AQ-10 Adult Aviva - Onebright

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AQ-10 (Adult) Aviva

A quick referral guide for adults (16+) with suspected autism who do 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).

Have you previously been assessed for autism and/or received a diagnosis?(Required)

Yes

No

I often notice small sounds when others do not(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I usually concentrate 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

I find it easy to do more than one thing at once(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

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

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I find it easy to 'read between the lines' when someone is talking to me(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I know how to tell if someone listening to me is getting bored(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

When I'm reading a story I find it difficult to work out the characters' intentions(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant etc)(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I find it easy to work out what someone is thinking or feeling just by looking at their face(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I find it difficult to work out people's intentions(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

I experience tics (rapid muscle movements or vocal sounds that are repeated and difficult to control)(Required)

Never

Occasionally

Often

Please tick one option per question only

Email

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