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Comprehensive Autism Assessment Tool (CAAT)

Autism Diagnostic Intake Report (ADIR)

Demographic Information

Background and History

Observation Notes

Sign, Submit, and Generate Intake Report

Section 1: Demographic and Background Information

Child’s First Name Child’s Middle Name Child’s Last Name Preferred Name (Nickname) Date of Birth Age Gender Primary Language Secondary Language(s)

Percentage of exposure to non-primary language(s)

Parent/Guardian Marital Status

Household 1 Details

Parent/Guardian Name Percentage of Time Child Resides Others in the Home

Name	Sex	Age	Relation

Household 2 Details

Parent/Guardian Name Percentage of Time Child Resides Others in the Home

Name	Sex	Age	Relation

Additional Siblings (not living with the child)

Name	Sex	Age

Extended Family Involvement: Are grandparents, aunts/uncles, or other extended family members involved?

Primary Concerns Desired Outcomes (e.g., diagnosis clarity, therapy goals) Additional Notes

Section 2: Background and History

LABOR & DELIVERY

Were medications used to induce or augment labor? Was the patient born premature? Were there complications during labor or delivery? Did the patient experience any problems while still in the hospital? Was the patient admitted to the NICU? The delivery was:

Any labor or delivery complications?

Complication	Check if Present
Breech
Forceps
Cord around neck
Other

Diet and CAMS

Does the child have any current Allergies? Is the child on a special diet?

DEVELOPMENTAL HISTORY

(Check all milestones achieved)

Social/Emotional:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Smiles socially (6–8 weeks)
Makes eye contact with caregiver (0–3 months)
Laughs aloud (3–4 months)
Recognizes familiar caregivers (4–7 months)
Shows stranger anxiety (6–12 months)
Shows appropriate caution in unfamiliar situations (8–18 months)
Responds to own name (6–9 months)
Engages in simple social games (peek-a-boo, pat-a-cake) (9–12 months)
Claps hands during excitement (9–12 months)
Shows affection to caregivers (10–18 months)
Shows awareness of others’ emotions (18–36 months)
Engages in parallel play next to other children (24–36 months)
Follows simple daily routines (2–3 years)

Cognitive:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Looks at and visually tracks toys (2–4 months)
Explores objects by mouthing (4–7 months)
Looks for partially hidden or missing objects (object permanence) (6–9 months)
Stacks 2–3 blocks or objects (15–18 months)
Imitates simple adult actions (12–24 months)
Follows one-step directions (12–18 months)
Plays with toys in simple, functional ways (12–24 months)
Uses two hands together to manipulate objects (10–14 months)
Engages in early pretend play (18–30 months)
Solves simple problems (tries different ways to reach a toy) (9–15 months)
Identifies at least 3 basic colors (2.5–3.5 years)
Follows two-step related directions (2–3 years)
Imitates actions, gestures, and sounds (9–18 months)
Recognizes basic dangers (hot items, heights) (2.5–4 years)
Avoids dangerous items when warned (3–5 years)

Language/ Communication:

Milestone	Yes,on time	Yes, but delayed	Not achieved
Babbling (4–6 months)
Cooing (2–3 months)
Pointing to communicate interest (9–14 months)
Reduplicated babbling “mamama” (6–9 months)
First meaningful word (10–15 months)
Names common objects (18–24 months)
Uses 2–3 word phrases (24–30 months)
Engages in simple turn-taking communication (18–36 months)
Uses 3+ word sentences (30–36 months)
Points to named items when asked “Where is ___?” (12–18 months)
Uses gestures to communicate (9–14 months)
Participates in simple back-and-forth conversation (3–4 years)
Asks simple WH-questions (what, where) (3–4 years)
Says own first name (30–36 months)
Tells simple stories using sentences (4–5 years)
Uses AAC system to communicate intentionally (any age, when AAC introduced)

Approx words (if known):

Physical / Movement:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Rolls over (4–6 months)
Sits independently (6–8 months)
Crawls on hands and knees (7–10 months)
Walks independently (12–15 months)
Jumps with both feet (24–36 months)
Climbs stairs with support (18–24 months)
Pedals tricycle (3 years)
Holds pencil or crayon with fisted grasp (12–18 months)
Scribbles spontaneously (15–18 months)
Kicks ball forward (24 months)
Catches ball with extended arms (36–48 months)

Daily Living Skills:

Grooming/Hygiene:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Daytime toileting trained (2.5–4 years)
Brushes hair with help (3–4 years)
Brushes teeth with help (2.5–3 years)
Washes hands independently (3–4 years)
Washes face with assistance (2–3 years)
Bathing/showering with supervision (4–6 years)

Feeding:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Uses utensils (spoon/fork) (18–24 months)
Drinks from cup or straw (12–18 months)
Uses fingers to feed self (8–12 months)
Helps serve or share food at table (4–6 years)
Eats independently with minimal mess (3–4 years)
Eats a variety of foods with minimal selectivity (3–4 years)

Dressing:

Milestone	Yes, on time	Yes, but delayed	Not achieved
Buttons clothes (3–4 years)
Zips clothes (3–4 years)
Takes off shoes/socks (2–3 years)
Ties shoelaces (5–6 years)
Takes clothes off independently (2–3 years)

How does your child ask for food? Sleep? Has the patient ever had loss or regression of a previously learned skill?

