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AQ-50

This form will prompt you to provide information designed to measure ASD (Autism Spectrum Disorder) propensity. Thank you for completing this form – Dr Niky D’Hulster
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    AQ-50

    The Adult Autism Spectrum Quotient (AQ)

     

    This test must be completed by the patient, although possibly with the assistance of close relatives. This questionnaires may only be completed by someone else (referred to as an informant) in the exceptional circumstance where the patient is unable to complete a questionnaire.

    The test consists of a list of 50 statements. Please read each statement carefully and rate how strongly you agree or disagree with it by clicking the relevant option. There are no right or wrong answers, or trick questions.

    Credit

    The test was developed by Simon Baron-Cohen and colleagues at the University of Cambridge.

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    Please indicate the patient's names. These names should match those indicated in the Administrative Intake.
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    Please enter the email address to which receipt of this completed form can be confirmed.
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    Please indicate if this questionnaire is completed by the patient or by an informant. An informant is someone close who shares the patient's life (typically a parent or spouse/partner).
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    Please indicate why the patient is unable to complete a questionnaire,
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    What is the relationship of the informant with the patient? The informant is the [select below] of the patient. If you select "Other", please complete field with appropriate relationship.
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    Please read each statement carefully and rate how strongly you agree or disagree with it by clicking the relevant option
    1 of 50
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    COMMENTS

     

    In the next field, you may insert precision, clarification or additional information that you have been unable to provide elsewhere in this form, but any other comment is welcome.

     

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    Please feel free to add here any precision, clarification, comment, question or additional information you may have.
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    FINAL STEP

     

    The AQ-50 Test for {name} is now almost ready to be submitted.

    If you want to review your input before submission, please navigate the form with the progress bar situated in the bottom of your browser's window.

    If any red dot appears on the progress bar, please click the dot and complete the corresponding field as appropriate.

    If your form is complete and the progress bar only shows green or grey dots, feel free to click SUBMIT.

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