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AUTISM TREATMENT AWARENESS SURVEY

David R. Donnelly

SUNY at Geneseo

This survey is intended to investigate how familiar family members of individuals with Autism Spectrum Disorder (ASD) are with treatment approaches used to treat ASD. In addition, factors that might affect acceptability of treatment approaches in general will be investigated. Results of this survey will hopefully be published, to help better understand individuals with ASD and their families, and to provide effective services to people with ASD. A copy of the results of this survey will be made available on request from the author.

This survey is anonymous; your name will not be associated with your responses in any way. Your voluntary participation is appreciated, and will help us to better understand treatment choice by families of individuals with ASDs. This survey is not an endorsement of any treatment listed, or an indication of the effectiveness of any treatment approach.

Please refer any questions, concerns, or comments to the author:

David R. Donnelly
P.O. Box 92566
Rochester, NY 14620
Email: drdonnelly@juno.com



INSTRUCTIONS:

Please PRINT or DOWNLOAD this survey. This survey can NOT be filled out directly on this web page. When completed please return the survey to the addresses listed above. Thank you for your willingness to increase our knowledge of ASD's.

IF YOU HAVE ALREADY FILLED OUT A COPY OF THIS SURVEY, PLEASE CONSIDER GIVING THIS SURVEY TO SOMEONE YOU KNOW WHO ALSO HAS A FAMILY MEMBER WITH ASD.



AUTISM TREATMENT SURVEY

Parent/Sibling form



CHARACTERISTICS OF INDIVIDUAL WITH ADS:



Age: _______        Sex:    M     F    

Relationship:   Parent   Sibling    Other Relative    Self

Please list any diagnoses which the individuals with ASD may have received:

_______________________________________________________________________________________

_______________________________________________________________________________________


Please CIRCLE your responses:

Cognitive level:   [Severe – Profound MR]   [Mild – Moderate MR]    [Average]   [Above Average]   

Academic level:    [Preschool]    [K-4]    [5-8]    [9-12]    [Undergraduate]     [Graduate]    [Post-graduate]

Vocational (over 21):    [professional/clinical]    [technical/skilled trades]    [general employment]    [supported competitive (enclave)]    [vocational training]    [sheltered workshop]    [day habilitation]    [day treatment]    [currently unemployed, or not participating in any of the above]    [other: _________________________]

Residence:   [with family]    [independent apartment/house]   [supported apartment]    [Individual Residential Alternative (IRA)]   [Community Residence (CR]    
Intermediate Care Facility (ICF):   [ICF less than 15 residents]    [ICF 16-30 residents]   [ICF 31-50 residents]    [ICF 51 -100 residents]   [ICF 101+ residents]    [Skilled Nursing Facility (SNF)]   other:[______________________________]

Location:   [urban]   [suburban]    [rural]   State/district_____________    Country ___________________

FAMILY CHARACTERISTICS:


Number of siblings: _____

Family income:   [below 20K]   [21 - 40K]     [41 - 60K]    [61 - 80K]   [81 - 100K]     [+100K]    [Prefer not to answer]

Do any additional family members have ASD?       Yes      No

Do you or members of your family:

   Have access to the Internet?      Yes   No

   Participate in family/ASD support groups/organizations?       Yes   No

   Work in Human Services occupations?       Yes   No



TREATMENT FAMILIARITY:

How FAMILIAR are you with the following treatment approaches for individuals with ASD?

Please use the following scale for your responses:


