you or she/he for I)?

 

 

 

6.

Does she/he ever use words that she/he seems to have invented or made up her/himself; put

 

 

 

 

 

 

 

 

things in odd, indirect ways; or use metaphorical ways of saying things (e.g., saying hot rain

 

 

 

for steam)?

 

 

 

 

 

 

 

7.

Does she/he ever say the same thing over and over in exactly the same way or insist that you

 

 

 

 

 

 

 

 

 

 

 

 

say the same thing over and over again?

 

 

 

 

 

 

 

 

 

 

 

8.

Does she/he have things that she/he seems to do in a very particular way or order or rituals

 

 

 

that she/he insists that you go through?

 

 

 

 

 

 

 

 

 

 

9.

Does her/his facial expressions usually seem appropriate to the particular situation, as far as

 

 

 

 

 

 

 

 

 

 

 

 

 

you can tell?

 

 

 

 

 

 

 

 

 

 

 

 

10.

Does she/he ever use your hand like a tool or as if it were part of his/her own body (e.g.,

 

 

 

pointing with your finger or putting your hand on a doorknob to get you to open the door)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Does she/he ever have any interests that preoccupy her/him and might seem odd to other

 

 

 

 

 

 

 

 

 

 

 

 

people (e.g., traffic lights, drainpipes, or timetables)?

 

 

 

 

 

 

 

 

 

 

 

12.

Does she/he ever seem to be more interested in parts of a toy or an object (e.g., spinning the

 

 

 

wheels of a car), rather than in using the object as it was intended?

 

 

 

 

 

 

 

13.

Does she/he ever have any special interests that are unusual in their intensity but otherwise

 

 

 

 

 

 

 

 

 

 

 

 

 

appropriate for his/her age and peer group (e.g., trains or dinosaurs)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Does she/he ever seem to be unusually interested in the sight, feel, sound, taste, or smell of

 

 

 

things or people?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

Does she/he ever have any mannerisms or off ways of moving her/his hands or fingers, such

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

as flapping or moving her/his fingers in front of her/his eyes?

 

 

 

 

 

 

 

 

 

 

 

16.

Does she/he ever have any complicated movements of her/his whole body, such as spinning

 

 

 

or repeatedly bouncing up and down?

 

 

 

 

 

 

 

 

 

ITEM

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

17.

Does she/he ever injure her/himself deliberately, such as by biting her/his arm or banging

 

 

 

 

 

 

 

 

 

 

 

 

 

her/his head?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

Does she/he ever have any objects (other than a soft toy or comfort blanket) that she/he has

 

 

 

 

to carry around?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

Does she/he have any particular friends or a best friend?

 

 

 

 

 

 

 

 

 

20.

Does she/he ever talk with you just to be friendly (rather than to get something)?

 

 

 

 

 

 

 

 

 

 

 

 

21.

Does she/he ever spontaneously copy you (or other people) or what you are doing (such as

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vacuuming, gardening, or mending things)?

 

 

 

 

 

 

 

 

 

 

 

22.

Does she/he ever spontaneously point at things around her/him just to show you things (not

 

 

 

 

because she/he wants them?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

Does she/he ever use gestures, other than pointing or pulling your hand, to let you know

 

 

 

 

 

 

 

 

 

 

 

 

 

what she/he wants?

 

 

 

 

 

 

 

 

 

 

 

 

24.

Does she/he nod her/his head to indicate yes?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

Does she/he shake her/his head to indicate no?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26.

Does she/he usually look at you directly in the face when doing things with you or talking with

 

 

 

 

you?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27.

Does she/he smile back if someone smiles at her/him?

 

 

 

 

 

 

 

 

 

 

 

 

 

28.

Does she/he ever show you things that interest her/him to engage your attention?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29.

Does she/he ever offer to share things other than food with you?

 

 

 

 

 

 

 

 

 

 

 

 

 

30.

Does she/he ever seem to want you to join in her/his enjoyment of something?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31.

Does she/he ever try to comfort you if you are sad or hurt?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.

If she/he wants something or wants help, does she/he look at you and use gestures with

 

 

 

 

sounds or words to get your attention?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

Does she/he show a normal range of facial expressions?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

Does she/he ever spontaneously join in and try to copy the actions in social games, such as

 

 

 

 

The Mulberry Bush or London Bridges Is Falling Down?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35.

Does she/he play any pretend or make-believe games?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36.

Does she/he seem interested in other children of approximately the same age whom she/he

 

 

 

 

does not know?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37.

Does she/he respond positively when another child approaches her/him?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38.

If you come into a room and start talking to her/him without calling her/his name, does

 

 

 

 

she/he usually look up and pay attention to you?

 

 

 

 

 

 

 

 

 

 

 

 

39.

Does she/he ever play imaginative games with another child in such a way that you can tell

 

 

 

 

 

 

 

 

 

 

 

 

that each child understands what the other is pretending?

 

 

 

 

 

 

 

 

 

 

 

40.

Does she/he play cooperatively in games that need some form of joining in with a group of

 

 

 

 

other children, such as hide-and-seek or ball games?

 

 

 

 

 

 

 

 

 

 

 

Form Characteristics

Fact Name Description
Purpose The Communication Questionnaire assesses social communication abilities in children.
Authors Developed by Michael Rutter, M.D., Anthony Bailey, M.D., Sibel Kazak Berument, Ph.D., Catherine Lord, Ph.D., and Andrew Pickles, Ph.D.
Format The form consists of multiple questions, answered with a simple "yes" or "no."
Target Audience This questionnaire is designed for the caregivers or guardians of subjects being evaluated.
Age Range The questionnaire can be used for children of various ages, but the appropriateness varies based on the child's developmental stage.
Behavioral Focus It examines social interactions, communication, and behavioral patterns in the past three months.
Confidentiality The form requires personal information about the subject and respondent, ensuring data is handled discreetly.
State-Specific Laws For use in clinical settings, it may be governed by state laws related to mental health assessments and patient confidentiality.

Guidelines on Utilizing Communication Questionnaire

Filling out the Communication Questionnaire form accurately is essential for providing valuable insights. Once completed, the form will assist in assessing communication behaviors effectively. Ensure that you have all relevant information on hand before starting.

  1. Write the name of the subject in the designated space.
  2. Enter the subject's date of birth (D.O.B.) and their age in the respective fields.
  3. Fill in the interview date in the appropriate section.
  4. Select the gender of the subject by marking either F for female or M for male.
  5. Provide the name of the respondent who is filling out the form.
  6. Indicate your relation to the subject in the specified space.
  7. Read the directions carefully and answer each question with a yes or no response based on the subject’s behavior during the past three months.
  8. For questions that ask about several related behaviors, select yes if any of those behaviors were observed.
  9. If unsure about a behavior, make your best judgment and provide an answer.
  10. Complete each question sequentially until all items are answered.

What You Should Know About This Form

What is the purpose of the Communication Questionnaire?

The Communication Questionnaire aims to assess an individual's social communication skills over the past three months. It is designed to gather insights on various behaviors, such as conversational abilities, facial expressions, and interactions with others. By providing a structured way to report these behaviors, the questionnaire helps professionals understand how an individual communicates and relates to the world around them.

Who should complete the Communication Questionnaire?

The questionnaire should be completed by a respondent who knows the individual well, such as a parent, guardian, or caregiver. This person must have regular interactions with the subject, as they can provide the most accurate information about the subject's communication patterns and behaviors. It's crucial that the respondent answers each question to the best of their ability to ensure the assessment is as accurate as possible.

How should questions be answered on the Communication Questionnaire?

Each question on the questionnaire is designed to be answered with "yes" or "no," in order to capture the presence or absence of specific behaviors. If the respondent has uncertainties, they should base their answers on their general observations over the past three months. In cases where the subject is unable to perform a task described in earlier questions, the respondent should skip to the indicated question, which allows for a smoother and more relevant completion of the form.

What happens after the Communication Questionnaire is completed?

