Does my child have Aspergers?

The following questionnaire is based on 32 questions which will be analysed by a qualified Child Psychotherapist. The evaluation will include the severity of any difficulty, if any, and advice on how to proceed with regard to your child's difficulty.


1. Age of child









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2. How long have you been concerned that your child may have a difficulty?






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3. Have there been any significant family changes, bereavements, traumas in the child's lifetime?


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4. Are there any other members of your immediate or extended family who have diagnosis or autism or aspergers?


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5. At what age did your child say their first word?

A value is required.


6. At what age did you child say their first phrase?

A value is required.


7. Has the course of language development run smoothly or did they lose language skills at any point?

A value is required.


8. Do you believe your child's language skills to be roughly right for their age?



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9. Do you believe your child's academic and intellectual skills to be roughly right for their age?



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10. Does your child have any difficulty making eye contact?



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11. Does your child show empathy for others when they are showing strong emotions of pain, frustration, etc?

A value is required.


12. Does your child show their emotions on their face, are they expressive?

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13. Does your child have difficulty making friends or interacting with others of the same age?

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14. How well does your child react to change?





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15. Does your child look to your for approval or encouragement when carrying out a difficult task?

A value is required.


16. Does your child seek to gain your attention and ask you to join in their play?

A value is required.


17. Does your child engage in creative or imaginative play, i.e. making up stories or acting out situations with figures?

A value is required.


18. Does you child become overly-absorbed with one specific type of play or sequence?

A value is required.


19. Does your child have any of the following? (please tick all that apply)




20. Does your child have any habits which might be thought of as odd?



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21. Are the symptoms which lead you to worry about your child consistently present or intermittent?



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22. Has anyone outside the family voiced concerns or noticed similar symptoms?





23. Is the child equally symptomatic with any carer?





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24. Does your child have any recurrent physical symptoms which do not have a known medical cause?

A value is required.


25. Does your child refuse to go to school or another environment which requires separation from parents?

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26. On a scale of 1-10 how disruptive are your child's difficulties to the child's daily life?


27. On a scale of 1-10 how disruptive are these difficulties to the parent's daily life?


28. How would you rate the parents' own anxiety levels with regard to your child's difficulty on a scale of 1-10?


29. How would you rate the frustration levels of the parents during phobic situations? on a scale of 1-10?


30. How would you describe your child's general temperament in general? (please tick all that apply)








31. What do you think underlies your child's difficulty? (please tick all that apply)









32. How do you feel about your child's difficulties? (please tick all that apply)







32. Please give a brief statement (up to 100 words) of any other information you feel is relevant to your child's difficulties.



A value is required.

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After submitting your Assessment you will be asked to make your payment of £50 to Ask A Child Therapist through Paypal.


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