Anxiety and ASD
Geneva Centre for Autism Parent Online Training Registration Form
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Phone Number
(000) 000-0000
Format: (000) 000-0000.
Your Child's Name
First Name
Last Name
Your Child's Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Your Postal Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which date/time are you planning to attend the free chat and learn with a BCBA:
Please Select
June 21: 9:30 am to 10:30 am
June 29: 12 pm to 1 pm
What are the triggers (causes) of your child's/teen's anxiety:
Difficult tasks/demands
Unfamiliar environment
Social situations
Lack of structure
Feeling tired/ill
Other
If you select other, please describe
Which strategies described in the video would you like to hear more information about during the live session (select all that apply):
How to alter the physical environments
First-then board
Schedules
Improving curriculum and activities
Social Stories
Sensory strategies
Increasing choice
Priming
Selecting replacement skills
Reinforcement
Tolerance training
Exposure
3 R's (record, rationalize, replace)
Extinction burst
Five-point scale
Please complete the table below and select the strategies you are familiar with, any success you've had, and which strategies you would like more information about.
Rows
Have used strategy
Successful/effective strategy
Would like more information
How to alter the physical environments
First-then board
Schedules
Improving curriculum and activities
Social Stories
Sensory strategies
Increasing choice
Priming
Selecting replacement skills
Reinforcement
Tolerance training
Exposure
3 R's (record, rationalize, replace)
Extinction burst
Five-point scale
How are you and/or your child currently managing their anxiety?
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