Once the questionnaire is completed, it can be reviewed by professionals such as psychologists, speech therapists, or special educators. They will analyze the responses to gain a better understanding of the individual's communication skills and social interactions. This information may then be used to inform further evaluations or interventions, ensuring that the needs of the individual are addressed appropriately.

Common mistakes

Completing the Communication Questionnaire form can seem straightforward, yet there are common pitfalls many respondents encounter. One major mistake is skipping questions. When a question mentions to "skip to question 8," it can be easy to overlook the instruction entirely. Such oversights may result in inaccurate or incomplete data, ultimately affecting the assessment of the subject's abilities.

Another frequent error involves misunderstandings regarding the nature of the behaviors being evaluated. Respondents may misinterpret questions due to vague phrasing. For instance, when asked if the subject can converse by "taking turns," there could be confusion about what constitutes a functional conversation. This ambiguity may lead to false negatives or positives, skewing the results of the questionnaire.

Inconsistent standards pose yet another challenge. Some individuals might evaluate behaviors based on different timelines, measuring a behavior’s presence over various intervals rather than the specified three months. This inconsistency in interpretation can create gaps or inconsistencies in the information provided, leading to misleading insights about the subject's social communication skills.

Respondents often grapple with uncertainties about their answers. The directive to answer based on personal beliefs instead of concrete observations might result in emotional rather than factual responses. This situation can skew responses toward either extreme—over-reporting difficulties or underestimating certain behaviors, thus distorting the assessment's accuracy.

Another common issue is the failure to provide specific context for behaviors. Details about unique situations requiring certain responses can enhance the accuracy of the answers. For example, if a subject is noted to be socially inappropriate, clarifying whether this occurs primarily in unfamiliar settings versus with trusted individuals can inform the evaluator's understanding significantly.

The structure of the questionnaire can also lead to mistakes. Respondents might misread multiple-choice options or inadvertently skip responding to one due to clicking errors. Concentrating on one section at a time can help mitigate this issue and ensure that all questions receive due diligence.

Improper distractions during the completion process can further hinder accuracy. It is vital for respondents to find a quiet space free from interruptions. External distractions can lead to rushed or distracted answers, which could compromise the integrity of the responses.

Additionally, individuals sometimes fail to involve the subject appropriately. When the subject is capable of providing input, allowing them to contribute where appropriate can provide richer, more nuanced data. Participation fosters a more engaged and accurate evaluation of their communication strengths and challenges.

Respondents may also underestimate the significance of seemingly minor questions. Every behavior, no matter how trivial it may appear at first glance, serves as part of the broader communicative context. Neglecting to acknowledge these behaviors can result in an incomplete understanding of the subject's social communication abilities.

Finally, once the questionnaire is completed, neglecting to review answers is an error that can have consequences. Double-checking not only helps catch mistakes but also solidifies the integrity of the responses. Verifying that every item was considered thoughtfully can contribute to a more reliable and valid assessment of the subject’s communicative functions.

Documents used along the form

The Communication Questionnaire form is an essential tool used by professionals to assess a person's social communication skills. To complement this form, several other documents often accompany it to provide a comprehensive understanding of an individual's communicative abilities and needs. Below are some commonly used forms and documents.

  • Developmental History Questionnaire: This document gathers detailed information regarding the individual’s developmental milestones, including language skills, motor skills, and social behavior. It provides context for interpreting results from the Communication Questionnaire.
  • Behavior Assessment Scale: This scale evaluates the frequency and intensity of specific behaviors in various settings. By obtaining this information, practitioners can identify any areas that may require intervention or support.
  • Parent/Caregiver Interview Guide: This guide is used during interviews with parents or caregivers to explore their observations and concerns regarding the individual's communication and social interactions. It helps to gain insights that may not be captured in standardized forms.
  • Observation Checklist: This document is utilized to record observations of the individual's behavior in natural settings. It allows professionals to see how a person communicates with others in real-life situations, providing a valuable perspective on their social skills.

Together, these documents create a clearer picture of an individual's social communication abilities, making it easier for professionals to identify the best strategies for support and intervention. Each document plays a pivotal role in gathering comprehensive data necessary for tailored approaches to communication development.

Similar forms

  • Childhood Autism Spectrum Test (CAST): Like the Communication Questionnaire, the CAST assesses social communication abilities in children, identifying potential developmental concerns through a series of simple yes/no questions.
  • Autism Diagnostic Observation Schedule (ADOS): The ADOS is an interactive diagnostic tool that evaluates communication, social interaction, and play in individuals. Similar to the questionnaire, it involves a structured format to gauge specific behaviors over a defined period.
  • Social Responsiveness Scale (SRS): The SRS measures social behaviors and emotional strength in children and adults. This tool, like the Communication Questionnaire, collects data through responses to carefully crafted questions aimed at identifying social difficulties.
  • Vineland Adaptive Behavior Scale: This scale assesses various adaptive behaviors, including communication, daily living skills, and socialization. It shares the questionnaire's objective of determining the effectiveness of social communication in a structured format.
  • Parenting Stress Index (PSI): The PSI measures stress levels and factors affecting parenting. Much like the Communication Questionnaire, it focuses on specific areas of concern and how they affect interpersonal communication dynamics within families.
  • Repetitive Behavior Scale-Revised (RBS-R): This scale evaluates repetitive behaviors and interests. Its approach parallels the Communication Questionnaire’s focus on identifying specific behavioral patterns and their implications for social communication.

Dos and Don'ts

When filling out the Communication Questionnaire form, adhering to specific guidelines will ensure clarity and accuracy in responses. Below are important points to consider for a successful completion:

  • Read all instructions carefully before starting.
  • Answer every question to the best of your ability.
  • Use yes or no options only; do not leave any questions unanswered.
  • Consider the last three months when reflecting on behaviors.
  • Provide details about the respondent and subject accurately.

However, certain pitfalls should be avoided to maintain the integrity of the questionnaire:

  • Do not rush through the questionnaire; take your time.
  • Avoid speculation; answer based on known behaviors.
  • Do not skip questions without reason; each one is essential.
  • Refrain from altering responses once submitted; ensure accuracy prior to submission.
  • Do not discuss answers with others until after completion, to keep responses independent.

Misconceptions

Here are five misconceptions about the Communication Questionnaire form:

  1. It only applies to children. Many believe this form is designed solely for assessing children. In reality, it can be utilized for individuals of various ages who exhibit communication challenges.
  2. All questions must be answered with certainty. Some think that they need to be completely sure of their answers. However, respondents are encouraged to answer based on observations, even if they are uncertain about specific behaviors.
  3. It's a detailed diagnostic tool. Many people see this questionnaire as a comprehensive diagnostic instrument. While it helps gather information, it does not replace professional assessments or evaluations.
  4. Yes and no answers reveal everything about communication skills. There's an assumption that simple yes or no answers provide complete insight into a person's communication abilities. In truth, the responses are a starting point and may require further exploration.
  5. Completing the form is optional. Some believe they may skip the questionnaire without consequences. Completing the form is often essential for gathering crucial information for a better understanding of communication needs.

Key takeaways

  • Complete Accurately: Ensure all questions are answered based on your observations of the individual's behavior over the past three months. Your insights are crucial.

  • Be Honest: Do not hesitate to indicate uncertainty. Your perceptions matter, even if some questions are challenging to answer.

  • Select Appropriately: Choose "yes" if any related behaviors are evident. This thoroughness will aid in a more accurate assessment.

  • Engage Collaboratively: If possible, discuss the responses with others who may also observe the individual. Different perspectives can improve accuracy.

  • Use Clear Language: Focus on straightforward interpretations of each question. Avoid convoluted reasoning that might cloud your responses.

  • Respect Confidentiality: Keep the information and discussion about the questionnaire private to protect the individual's privacy.

  • Prioritize Completion: Fill out the form in a timely manner to ensure that the assessment process can move forward without delay.

  • Seek Clarifications: If any question seems confusing, reach out for guidance. Understanding each question fully is vital for accurate responses.