Not at all
Vaguely
Somewhat
Familiar
Very
Applied Behavior Analysis:
0
1
2
3
4
   Aversive Conditioning:
0
1
2
3
4
   Discrete Trial Training:
0
1
2
3
4
   Functional Analysis:
0
1
2
3
4
   Functional Communication Training:
0
1
2
3
4
   Incidental Teaching:
0
1
2
3
4
Aerobic Exercise Therapy
0
1
2
3
4
Aromatherapy:
0
1
2
3
4
Auditory Integration Training:
0
1
2
3
4
Cognitive-Behavior Therapy:
0
1
2
3
4
   Visual Imaging:
0
1
2
3
4
Systematic Desensitization:
0
1
2
3
4
Counseling/psychotherapy:
0
1
2
3
4
Dietary/Allergy Treatment:
0
1
2
3
4
Exercise Therapy:
0
1
2
3
4
Facilitated Communication:
0
1
2
3
4
Hug Therapy:
0
1
2
3
4
Music Therapy:
0
1
2
3
4
Psychoanalysis:
0
1
2
3
4
Psychosocial Intervention:
0
1
2
3
4
Sensory Integration Training:
0
1
2
3
4
   Brushing:
0
1
2
3
4
   Joint Compression:
0
1
2
3
4
Vestibular Stimulation:
0
1
2
3
4
   Weighted Blanket/Vest:
0
1
2
3
4
Skills Training:
0
1
2
3
4
Planned Activities Training:
0
1
2
3
4
Spatial Orientation Training:
0
1
2
3
4
Visual Stimulation Therapy:
0
1
2
3
4
Pharmacological:
0
1
2
3
4
   Carbamazepine:
0
1
2
3
4
   Clomipramine:
0
1
2
3
4
   Fluoxetine:
0
1
2
3
4
   Paroxetine:
0
1
2
3
4
   Risperidone:
0
1
2
3
4
   Ritalin:
0
1
2
3
4




TREATMENT EFFECTIVENESS:

How EFFECTIVE do you believe the following treatment approaches are for individuals with ASD?

Please use the following scale for your responses:


Not at all
Slightly
Moderately Effective
Very
Don't Know
Applied Behavior Analysis:
1
2
3
4
DK
   Aversive Conditioning:
1
2
3
4
DK
   Discrete Trial Training:
1
2
3
4
DK
   Functional Analysis:
1
2
3
4
DK
   Functional Communication Training:
1
2
3
4
DK
   Incidental Teaching:
1
2
3
4
DK
Aerobic Exercise Therapy
1
2
3
4
DK
Aromatherapy:
1
2
3
4
DK
Auditory Integration Training:
1
2
3
4
DK
Cognitive-Behavior Therapy:
1
2
3
4
DK
   Visual Imaging:
1
2
3
4
DK
Systematic Desensitization:
1
2
3
4
DK
Counseling/psychotherapy:
1
2
3
4
DK
Dietary/Allergy Treatment:
1
2
3
4
DK
Exercise Therapy:
1
2
3
4
DK
Facilitated Communication:
1
2
3
4
DK
Hug Therapy:
1
2
3
4
DK
Music Therapy:
1
2
3
4
DK
Psychoanalysis:
1
2
3
4
DK
Psychosocial Intervention:
1
2
3
4
DK
Sensory Integration Training:
1
2
3
4
DK
   Brushing:
1
2
3
4
DK
   Joint Compression:
1
2
3
4
DK
Vestibular Stimulation:
1
2
3
4
DK
   Weighted Blanket/Vest:
1
2
3
4
DK
Skills Training:
1
2
3
4
DK
Planned Activities Training:
1
2
3
4
DK
Spatial Orientation Training:
1
2
3
4
DK
Visual Stimulation Therapy:
1
2
3
4
DK
Pharmacological:
1
2
3
4
DK
   Carbamazepine:
1
2
3
4
DK
   Clomipramine:
1
2
3
4
DK
   Fluoxetine:
1
2
3
4
DK
   Paroxetine:
1
2
3
4
DK
   Risperidone:
1
2
3
4
DK
   Ritalin:
1
2
3
4
DK




TREATMENT ACCEPTABILITY:

How ACCEPTABLE do you believe the following treatment approaches are for individuals with ASD?

Please use the following scale for your responses:


Not at all
Slightly
Moderately Acceptable
Very
Don't Know
Applied Behavior Analysis:
1
2
3
4
DK
   Aversive Conditioning:
1
2
3
4
DK
   Discrete Trial Training:
1
2
3
4
DK
   Functional Analysis:
1
2
3
4
DK
   Functional Communication Training:
1
2
3
4
DK
   Incidental Teaching:
1
2
3
4
DK
Aerobic Exercise Therapy
1
2
3
4
DK
Aromatherapy:
1
2
3
4
DK
Auditory Integration Training:
1
2
3
4
DK
Cognitive-Behavior Therapy:
1
2
3
4
DK
   Visual Imaging:
1
2
3
4
DK
Systematic Desensitization:
1
2
3
4
DK
Counseling/psychotherapy:
1
2
3
4
DK
Dietary/Allergy Treatment:
1
2
3
4
DK
Exercise Therapy:
1
2
3
4
DK
Facilitated Communication:
1
2
3
4
DK
Hug Therapy:
1
2
3
4
DK
Music Therapy:
1
2
3
4
DK
Psychoanalysis:
1
2
3
4
DK
Psychosocial Intervention:
1
2
3
4
DK
Sensory Integration Training:
1
2
3
4
DK
   Brushing:
1
2
3
4
DK
   Joint Compression:
1
2
3
4
DK
Vestibular Stimulation:
1
2
3
4
DK
   Weighted Blanket/Vest:
1
2
3
4
DK
Skills Training:
1
2
3
4
DK
Planned Activities Training:
1
2
3
4
DK
Spatial Orientation Training:
1
2
3
4
DK
Visual Stimulation Therapy:
1
2
3
4
DK
Pharmacological:
1
2
3
4
DK
   Carbamazepine:
1
2
3
4
DK
   Clomipramine:
1
2
3
4
DK
   Fluoxetine:
1
2
3
4
DK
   Paroxetine:
1
2
3
4
DK
   Risperidone:
1
2
3
4
DK
   Ritalin:
1
2
3
4
DK




