Parent Questionnaire - Autistic Spectrum Disorder / Autism and Secondary School Experience


These questions are about your child, their abilities, their Autism or ASD and their schooling.







Please only answer if you are the parent of a student in secondary school with a diagnosis of Autism / ASD living in the Republic of Ireland.


Any queries or questions contact Katie Cremin: cremink@tcd.ie or 0878161845

Geographic area
Your child' s date of birth
Your answer
Gender of your child
Your child's age at diagnosis
Your answer
Any co-occuring diagnosis?
Do you have a recent psychological assessment for your child?
if yes - can you provide some detail such as level of intellectual ability or IQ?
Your answer
How well can your child carry out a conversation?
please choose one option
How often would your child join in group activities without being told?
please choose one option
Would your child make friends easily?
please choose one option
How often would your child seem confident in social situations / parties or groups ?
please choose one option
Can your child dress him or herself completely?
please choose one option
How well can your child tell the time on a clock with hands?
please choose one option
How well can your child read and understand common signs, like STOP, MEN, WOMEN, or DANGER ?
please choose one option
How well can your child get to places outside the home, like to a nearby shops or park, or to a neighbors house?
please choose one option
How would you describe your child's schooling?
Does your child spend any part of the day in
Does your child have an SNA
Does your child have an IEP (Individualised Educational Plan)
Is school transport / bus provided for your child?
Has your child ever missed secondary school for a period longer than two weeks?
please provide details below
Your answer
Has your child experienced different school placements since they entered secondary school?
please provide details below
Your answer
Has your child ever had a behaviour support plan tailored to their individual needs?
please provide details below
Your answer
Does your child participate in extracurricular activities in the school setting?
please provide details below
Your answer
Does your child participate in extracurricular activities outside of the school setting?
please provide details below
Your answer
How has your child settled in secondary school
How well would you say your child gets along with other students at the school?
How well would you say your child gets along with teachers at the school?
Think about your child's experience at secondary school this year. How would you agree with the following statements.
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
School is challenging
He / she enjoys school
There is an adult at the school who knows him/her and cares about him / her
The school is good at meeting his / her individual needs
He / she is getting the support services from the school the he/ she needs to do well in school
Does your child attend a service for children with ASD
Do they receive support in secondary school from this service? (if yes to previous question)
These questions have been included as a measure of ASD in children and youth.
Please answer each question by clicking yes or no. A few questions ask about several related types of behavior: Please tick yes if any of these behaviors have ever been present. Although you may be uncertain about whether some behaviours were ever present or not, please answer yes or no to every question on the basis of what you think.
yes
no
1. Is she/he now able to talk using short phrases or sentences?
2. Can you have a to and fro “conversation” with her/him that involves taking turns or building on what you have said?
3. Has she/he ever used odd phrases or said the same thing over and over in almost exactly the same way (either phrases that she/he has heard other people use or ones that she/he has made up)?
4. Has she/he ever used socially inappropriate questions or statements? For example, has she/he ever regularly asked personal questions or made personal comments at awkward times?
5. Has she/he ever got his/her pronouns mixed up (e.g., saying you or she/he for I)?
6. Has she/he ever used words that she/he seemed to have invented or made up her/himself; put things in odd, indirect ways; or used metaphorical ways of saying things (e.g., saying hot rain for steam)?
7. Has she/he ever said the same thing over and over in exactly the same way or insisted that you say the same thing over and over again?
8. Has she/he ever had things that she/he seemed to have to do in a very particular way or order or rituals that she/he insisted that you go through?
9. Has her/his facial expressions usually seemed appropriate to the particular situation, as far as you could tell?
10. Has she/he ever used your hand like a tool or as if it were part of her/his own body (e.g., pointing with your finger, putting your hand on a doorknob to get you to open the door)?
11. Has she/he ever had any interests that preoccupy her/him and might seem odd to other people (e.g., traffic lights, drainpipes, or timetables)?
12. Has she/he ever seemed to be more interested in parts of a toy or an object (e.g., spinning the wheels of a car), rather than using the object as it was intended?
13. Has she/he ever had any special interests that were unusual in their intensity but otherwise appropriate for her/his age and peer group (e.g., trains, dinosaurs)?
14. Has she/he ever seemed to be unusually interested in the sight, feel, sound, taste, or smell of things or people?
15. Has she/he ever had any mannerisms or odd ways of moving her/his hands or fingers, such as flapping or moving her/his fingers in front of her/his eyes?
16. Has she/he ever had any complicated movements of her/his whole body, such as spinning or repeatedly bouncing up and down?
17. Has she/he ever injured her/himself deliberately, such as by biting her/his arm or banging her/his head?
18. Has she/he ever had any objects (other than a soft toy or comfort blanket) that she/he had to carry around?
19. Does she/he have any particular friends or a best friend?
part 2
