The individual with autism at a '4' is not able to manage many choices or decision-making.
Box '5' represents the crisis or most heightened stage of the individual's anxiety.
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Simply, empty text boxes are placed beside each number (5 point scale of course) on the curve for the author to describe the most important details of each 'level' of anxiety.
This worksheet then can be easily shared not only with teachers, but parents, babysitters, paraprofessionals, substitutes and anyone else who is significant to the individual with autism.