AQ-10 Child Aviva - Onebright

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AQ-10 (Child) Aviva

A quick referral guide for parents to complete about a child aged 4-11 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 often notices small sounds when others do not(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

S/he finds it easy to go back and forth between different activities(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

S/he doesn't know how to keep a conversation going with her/his peers(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 is read a story, s/he finds it difficult to work out the character's intentions or feelings(Required)

Definitely agree

Slightly agree

Slightly disagree

Definitely disagree

Please tick one option per question only

When s/he was in preschool, 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 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

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

Phone

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

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