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Page 8 of 21 Persico et al. Rare Dis Orphan Drugs J 2023;2:xx https://dx.doi.org/10.20517/rdodj.2023.08

Table 3. Visual Analog Scales (VAS) used to assess core autism symptoms based on DSM-5 criteria for Autism Spectrum
Disorder [36] , and additional behaviors of clinical relevance. Each item ranges from 0 (symptom absent) to 10 (extreme severity)

ITEMS DEFINITION
Socio-emotional skills Deficits in socio-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal
back-and-forth conversation, to reduced sharing of interests, emotions, or affect, to failure to initiate or respond to
social interactions
Non-verbal Deficits in nonverbal communication behaviors used for social interaction, ranging from poorly integrated verbal and
communication behaviors nonverbal communication to abnormalities in eye contact and body language or deficits in understanding and use of
gestures
Verbal communication Deficits in expressive language and verbal communication behaviors used for social interaction
behaviors
- expressive language
Verbal communicative Deficits in receptive language and verbal communication behaviors used for social interaction
behaviors
- receptive language
Theory of mind Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting
behavior to suit various social contexts, to difficulties in sharing imaginative play or in making friends, to absence of
interest in peers
Stereotyped or repetitive Stereotyped or repetitive motor movements, use of objects, or speech
motor movements
Sameness Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
Restricted interests Highly restricted, fixated interests that are abnormal in intensity and/or focus
Hold an object in hand Strong attachment or concern for objects which are often held in the hand for a long time or continuously
Sensory issues Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
Imitation Deficit of imitation with objects and/or imitation of actions and/or verbal imitation.
Play Quality of spontaneous play (i.e., functional/imitation play, symbolic/representational play)
Fine-motor skills Motor control deficits in small movements of the
hands and fingers, as well as in small muscles of the face and mouth (tongue)
Gross-motor skills Motor control deficits in global movements, such as
pushing and manipulating large objects, rolling around, climbing, and jumping.
Joint attention Lack of ability to coordinate attention with another person, i.e., you point at an object and see if the child looks in
that direction and then turns his/her gaze back towards you.
Enjoyment in shared play Lack of participation in play activities with others, employing exchanges of glances and smiles.

B. Social Responsiveness Scale (SRS) , a 65-item questionnaire used to assess social impairment,
[46]
communication deficits, and repetitive behaviors in children and adolescents 4-18 years old. Autism is
severe, moderate, or mild when T-scores are > 75, 66-75, or 60-65, respectively. Scores < 60 are not clinically
significant.

[47]
C. Repetitive Behaviors Scale - Revised (RBS-R) , a 44-item parental questionnaire used to assess repetitive
behaviors in children 6-17 years old. Each behavior is rated on a 0-3 point scale to measure increasing
symptom severity, as does the overall global score ranging from 0-100.

D. Aberrant Behaviour Checklist (ABC) , a 58-item parental questionnaire used to assess problem
[48]
behaviors rated on a 0-3 point scale to measure increasing severity.

E. Short Sensory Profile (SSP) , a 38-item parental questionnaire assessing sensory processing, sensory
[49]
modulation, and behavioral/emotional responses. The overall score ranges from 0 to 190, with lower scores
reflecting greater symptom severity.