Autism Survey

This survey is for purposes of determining characteristics standard to autism, and should be completed by people who do not know whether they are autistic only. Neurotypical parents and professionals, and people who are positive they are autistic, do not take this survey. Click here for the neurotypical perspective survey, or here for the autistic perspective survey. The purpose of this particular survey is not to find out whether you are autistic, but to determine how autism is seen through your eyes.

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)

Have you been diagnosed by a professional?

Please state the year of your birth (required):

Please state your gender:

DSM-IV Criteria (Autism and Asperger's combined)

Please use the text boxes for clarification of answers if needed.

(I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction

(B) Failure to develop peer relationships appropriate to developmental level

(C) A lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)

(D) Lack of social or emotional reciprocity

(II) Qualitative impairments in communication, as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) Stereotyped and repetitive use of language or idiosyncratic language

(d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(III) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:

(a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) Apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

(d) Persistent precoccupation with parts of objects

(IV) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

(V) The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

Please explain your difficulties in the following areas.

Sensory Issues

Executive Dysfunction

Executive functions are the higher-order processes that enable us to plan, sequence, initiate, and sustain our behavior towards some goal, incorporating feedback and making adjustments along the way.

Executive functions include, but may not be limited to: