SRS 2 Template
SRS 2 Template
Date:
The Social Responsiveness Scale-2nd Edition (SRS-2) is a behavior questionnaire that covers the
various dimensions of interpersonal behavior, communication, and repetitive/stereotypic
behavior that are characteristic of autism spectrum disorders. The SRS-2 questionnaire was
completed by (raters) based on his/her observations and interactions with Student.
The SRS-2 examines several areas including social awareness, social cognition, social
communication, social motivation, and restricted interests and repetitive behaviors. The SRS-2
also provides a Total Score, which is a comprehensive or overall social responsiveness rating.
Scores in the mild range indicate mild to moderate interference in everyday social interactions.
Scores in the moderate range indicate deficiencies in reciprocal social behavior that lead to
substantial interference with everyday social interactions. A rating in the severe range suggests a
severe interference in everyday social interactions. Scores that are within normal limits are
generally not associated with clinically significant autism spectrum disorders.
Social Awareness is the ability to pick up on social cues. Responses from parents and teachers
indicated (describe results from raters.)
Social Cognition is the ability to interpret social cues once they are picked up. Responses from
parents and teachers indicated (describe results from raters.)
Social Communication includes expressive social communication and represents the motoric
aspects of reciprocal social behavior. Responses from parents and teachers indicated (describe
results from raters.)
Social Motivation is the extent to which an individual is generally motivated to engage in social-
interpersonal behavior. This scale also takes into account social anxiety, inhibition, and empathic
orientation. Responses from parents and teachers indicated (describe results from raters.)
Restricted Interests and Repetitive Behavior includes stereotypical behaviors or highly restricted
interests that are characteristic of autism. Responses from parents and teachers indicated
(describe results from raters.)
The overall SRS Total Scores of (insert Total Scores) for (Rater 1, Rater 2, etc.) are in the
severe/moderate/mild range, which suggests severe/substantial/mild to moderate interference in
every day social interactions. Scores in this range are/are not associated with clinical diagnoses
of autism spectrum disorder.
Differences between parent ratings and teacher ratings suggest that (Student) demonstrates
greater social impairments in his/her home/school environment whereas significant social
impairments associated with autism are not reported in the home/school environment.
OR
Similarities across parent ratings and teacher ratings indicate that (Student) demonstrates a
consistent degree of social impairments across environments.