MindWeal Parent ASD Questionnaire

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Welcome to our exploration of ASD (Autism Spectrum Disorder). Your insights are invaluable for us to understand your child's unique journey.

Delving into ASD means uncovering how social, communicative, and behavioral differences uniquely play out for your child. The questions ahead are detailed and might take some time. Your role? Invaluable! You help us see the world through your child's eyes.

Let's team up, decode the intricacies, and champion your child's individual journey with warmth and understanding.

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Today's Date:* This field is required.

Date

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Child's Name:* This field is required.

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Child's Date of Birth:* This field is required.

Date

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Name of Person filling the form: * This field is required.

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Relationship of person filling the form to the child:* This field is required.

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1. Does your child struggle with engaging in the easy, back-and-forth small talk that often happens in social settings?* This field is required.

Yes

No

Not quite sure

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2. In social situations, does your child sometimes say things or ask questions that might seem a bit out of place or unexpected?* This field is required.

Yes

No

Not certain

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3. Does your child tend to take things said in conversation at face value, overlooking the implied or 'between the lines' meanings?* This field is required.

Yes

No

Not quite sure

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4. Every child expresses enthusiasm in their own unique way, and not all may outwardly show what catches their interest. Does your child actively seek to show you things that excite them, such as a new toy or a game they are enjoying?* This field is required.

Yes

No

Not quite sure

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5. Has your child shown a tendency to voluntarily share their possessions, such as toys or food, with you or others?* This field is required.

Yes

No

Not quite sure

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6. Sharing emotions is a unique and varied experience for every child. Does your child show or communicate feelings of happiness or excitement with you or others?* This field is required.

Yes

No

Not quite sure

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7. Children often respond in various ways to others' discomfort or distress, although they may not always recognize or react to these situations. Does your child attempt to offer comfort or assistance when they notice someone feeling unwell or distressed?* This field is required.

Yes

No

Not quite sure

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8. Kids typically vary their actions to align with different environments, though some may not always modify their behavior accordingly. Have you observed your child changing their behavior to suit various social contexts, such as being reserved around strangers or in places like a church?* This field is required.

Yes

No

Not quite sure

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9. Does your child seem to have trouble making friends, not because they're nervous or worried about being judged, but because they either don't seem interested or don't quite grasp how to connect with others?* This field is required.

Yes

No

Not sure

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10. Does your child make eye contact during conversations?* This field is required.

Yes

No

Not quite sure

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11. Sharing glances can create a silent dialogue that deepens bonds during shared activities. Does your child often look to your face for reactions while you're engaged in an activity together?* This field is required.

Yes

No

Not quite sure

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12. In social settings or when meeting new people, does your child use a smile to greet others?* This field is required.

Yes

No

Not quite sure

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13. If someone smiles at your child during social interactions, how does your child typically react?* This field is required.

Returns the smile

Rarely or never smiles back

I am uncertain of their usual response

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14. Does your child regularly use common non-verbal, like waving to say goodbye or putting a finger to our lips for silence, in their interactions?* This field is required.

Yes, they use gestures regularly

No, they seldom use gestures

I am not sure

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15. Just as every child has a unique laugh, the way they show joy, surprise, or concern can also vary. Some kids might not express their feelings in the expected ways, or might have a subtler range of facial expressions. Does your child show a wide range of facial expressions?* This field is required.

Yes, they have a diverse range of expressions

No, their expressions are more subtle or less varied

I'm not sure or it's hard to tell

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16. Do your child’s facial expressions typically mirror their emotions or the context of what they’re communicating?* This field is required.

Yes

No

Not quite sure

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17. It's natural for body language to vary from child to child, especially in new or social situations. Have you noticed your child exhibiting body language that stands out as atypical or awkward when interacting with others?* This field is required.

Yes

No

Not quite sure

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18. Recognizing and making sense of body language and facial expressions is a subtle yet complex skill that not all children master at the same pace. Does your child find it difficult to grasp the body language and facial expressions of others?* This field is required.

Yes

No

Not quite sure

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19. Kids with ASD may not naturally understand personal space and stand too close (in contrast to kids with ADHD who might invade space due to their energy). Does your child understand the concept of personal space, like not standing too close to others?* This field is required.

Yes

No

Not quite sure

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20. Children with ASD might exhibit repetitive behaviors that are quite distinct. Unlike the spontaneous, energetic movements seen in hyperactivity, these can be patterned and persistent, often taking the form of hand flapping or twisting actions near the face. Have you noticed your child engaging in any repetitive behaviors or movements that seem to have a pattern or routine to them?* This field is required.

Yes

No

Not quite sure

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21. Each child has their own style of expressing themselves, and sometimes they come up with their own quirky phrases or sayings. Does your child frequently use phrases or expressions that are unconventional or unique?* This field is required.

Yes

No

Not quite sure

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22. While it's normal for children to echo favorite catchphrases, kids with ASD may repeat phrases or sentences more frequently and repetitively. Does your child often repeat the same phrases or sentences?* This field is required.

Yes

No

Not quite sure

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23. While all kids might repeat words or phrases, children with ASD may show echolalia, repeating what they've heard right away or later. Does your student often echo words or phrases shortly after hearing them or at a later time?* This field is required.

Yes

No

Not quite sure

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24. Each child has their own unique way of speaking, which adds to their individuality. Some speech patterns may suggest ASD. Please check ALL that apply to your student's speech:

Uses a unique tone of voice, like sounding robotic or lecture-like

Doesn't realize when speaking too loudly

Speaks so slowly, quickly, or unevenly that it's challenging to understand.

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25. Children can be creative with language, sometimes making up their own words. This can be part of their individuality or a sign of ASD. Does your child often use words that seem made-up or invented by them?* This field is required.

Yes

No

Not quite sure

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26. Creative descriptions can reflect a child's inventive mind, but in the context of ASD, they may indicate different ways of interpreting the world. Does your child often describe everyday objects or events in an unusual or indirect ways, like calling steam "hot rain"?* This field is required.

Yes

No

Not quite sure

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27. Does your child frequently mix up pronouns, such as using "you" instead of "I" or saying "he" or "she" when referring to themselves?* This field is required.

Yes

No

Not quite sure

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28. Children with ASD can be upset by even small changes in their environment. Does your child gets upset by minor changes in familiar surroundings, like moving furniture in the living room?* This field is required.

Yes

No

Not quite sure

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29. Children with ASD may struggle with small changes to their routines or surroundings. Does your student gets distressed by how their belongings are arranged or slight changes in their daily routine, like switching from long to short sleeves?* This field is required.

Yes

No

Not quite sure

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30. Many children with ASD show a keen interest in order and symmetry, finding comfort in predictable patterns and arrangements. Does your child display any of the following behaviors that suggest a preference for symmetry or specific order? Select ALL that resonate with your child’s behavior:

Always lines up toys in a particular order

Likes to arrange objects symmetrically or in a special sequence

Seems really drawn to patterns that are symmetrical

None of the above

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31. Does your child find it tough to switch between tasks, often becoming really absorbed in completing one thing before moving on to the next? (Remember, this question doesn't cover situations where most children might choose a fun activity over a less enjoyable one, such as picking playtime over chores).* This field is required.

Yes

No

Not quite sure

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32. Has your child ever seemed compelled to do things in a specific order or way? Like they have a set 'routine' or 'ritual' they feel they must stick to?* This field is required.

Yes

No

Not quite sure

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33. Children on the autism spectrum often exhibit remarkably deep and focused interests that may seem too intense. Does your child have any hobbies or interests that stand out due to their unusually intense focus?* This field is required.

Yes

No

Not quite sure

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34. Children with ASD may focus intensely on specific interests that go beyond typical childhood preferences. Does your child have peculiar or unusual interests, like a strong fascination with lights, street signs, toilets, or vacuum cleaners?* This field is required.

Yes

No

Not sure

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35. Children with ASD may become deeply attached to certain items, which give them comfort or a sense of security. These attachments can extend beyond typical objects like a teddy bear or blanket. Is your child strongly attached to an item they often carry, whether it's a common object like a blanket or something unusual like a pipe or a stone?* This field is required.

Yes

No

Not sure

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36. Does your child display heightened sensitivity to noise? In other words, do they react strongly or seem bothered by loud sounds more than other kids?* This field is required.

Yes

No

Not sure

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37. Does your child sometimes become noticeably upset or irritated by specific sounds, like someone coughing or a baby crying?* This field is required.

Yes

No

Not sure

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38. Does your child react strongly to certain aspects of food, like taste, smell, texture, or appearance, and/or engage in rituals related to these aspects?* This field is required.

Yes

No

Not sure

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39. Children on the autism spectrum often exhibit distinct preferences or fascinations due to their heightened sensory awareness. We're exploring the various ways your child may experience the world around them. Select ALL the statements listed below that apply to your child:

Shows an unusual interest in the appearance, feel, sound, taste, or smell of objects or people. For instance, they might sniff toys, objects or people in a way that seems out of the ordinary.

Appears overly concerned with the feel or texture of items they come into contact with.

Displays a noticeable fascination with observing lights or watching objects as they spin.

None of the above

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Total score:

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Current Score Interpretation (Beta version)

Score	Interpretation
0 - 20	ASD not likely
21 - 50	ASD somewhat likely
51 - 126	ASD likely
127 - 162	ASD very likely