TREATMENT EXPERIENCE:

Please indicate which treatments your child/sibling has experienced and which have been
effective by placing an "X" in the appropriate space below.
Please use the following scale for your reponses:
Tried
Effective
Applied Behavior Analysis:
______
________
   Aversive Conditioning:
______
________
   Discrete Trial Training:
______
________
   Functional Analysis:
______
________
   Functional Communication Training:
______
________
   Incidental Teaching:
______
________
Aerobic Exercise Therapy
______
________
Aromatherapy:
______
________
Auditory Integration Training:
______
________
Cognitive-Behavior Therapy:
______
________
   Visual Imaging:
______
________
Systematic Desensitization:
______
________
Counseling/psychotherapy:
______
________
Dietary/Allergy Treatment:
______
________
Exercise Therapy:
______
________
Facilitated Communication:
______
________
Hug Therapy:
______
________
Music Therapy:
______
________
Psychoanalysis:
______
________
Psychosocial Intervention:
______
________
Sensory Integration Training:
______
________
   Brushing:
______
________
   Joint Compression:
______
________
Vestibular Stimulation:
______
________
   Weighted Blanket/Vest:
______
________
Skills Training:
______
________
Planned Activities Training:
______
________
Spatial Orientation Training:
______
________
Visual Stimulation Therapy:
______
________
Pharmacological:
______
________
   Carbamazepine:
______
________
   Clomipramine:
______
________
   Fluoxetine:
______
________
   Paroxetine:
______
________
   Risperidone:
______
________
   Ritalin:
______
________




Please indicate the number that best matches your response to each question using the following scale:

   
        Disagree Strongly
         Disagree
         Neutral
         Agree
         Agree Strongly
         1
         2
         3
         4
         5

_____ Objective data about effectiveness is important in selecting a treatment.

_____ Clinicians are not always well informed.

_____ Behavior modification is cruel.

_____ Your 'gut feeling' is more important than graphs in knowing if something is working.

_____ All treatments are equally effective.

_____ Applied Behavior Analysis can have remarkable results when used consistently.

_____ Individuals with ASD have the ability to 'know' what others are thinking.

_____ The best way to tell if a treatment works is to keep careful data.

_____ Planning and goals are important in working with people with ASD.

_____ If the results of a treatment do not last, it wasn't effective.

_____ In general, behaviorists seem cold.

_____ I would try a treatment if it worked for someone else.

_____ Multiple treatments at the same time are more likely to succeed.

_____ Knowing a clinician's credentials is important in choosing a treatment.

_____ In treatment as in life, if the claims seem too good to be true, they probably aren't.

_____ Trying to keep objective data can make an effective treatment stop working.




If you would be willing to participate in a more detailed research survey on this topic, please fill out the form below and enclose with the survey. All address forms will be separated before the surveys are compiled.



NAME:_______________________________________
ADDRESS:____________________________________
_____________________________________________
_____________________________________________

PHONE:   (       )      -

E-MAIL:________________________________



PLEASE RETURN COMPLETED SURVEY TO:



David R. Donnelly
P.O. Box 92566
Rochester, NY 14620
Email:drdonnelly@juno.com



The O.A.S.I.S. (Online Asperger Syndrome Information and Support) Web Page and all O.A.S.I.S. links from the main page and formatting of those links (http://www.udel.edu/bkirby/asperger/)are © by Barbara L. Kirby For permission to reprint, please contact bkirby@udel.edu

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