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(Required) Name & date of birth or client ID/reference numberDo 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).S/he notices patterns in things all the time(Required) Definitely agree Slightly agree Slightly disagree Definitely disagree Please tick one option per question onlyS/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 onlyIn 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 onlyIf 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 onlyS/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 onlyS/he is good at social chit-chat(Required) Definitely agree Slightly agree Slightly disagree Definitely disagree Please tick one option per question onlyWhen 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 onlyS/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 onlyS/he finds social situations easy(Required) Definitely agree Slightly agree Slightly disagree Definitely disagree Please tick one option per question onlyS/he finds it hard to make new friends(Required) Definitely agree Slightly agree Slightly disagree Definitely disagree Please tick one option per question onlyS/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
