Wooster College Research

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Dear Friend of ASO;

Information on another research survey follows my signature. FYI - please share.

Sincerely,

Barbara C. YavorcikPresidentAutism Society of Ohio701 S. Main St.Akron, OH 44311(330) 376-0211fax: (330) 376-1226email: askASO@...home: byavorcik@...web: www.autismohio.org Please note: This is provided for information purposes only. The ASO does not endorse or recommend any providers, methodologies or services. Providing this information should not be construed as an endorsement by the ASO, either explicit or impiled.

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Dear Survey Participant,I'd like to thank you in advance for helping me with this research study. In order for you to return the survey to me anonymously, I have created an e-mail account for you to use. Simply go to http://www.hotmail.com and use the following account:Username/e-mail address: issurvey05@...Password: autism05Send the filled out survey to cgalloway@....Thank you again for your time.Sincerely,Caitlin Galloway

Hello, my name is Caitlin Galloway, and I am a student at The College of Wooster. I am conducting a research study to better understand the nature of autism and its therapy techniques. Please note that by completing the following questionnaire, you are allowing your answers to be analyzed. All answers will be kept confidential and anonymous. You have the right to discontinue participation in this study without any consequences. If you have any questions, please contact me at cgalloway@..., or my advisor, Dr. Pamela at pmitchell@..., (330) 263-2031.

Answer the following questions by selecting the most appropriate answer:

1. Are you over 18 years old: Yes No

2. What is your gender: M F

3. What is your relationship to the child: Parent

Grandparent

Aunt/Uncle

Other (specify): __________________

4. How is the child: _____________

5. What age was the child diagnosed: _____________

6. What therapy techniques have you utilized: (check all that apply)

Floor Time (Greenspan Approach)

Discrete Trials (Lovaas Method)

Delacto Method

Speech-Language Therapy

Occupational Therapy

Music Therapy

Sensory Integration Therapy

Other (please specify): _________________________________

7. How long have you been using the above technique/s: _______________

8. What changes in your child do you believe are mostly due to therapy (check all that apply):

______ Ability to maintain attention

______ Improvement in social skills

______ Ability to establish a routine

______ Ability to control environment

______ Ability to communicate effectively

______ Other __________________________________________________________

9. What changes in your child do you believe are mostly due to your efforts with your child:

______ Ability to maintain attention

______ Improvement in social skills

______ Ability to establish a routine

______ Ability to control environment

______ Ability to communicate effectively

______ Other __________________________________________________________

10. What changes in your child do you believe would have happened as much as they have to date without your specific efforts or therapy:

______ Ability to maintain attention

______ Improvement in social skills

______ Ability to establish a routine

______ Ability to control environment

______ Ability to communicate effectively

______ Other __________________________________________________________

11. Overall, which do you feel has had the greatest impact on your child’s development (please rank from 1-3; 1 having the most impact and 3 having the least impact):

______ Therapy

______ Your interactions

______ Natural development

Please rank the extent to which these have carried over (the child takes what s/he has learned in the therapy setting into his/her everyday life)

0= no carry over, 5=constant carry over:

12. Ability to maintain attention:

0 1 2 3 4 5

13. Improvement in social skills

0 1 2 3 4 5

14. Ability to establish a routine

0 1 2 3 4 5

15. Ability to control environment

0 1 2 3 4 5

16. Ability to communicate effectively

0 1 2 3 4 5

Please rank the following environmental factors 1 being that which grabs the child’s attention quickest and holds it the longest, and 5 being that which does so the least:

______ Light

______ Visual Motion

______ Movement

______ Music

______ Touch

______ Human Voice

______ Other Sounds (please lists examples): _________________________

_________________________

_________________________

_________________________

Thank you for your time!