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(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 often notices small sounds when others do not(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 onlyS/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 onlyS/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 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 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 onlyWhen 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 onlyS/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 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