At what age did you first notice the loss of skill?

Sensory Integration / Regulation

Describe your child’s overall affect, activity level, and attention (check all that apply): Are there concerns regarding any of the following areas?

Vision (flickering lights, spin)

Tactile (shaving, nails, textures)

Hearing (vacuum, toilet flushing)

Taste (mouthing)

Body Awareness (pain tolerance, jumping, running)

Smell (smells objects/people)

Vestibular (spinning, balance, falling)

Interoception (feels hungry, constipation)

Reaction to these sensitivities (check all that apply):

Reaction	Present
crying
running away
hands over ears

Educational History

Hand preference: Typical Day: Please describe a Typical Weekday and Weekend What are the patient’s interests and hobbies? What are some of the patient’s strengths?

Problem Behavior(s)

Are there concerns regarding any of the following areas?

Behavior	Check if Present
Aggression Toward Others
Self-Injurious Behavior
Difficulty with Transitions
Inappropriate Conversation
Inappropriate Behavior
Ritualistic Behavior
Repetitive Behavior
Fixations (shows, numbers, objects)

Please describe any behavioral concerns you have at this time: Does the patient make friends easily? Are there any concerns regarding the patient’s social skills or interests?

Has the patient been exposed to any form of abuse, neglect or domestic violence?

Has the patient experienced any recent significant stressors (e.g. moves, losses)? Additional Comments:

MEDICAL HISTORY & EVALUATIONS

For each condition/symptom below, please indicate if it is/was a health problem:

Sleep	Yes No Unsure	Blood / Anemia	Yes No Unsure
Vision	Yes No Unsure	Skin condition	Yes No Unsure
Hearing	Yes No Unsure	Endocrine or hormone	Yes No Unsure
Dental	Yes No Unsure	Seizures	Yes No Unsure
Heart	Yes No Unsure	Head injury	Yes No Unsure
Asthma	Yes No Unsure	Failure to Thrive	Yes No Unsure
Nausea / Vomiting	Yes No Unsure	Feeding	Yes No Unsure

2. Has the patient had any of the following evaluations? If yes, (Please provide supporting documentation)

Evaluations	Yes / No / Unsure	Normal / Abnormal
Audiological Evaluation	Yes No Unsure	Normal Abnormal
Vision Evaluation	Yes No Unsure	Normal Abnormal
Head Imaging (MRI, CT, Ultrasound)	Yes No Unsure	Normal Abnormal
Genetic Testing	Yes No Unsure	Normal Abnormal
EEG	Yes No Unsure	Normal Abnormal
Psychological Evaluation (e.g., IQ)	Yes No Unsure	Normal Abnormal
Other Evaluations, Procedures or Results:	Yes No Unsure	Normal Abnormal

If any of the above were “Abnormal,” please explain:

3. Please indicate whether your child has ever been diagnosed with or suspected of having any of the following conditions:

Disorder / Condition	Status (Diagnosed / Suspected / Never)	Report
Down Syndrome	Diagnosed Suspected Never
Attention Deficit Hyperactivity Disorder (ADHD) / ADD	Diagnosed Suspected Never
Autism Spectrum Disorder (ASD)	Diagnosed Suspected Never
Developmental Delay / Intellectual Disability	Diagnosed Suspected Never
Other:	Diagnosed Suspected Never

4. Please list any other biomedical interventions:

Medication	Dosage / Time	Duration	Comments

5. Has the patient ever been seen by an Occupational Therapist, Speech and Language Therapist, Psychiatrist, Psychologist, or other mental health counselor?
No Yes

If yes, please provide the following information:

Current Therapy History	Agency / Therapist	Duration	Evaluations available for review?	Improvements?
Occupational therapy
Physical therapy
Speech/Language therapy
Psychology
Behavioral therapy
Other:

Additional Notes:

Observation Notes

1. General Appearance and Behavior

Observation	Yes	No
Child is well-groomed / wearing appropriate clothing?
Child's facial expression is typical / neutral?
Child's activity level appears age-appropriate?
Child manages transitions calmly (no major distress)?

2. Interaction with Parent/Guardian

Observation	Yes	No
Child displays secure attachment / seeks proximity to parent?
Child shows separation anxiety when parent leaves?
Child generally complies with parent's instructions or redirections?

3. Social Interaction with Clinician

Observation	Yes	No
Child initiates social interaction (talking, gestures) with clinician?
Child makes eye contact spontaneously?
Child shares enjoyment / joint attention with clinician?

