These 10 questions will only take a few minutes. It's very important that you fill them out because this info is crucial for making the live course maximally useful for you and your loved one on the spectrum. Let's go! It'll be quick and painless!
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Question 1 of 12
Question 2 of 12
Please type the full name of your loved one on the spectrum below.
Question 3 of 12
How old is your loved one on the spectrum?
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40+
Question 4 of 12
What is your child/adult's diagnosis?
ASD
Asperger
PDD
Sensory Processing Disorder
Childhood Disintegrative Disorder
Other
Question 5 of 12
What are the current crisis symptoms?
Hitting/pinching/biting/scratching others
Hitting/pinching/biting/scratching themselves
Screaming
Crying/sobbing
Yelling at/swearing at others
Intense or constant fighting with siblings
Breaking things
Has been expelled from school
In trouble in school
Seems anxious or depressed
Says they are anxious or depressed
Question 6 of 12
How many times total over the past two weeks would you say that the crisis has erupted (i.e. how many times over the past two weeks has your loved one exhibited the crisis symptoms listed in the previous question)?
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75+
Question 7 of 12
As best you can, please rate the severity of the current crisis on a scale of 0 to 10, with 0 being no crisis, 1 being very mild, and 10 being the most severe:
Question 8 of 12
Have you read any of Raun or Kate’s books?
Autism Breakthrough: The Groundbreaking Method That Helped Families All Over the World by Raun K. Kaufman
Autistic Logistics: A Parent’s Guide to Tackling Bedtime, Toilet Training, Meltdowns, Hitting, and Other Everyday Challenges by Kate C. Wilde
The Autism Language Launcher: A Parent’s Guide to Helping Your Child Turn Sounds and Words into Simple Conversations by Kate C. Wilde
I have not yet read any of these books
Question 9 of 12
Are you a parent, a family member, an educator/professional, or something else? (Choose one.)
Parent
Family member
Educator/professional
Question 10 of 12
As best you can, please rate the severity of the your own stress level, given the current state of your crisis, with 0 being no stress, 1 being very mild, and 10 being the most severe:
Question 11 of 12
How did you FIRST hear about ACT (Autism Crisis Turnaround)?
Facebook ad
A friend recommended it
A professional or doctor recommended it
Raun’s Facebook page
Kate’s Facebook page
One of Raun’s Facebook Lives
Exceptional Needs Today
US Autism Association
Podcast interview
Video “commercial” with Raun & Kate introducing the ACT protocol
Question 12 of 12
What prompted you to actually sign up for this course?
Free webinar
Been following you for a while…then the situation with my child/adult recently worsened.