For the following behaviors, please focus on the time period between your child’s fourth and fifth birthdays. You may find it easier to remember how things were at that time by focusing on key events, such as starting school, moving house, Christmas time, or other specific events that are particularly memorable for you as a family. If your child is not yet 4 years old, please consider her or his behavior in the past 12 months.
yes
no
20. When she/he was 4 to 5, did she/he ever talk with you just to be friendly (rather than to get something)?
21. When she/he was 4 to 5, did she/he ever spontaneously copy you (or other people) or what you were doing (such as vacuuming, gardening, or mending things)?
22. When she/he was 4 to 5, did she/he ever spontaneously point at things around her/him just to show you things (not because she/he wanted them)?
23. When she/he was 4 to 5, did she/he ever use gestures, other than pointing or pulling your hand, to let you know what she/he wanted?
24. When she/he was 4 to 5, did she/he not her/his head to mean yes?
25. When she/he was 4 to 5, did she/he shake her/his head to mean no?
26. When she/he was 4 to 5, did she/he usually look at you directly in the face when doing things with you or talking with you?
27. When she/he was 4 to 5, did she/he smile back if someone smiled at her/him?
28. When she/he was 4 to 5, did she/he ever show you things that interested her/him to engage your attention?
29. When she/he was 4 to 5, did she/he ever offer to share things other than food with you?
30. When she/he was 4 to 5, did she/he ever seem to want you to join in her/his enjoyment of something?
31. When she/he was 4 to 5, did she/he ever try to comfort you if you were sad or hurt?
32. When she/he was 4 to 5, when she/he wanted something or wanted help, did she/he look at you and use gestures with sounds or words to get your attention?
32. When she/he was 4 to 5, when she/he wanted something or wanted help, did she/he look at you and use gestures with sounds or words to get your attention?
33. When she/he was 4 to 5, did she/he show a normal range of facial expressions?
34. When she/he was 4 to 5, did she/he ever spontaneously join in and try to copy the actions in social games, such as The Mulberry Bush or London Bridge is Falling Down?
35. When she/he was 4 to 5, did she/he play any pretend or make-believe games?
36. When she/he was 4 to 5, did she/he seem interested in other children of approximately the same age whom she/he did not know?
37. When she/he was 4 to 5, did she/he respond positively when another child approached her/him?
38. When she/he was 4 to 5, if you came into a room and started talking to her/him without calling her/his name, did she/he usually look up and pay attention to you?
39. When she/he was 4 to 5, did she/he ever play imaginative games with another child in such a way that you could tell that they each understood what the other was pretending?
40. When she/he was 4 to 5, did she/he play cooperatively in games that required joining in with a group of other children, such as hide-and-seek or ball games?
I would like to send your son / daughter's teacher a questionnaire in relation to social competence and behaviour in school. Please provide contact details of your chosen teacher / school personnel to whom I can send this questionnaire and details of the study. Alternatively please include your own contact details if you would like to give the documents to the teacher yourself
please complete contact details below. (please include your child's name so as I can identify then them to the school)
Your answer
The follow up to this study will look at engagement and satisfaction with the secondary school experience. Please provide your contact details below if you would like to be contacted in relation to this phase of the study.
please complete contact details below.
Your answer
Please provide an e-mail address (if you have one or not already given above), so that I can contact you in relation to this study. *note: contact details will be stored separately to questionnaires in order to retain anonymity.
Your answer
Consent
I consent to taking part in this research project. I understand that agreeing to take part means that I am willing to: 1. Complete the Social Communication Questionnaires about my child. 2. Provide information about my child and their school. 3. Give permission for my child’s teacher to be contacted to complete a questionnaire about my child. 4. Give my contact details. 5. Allow the information gathered to be used anonymously in the research project which may be published in a journal or at a conference. 6. Be contacted in the future if my information is wanted for further research. I understand that no personally identifiable information will be included in the research reports. Personally identifiably information will not be published or disclosed to anyone outside the study. All information will be stored in locked filing cabinet or as encrypted files on password protected computers. If I wish to access my information at any stage, it will be made available to me. I have the right to access my personal data at any time under the Freedom of Information Act (1997). The information I provide will be stored at Trinity College Dublin for a period of 10 years. I may request access to my information at any time of the study or at any point during the 10 year period. If information emerges that raises a serious concern for the safety or well-being of any individual, the researcher will be required to report this through the appropriate channels. I understand that there is a risk that I could become upset by the issues raised during the research project and the researchers will provide support or find the relevant support for me in this instance. I understand that I can withdraw from the study if I want to. I may also request any data pertaining to me or my child be removed from the study prior to the point of analysis and submission of the research report or publication (i.e. September 2016).
Please fill your name if you consent to take part in the research project
Your answer
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