4. Communication and Language

Observation	Yes	No
Child uses verbal communication (phrases, sentences) spontaneously?
Child displays echolalia or repeated speech patterns?
Child uses nonverbal communication (gestures, sign, PECS) effectively?

5. Motor Skills and Movement

Observation	Yes	No
Any hand-flapping or stimming observed?
Child walks or runs on tiptoes?
Fine motor skills appear age-appropriate? (picking small objects, drawing, etc.)

6. Emotional Regulation and Affect

Observation	Yes	No
Child appears calm / content most of the session?
Child tolerates minor frustrations without significant meltdown?
Child self-regulates or quickly calms with minimal support?

7. Play and Engagement

Observation	Yes	No
Child engages in imaginative or pretend play?
Child enjoys constructive play (blocks, puzzles) or similar?
Child demonstrates repetitive or fixated patterns of play?

8. Sensory Responses

Observation	Yes	No
Child reacts strongly to loud/unexpected noises?
Child avoids or seeks certain tactile input?
Child seems fascinated or averse to spinning objects/lights?

9. Perseverations, Rituals, Rigidities

Observation	Yes	No
Child strongly adheres to routines / shows distress if disrupted?
Child exhibits fixations on certain shows, objects, or numbers?

10. Cooperation and Attention

Observation	Yes	No
Child is generally compliant with instructions?
Child maintains attention to tasks or easily distracted?

11. Notable Strengths

12. Concerns / Additional Comments

mostly quiet	overly active
tires easily	talkative
impulsive	resistant to change
clumsy	nervous habits
stubborn	happy
difficulty separating from caregiver

Item	Score (1–4)	Clinician Notes (optional)
1. Relating to People
2. Imitation
3. Emotional Response
4. Body Use
5. Object Use
6. Adaptation to Change
7. Visual Response
8. Listening Response
9. Taste, Smell & Touch Response
10. Fear or Nervousness
11. Verbal Communication
12. Nonverbal Communication
13. Activity Level
14. Intellectual Response Consistency
15. General Impressions

Domain	Verbal	Nonverbal	Notes
Fluid Reasoning
Knowledge
Quantitative Reasoning
Visual-Spatial Processing
Working Memory

Item	Score
Communication
Reciprocal Social Interaction
Play / Imagination
Stereotyped Behaviors & Restricted Interests
Overall Impression

ADL	Independence	Notes
Feeding
Dressing (Upper)
Dressing (Lower)
Toileting
Grooming/Hygiene
Bathing/Showering
Sleep
Play/Leisure
School/Participation

Domain	Status	Notes
Auditory
Visual
Tactile
Vestibular
Proprioception
Oral
Interoception

Skill	Status	Notes
Grasp & release / tool use
In-hand manipulation
Bilateral coordination
Hand dominance
Visual motor integration/handwriting

Skill	Status	Notes
Postural control / core
Balance
Motor planning (praxis)
Strength/Endurance

Area	Difficulty (0–4)	Notes
Attention to task
Initiation
Sustained attention
Flexibility / Transitions
Working memory
Planning / Organization
Emotional regulation
Sensory regulation

Observation	Yes	No
Attends to task > 3 minutes
Transitions with minimal support
Imitates actions/gestures
Uses two hands together functionally
Follows 1-step directions
Follows 2-step directions

CAAT Platform Login

Comprehensive Autism Assessment Tool (CAAT)

Section 1: Demographic and Background Information

Section 2: Background and History

PREGNANCY & BIRTH HISTORY

LABOR & DELIVERY

Diet and CAMS

DEVELOPMENTAL HISTORY

Sensory Integration / Regulation

Educational History

Problem Behavior(s)

MEDICAL HISTORY & EVALUATIONS

Observation Notes

Sign, Submit & Generate Intake Report

Section 1: Psychological

Childhood Autism Rating Scale (CARS-2)

Stanford-Binet Intelligence Scales (SB5)

Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2)

Observations During Assessment

IEP Goal Domains (Target Areas)

Section 2: Occupational Therapy

Parent/Caregiver Interview — Functional Concerns

Occupational Profile & Daily Routines

Feeding & Oral-Motor

Activities of Daily Living (ADLs)

Sensory Processing

Fine Motor & Visual Motor/Perceptual

Gross Motor & Praxis

CAAT-OT Core (Unified Form)

Executive Function & Self-Regulation

Handwriting & School Participation — Detail

Risk & Safety

Caregiver Priorities (COPM micro-scoring)

Goal Attainment Scaling (GAS)

Therapist Clinical Observations (during OT session)

Assistive Technology & Environmental Supports

OT Summary & Plan

Section 3: Speech & Language

Section 4: Behavioral

Section 5: Special Education

Section 6: Vocational

Section 7: Sign and Submit

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