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Your Role

Professional Professional and Parent Parent Other Relation
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About You

Mr Mrs Miss Mx Dr Prof Other
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 Male Female Not Specified
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 Antrim Armagh Carlow Cavan Clare Cork Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Londonderry/Derry Longford Louth Mayo Meath Monaghan Offaly OTHER Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow
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About your profession

Behaviour Therapist Classroom Assistant Education Professional Education Psychologist HSE (Primary Care + Disability Staff Only) Occupational Therapist Physiotherapist Speech and Language Therapist Teacher Teaching Assistant Other
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Nursery/Play/Pre School Mainstream Primary Special Education Setting/Autism Class Post Primary Further/Higher/Technical Educational Setting University Home Schooled None Other
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ROI School Maintained (NI) Controlled (NI) Integrated (NI) Irish Medium (NI)
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About the Child/Children you are related to that have autism

Male Female Not Specified
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Date of birth
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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January February March April May June July August September October November December
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1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
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1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
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 Nursery/Play/Pre School Mainstream Primary Special Education Setting/Autism Class Post Primary Further/Higher/Technical Educational Setting University Home Schooled None Other
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Autism ASD Asperger syndrome ASC PDA Awaiting Diagnosis Other

Which are the main areas currently affected by autism?

Anxiety Attention Behaviour Communication Daily Living Skills Family Life Interests and Hobbies Learning People and Places Physical Activity/Motor Skills School Attendance Sensory Processing Sleep Socialising and Play Transitions Between Activities

Diagnosed co-occurring conditions?

Anxiety Disorder Attention-deficit Hyperactivity Disorder (ADHD) Cerebral Palsy Developmental Coordination Disorder (DCD) Down Syndrome Dyslexia Dyspraxia Obsessive-compulsive Disorder (OCD) Oppositional Defiance Disorder (ODD)
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