AQ-10 Adolescent Aviva - Onebright

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AQ-10 (Adolescent) Aviva

A quick referral guide for parents to complete about a teenager aged 12-15 years old with suspected autism who does not have a learning disability.

Client ID/Reference Number(Required)

Do you have any immediate concerns around the safety of yourself or the person you are completing this form on behalf of?(Required)

Yes

No

If you have answered ‘Yes’ to this question, please note that Onebright does not provide a crisis response service. If you have urgent wellbeing concerns please contact your GP, GP out of hours service, NHS 111, 999, or the Samaritans on 116 123 (UK & ROI).

Has your child previously been assessed for autism and/or received a diagnosis?(Required)

Yes

No

S/he notices patterns in things all the time(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he usually concentrates more on the whole picture, rather than the small details(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

In a social group, s/he can easily keep track of several different people's conversations(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

If there is an interruption, s/he can switch back to what s/he was doing very quickly(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he frequently finds that s/he doesn't know how to keep a conversation going(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he is good at social chit-chat(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

When s/he was younger, s/he used to enjoy playing games involving pretending with other children(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he finds it difficult to imagine what it would be like to be someone else(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he finds social situations easy(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he finds it hard to make new friends(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he experiences tics (rapid muscle movements or vocal sounds that are repeated and difficult to control)(Required)

Never

Occassionally

Often

Please tick one option per question only

Name

This field is for validation purposes and should be left unchanged.

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