Autism Spectrum Disorder Diagnosis Survey
* Required
Remember, your contact information is not required
Name
Your answer
Email
Your answer
Contact Number
Your answer
Who in your family is on the Spectrum?
*
Son
Daughter
Nephew
Neice
Cousin
Mother
Father
Aunt
Uncle
Other
Other:
Required
Where was the diagnosis administered?
*
Your answer
Which professional conducted the diagnosis?
*
Child Psychiatrist
Child Psychologist
Speech and Language Therapist
On a scale of 1-5, how would you rate your comfort level during diagnosis?
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Uncomfortable
1
2
3
4
5
Confidently Comfortable
On a scale of 1-5, how would you rate your understanding of ASD during the time of diagnosis?
*
1 - Never heard of Autism
2 - Beginners Knowledge (heard Autism mentioned briefly)
3 - Competent Knowledge
4 - Advanced Knowledge
5 - Expert Knowledge
Other:
If you answered "5 - Expert Knowledge" in the question above, detail how. Ex: "I am a child therapist" or "SPED teacher"
Your answer
After you received your diagnosis, were "Next Steps" offered for treatment?
*
Yes
No
Other:
If answered, "Yes" in the question above, detail what your options were.
Your answer
Here's where things start to get interesting!
Have you ever looked at your family member and asked, "Goodness! I wish I knew what was going on in there".
*
Yes
No
Maybe
In addition to the diagnosis paperwork received, would you have preferred scientific data?
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Yes
No
Maybe
Are you familiar with a Brain Scan?
*
Yes
What in the world is that?
In case you have never heard of a brain scan...
A brain scan generates images of the brain for the purpose of either measuring activity or shape. The purpose of a scan is to have closer look at the brain and to provide information that will assist in your diagnosis.
In addition to the diagnosis paperwork received, would you have preferred your family member receive a brain scan?
*
Yes
No
Maybe
Sample Brain Scan
Do you have any questions about brain scans? If so, please ask your question below.
Your answer
Are you familiar with a biosensor?
*
Yes
No
Maybe
In case you have never heard of a biosensor...
A biosensor is a device that measures biological or chemical reactions by generating signals proportional to the concentration of an analyte in the reaction.
Simply put, biosensor can work to track the movements, reactions signaling of our brains when someone asks us a question.
In addition to the diagnosis paperwork received, would you have preferred your family member to wear a device to measure brain activity?
*
Yes
No
Maybe
Do you have any questions about biosensors? If so, please ask your question below.
Your answer
Have you ever thought it might be a good idea to have physiological data to best help you make informed decisions on the care of your family member with ASD?
*
Yes
No
Maybe
Have these questions provoked you to have follow up question(s)? If so, please ask your question below.
Your answer
If you would like to be contacted about further research, please scroll up to the top of the page and put in your contact information. You may also leave it below.
Your answer
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