Autism Spectrum Disorder Diagnosis Survey
Remember, your contact information is not required
Name
Email
Contact Number
Who in your family is on the Spectrum? *
Required
Where was the diagnosis administered? *
Which professional conducted the diagnosis? *
On a scale of 1-5, how would you rate your comfort level during diagnosis? *
Uncomfortable
Confidently Comfortable
On a scale of 1-5, how would you rate your understanding of ASD during the time of diagnosis? *
If you answered "5 - Expert Knowledge" in the question above, detail how. Ex: "I am a child therapist" or "SPED teacher"
After you received your diagnosis, were "Next Steps" offered for treatment? *
If answered, "Yes" in the question above, detail what your options were.
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". *
Captionless Image
In addition to the diagnosis paperwork received, would you have preferred scientific data? *
Are you familiar with a Brain Scan? *
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? *
Sample Brain Scan
Do you have any questions about brain scans? If so, please ask your question below.
Are you familiar with a biosensor? *
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? *
Do you have any questions about biosensors? If so, please ask your question below.
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? *
Captionless Image
Have these questions provoked you to have follow up question(s)? If so, please ask your question below.
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms