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Parent questionnaire · child / teenager
ASD / Asperger Screening Questionnaire for a Child or Teenager
This questionnaire asks you to describe your child’s functioning across several areas: communication, social relationships, routines, interests, sensory processing and development. Whenever possible, think about both their current functioning and what you observed earlier in childhood.
How should you answer? Copy the questions into a document or e-mail and answer underneath each one. To keep the analysis clear and precise, try to remain relatively concise, around four Word pages at most, without worrying if you go slightly over when certain details seem important.
Concrete examples are especially useful. They help show how the characteristic appears in everyday life and make the analysis more precise.
Your answers are personally analyzed by Luc MARTRENCHAR, a clinical psychologist specializing in Autism Spectrum profiles.
Terminology: the expression “Asperger syndrome” remains widely used, but it is no longer a distinct diagnosis in current classifications: it is included within Autism Spectrum Disorder (ASD). This questionnaire is designed to explore the possibility of ASD across its different presentations, not only the profile formerly referred to as Asperger syndrome.
General information and communication
0) How old is your child / teenager?
1) At any point in their life, has your child had difficulty expressing their emotions and/or interests?
2) At any point in their life, has your child had difficulty understanding other people’s non-verbal communication, such as facial expressions or gestures?
3) Can they tell what other people are feeling, even when those people do not talk about it?
4) At any point in their life, has your child had difficulty expressing things non-verbally through gestures or facial expressions?
5) At any point in their life, has your child had difficulty making eye contact with other people?
Social relationships
6) At any point in their life, has your child had difficulty making friends?
7) Do they have friends who are more than casual acquaintances?
18) Does your child find social relationships difficult?
19) Is it easy for them to know when to speak and when to listen?
Repetition, routines and change
8) At any point in their life, has your child made certain movements repeatedly?
9) At any point in their life, did they echo what other people said or imitate exactly what other people did?
10) At any point in their life, has your child had difficulty with change, even small changes, such as taking a different route to school?
11) Do they have, or did they previously have, rituals or routines?
12) Do they like doing things in the same way or talking about the same subjects repeatedly?
13) At any point in their life, have they had one or a few interests to which they devoted themselves very intensely, perhaps to the point of leaving little time for other things?
Sensory differences and interests
14) Is your child very sensitive through certain senses, for example to some lights, smells, noises, clothing textures on the skin or food textures?
15) Is your child unusually insensitive to pain, cold or strong smells?
16) Is your child fascinated by numbers or dates?
17) Are they interested in license plate numbers or other similar kinds of information?
Imagination and coordination
20) At any point in their life, have they been physically clumsy?
21) Do they have a rich imagination?
22) For example, can they easily imagine what the characters in a novel might look like?
Previous assessments and family context
23) Have they ever taken an intelligence test such as the WPPSI, WISC or WAIS?
24) If so, what were the main scores, such as IQ, index scores and subtest scores?
25) To your knowledge, do other members of the family have Asperger syndrome / Autism Spectrum Disorder?
Finished?
Read through your answers once more to make sure they describe your child’s functioning as accurately as possible. You do not need to try to make the answers fit a particular profile.
This questionnaire is not, by itself, a diagnosis. Its purpose is to support an initial, reasoned assessment of how relevant the ASD hypothesis appears.
