Autism Survey
This survey is for purposes of determining characteristics standard to autism, and should be completed by people on the autistic spectrum only, whether diagnosed or not. Neurotypical parents and professionals, do not take this survey. Click here for the neurotypical perspective survey. The purpose of this particular survey is not to find out your perceptions of your autistic child/patient's condition, but to determine how autism is seen through the eyes of the autistic.
The following questions are a general survey of traits that are commonly considered to be indicative of autism. Please answer these questions as briefly as possible. However, keeping in mind that pat answers are often not entirely applicable, text input has been provided to allow for explanation of the answer if you feel there is a need for it.
All radio () button choices are required. Just give the closest answer you can or "No" if you really just don't know. All other required fields are marked as such.
A Note to Curmudgeons: If you have the need to make a snide, cynical or sarcastic remark, feel free, but please identify it as such. :-) |
Classification (for statistical purposes only) |
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There is some debate on whether Asperger's is autism or a derivitive thereof, and also whether LFA or HFA are even valid diagnoses. Therefore, for purposes of general classification, please state your "degree" of autism. |
Low-Functioning Autistic (LFA)
High-Functioning Autistic (HFA)
Asperger's Syndrome (AS)
Autistic Spectrum Disorder (ASD)
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
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If LFA or HFA, please explain this conclusion briefly: |
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Have you been diagnosed by a professional? |
Yes
No
If no, explain: |
Please state the year of your birth (required): |
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Please state your gender: |
Female
Male
Other (AIS or Hermaphroditic) |
Autism/Asperger's (Based on "Asperger's Syndrome Characteristics" by Roger Meyer)
(I) Social Characteristics |
(a) Difficulty in accepting criticism or correction: |
Significant
Moderate
Mild
No
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(b) Difficulty in offering correction or criticism without appearing harsh, pedantic or insensitive |
Significant
Moderate
Mild
No
|
(c) Difficulty in perceiving and applying unwritten social rules or protocols |
Significant
Moderate
Mild
No
|
(d) "Immature" manners |
Significant
Moderate
Mild
No
|
(e) Failure to distinguish between private and public personal care habits: i.e., brushing, public attention to skin problems, nose picking, teeth picking, ear canal cleaning, clothing arrangement |
Significant
Moderate
Mild
No
|
(f) Naïve trust in others |
Significant
Moderate
Mild
No
|
(g) Shyness |
Significant
Moderate
Mild
No
|
(h) Low or no conversational participation in group meetings or conferences |
Significant
Moderate
Mild
No
|
(i) Constant anxiety about performance and acceptance, despite recognition and commendation |
Significant
Moderate
Mild
No
|
(j) Scrupulous honesty, often expressed in an apparently disarming or inappropriate manner or setting |
Significant
Moderate
Mild
No
|
(k) Bluntness in emotional expression |
Significant
Moderate
Mild
No
|
(l) "Flat effect" (appears unemotional to others) |
Significant
Moderate
Mild
No
|
(m) Discomfort manipulating or "playing games" with others |
Significant
Moderate
Mild
No
|
(n) Unmodulated reaction in being manipulated, patronized, or "handled" by others |
Significant
Moderate
Mild
No
|
(o) Low to medium level of paranoia |
Significant
Moderate
Mild
No
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(p) Low to no apparent sense of humor; bizarre sense of humor (often stemming from a "private" internal thread of humor being inserted in public conversation without preparation or warming others up to the reason for the "punchline") |
Significant
Moderate
Mild
No
|
(q) Difficulty with reciprocal displays of pleasantries and greetings |
Significant
Moderate
Mild
No
|
(r) Problems expressing empathy or comfort to/with others: sadness, condolence, congratulations, etc. |
Significant
Moderate
Mild
No
|
(s) Pouting, ruminating, fixating on bad experiences with people or events for an inordinate length of time |
Significant
Moderate
Mild
No
|
(t) Difficulty with adopting a social mask to obscure real feelings, moods, reactions |
Significant
Moderate
Mild
No
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(u) Using social masks inappropriately (you are "x" while everyone else is "y"?) (ex.: "friend" mask at work, etc.) |
Significant
Moderate
Mild
No
|
(v) Abrupt and strong expression of likes and dislikes |
Significant
Moderate
Mild
No
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(w) Rigid adherence to rules and social conventions where flexibility is desirable |
Significant
Moderate
Mild
No
|
(x) Apparent absence of relaxation, recreational, or "time out" activities |
Significant
Moderate
Mild
No
|
(y) "Serious" all the time |
Significant
Moderate
Mild
No
|
(z) Known for single-mindedness |
Significant
Moderate
Mild
No
|
(aa) Flash temper |
Significant
Moderate
Mild
No
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(bb) Tantrums |
Significant
Moderate
Mild
No
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(cc) Excessive talk |
Significant
Moderate
Mild
No
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(dd) Difficulty in forming friendships and intimate relationships; difficulty in distinguishing between acquaintance and friendship |
Significant
Moderate
Mild
No
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(ee) Social isolation and intense concern for privacy |
Significant
Moderate
Mild
No
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(ff) Limited clothing preference; discomfort with formal attire or uniforms |
Significant
Moderate
Mild
No
|
(gg) Preference for bland or bare environments in living arrangements |
Significant
Moderate
Mild
No
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(hh) Difficulty judging others' personal space |
Significant
Moderate
Mild
No
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(ii) Limited by intensely pursued interests |
Significant
Moderate
Mild
No
|
(jj) Often perceived as "being in their own world" |
Significant
Moderate
Mild
No
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(II) Physical Manifestations |
(a) Balance difficulties |
Significant
Moderate
Mild
No
|
(b) Difficulty in judging distances, height, depth |
Significant
Moderate
Mild
No
|
(c) Difficulty in recognizing others' faces (prosopagnosia) |
Significant
Moderate
Mild
No
|
(d) Self-injurious or disfiguring behaviors |
Significant
Moderate
Mild
No
|
(e) Nail-biting |
Significant
Moderate
Mild
No
|
(f) Unusual gait, stance, posture |
Significant
Moderate
Mild
No
|
(g) Low apparent sexual interest |
Significant
Moderate
Mild
No
|
(h) Sleep difficulties |
Significant
Moderate
Mild
No
|
(i) Verbosity |
Significant
Moderate
Mild
No
|
(j) Difficulty expressing anger (excessive or "bottled up") |
Significant
Moderate
Mild
No
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(k) Flat or monotone vocal expression; limited range of inflection
| Significant
Moderate
Mild
No
|
(l) Elevated voice volume during periods of stress and frustration |
Significant
Moderate
Mild
No
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(m) Strong food preferences and aversions |
Significant
Moderate
Mild
No
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(n) Unusual and rigidly adhered to eating behaviors |
Significant
Moderate
Mild
No
|
(o) Bad or unusual personal hygiene |
Significant
Moderate
Mild
No
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