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Step 1 of 15 - Welcome

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Welcome to our FREE screening form for Autism (and Autism with the PDA profile)



Once you have completed this screening, you will receive an automatic email with a link to your screening feedback. In addition to the feedback itself, you will also receive full details of our assessment prices (including various options), information on the assessment, the assessment process, and a link to our FAQs.

Please follow the instructions below and provide as much detail as possible in order for us to provide you with the most appropriate feedback.

Should you wish to stop at any point, please click the above 'back to site' button to go back to the screening page.

We wish to make it clear that this screening is totally free of charge, and does not oblige you to book a formal assessment with us, even though the feedback may suggest an assessment is warranted.

Please note - we recommend that you allow up to 15 minutes for completing this form as we cannot save or accept partially submitted forms. As part of our security policy regarding personal data, everything submitted is automatically erased from our website after 24 hours and Help for Psychology Services will only store your results data for a period of 30 days, should you decide to proceed with any of our services.



If you're ready to begin, please click Next below.



© Copyright Help for Psychology Services Ltd 2021

Is your child under the age of five?(Required)

Help for Psychology are not able to assess children under the age of five, unless they have previously been formally seen by a Paediatrician. We would also require written evidence that the referral is supported, and that other underlying medical conditions have been explored.

Children between the age of three and five, who have been seen by a Paediatrician can only be assessed face-to-face in our Norwich clinic, and parents need to be aware that several separate appointments might be needed, including a review appointment, and that this may affect the cost of the assessment. Please email our team for further information, where we can advise on the appropriate next steps.



School

Does young person appear to have any difficulty with reading, writing or spelling?(Required)
Does he/she/they go to a special school or have any extra help?(Required)
Does the young person find it difficult to attend school?(Required)
Has he/she/they ever been excluded from school?(Required)
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Birth and Early Development

Were any difficulties experienced during your pregnancy?(Required)
Please select the difficulties experienced:(Required)
Was the child born(Required)
Was labour straightforward?(Required)
Did the child sleep well as a baby?(Required)
Were there any difficulties with feeding the child as a baby?(Required)
Please select the difficulties experienced:(Required)
Was the child interested in people/other children as a baby?(Required)
Was there any delay in the child reaching developmental milestones, e.g. walking?(Required)
Did the child bring toys or books to share with you as an infant?(Required)
Did the child point to share interest?(Required)
Did the child suffer from any serious illnesses as a baby?(Required)
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Early Language and Communication

Did the child babble and coo as an infant?(Required)
Was there any delay in the child learning to speak?(Required)
Were there ever any concerns about the child's hearing?(Required)
Were there ever any concerns about their understanding of language?(Required)
Did the child need support from a Speech and Language therapist?(Required)
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Language and Current Communication

Does the child find it difficult to follow a conversation, particularly if it is noisy or several people are talking?(Required)
Does he/she/they appear to know when to join in with conversations?(Required)
Does he/she/they sometimes find it hard to know what to say to people?(Required)
Does the child ever try to dominate conversations or interrupt when others are talking?(Required)
If something really interests the child, do they find it hard to stop talking about it?(Required)
Have you (or others) ever felt that the child is being rude when they claim they are just being honest?(Required)
Does the child always ‘get’ the joke when people are laughing?(Required)
Is the child very literal in the way they interpret things (for example, would they be confused by someone saying ‘Did you get out of bed the wrong side today’?)(Required)
Does it appear to annoy the child when people don’t always say exactly what they mean?(Required)
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Social Interaction and Relationships

Does the child interact inappropriately with strangers? For example, are they either overfamiliar or overly wary?(Required)
Does the child have difficulty separating from their caregiver(s)?(Required)
Does the child struggle to share their caregiver(s)’ attention?(Required)
Does the child enjoy socialising with peers?(Required)
Does the child find it difficult to form or maintain friendships?(Required)
Would the child tend to be:(Required)
Does he/she/they regularly get invited on playdates?(Required)
If peers come to your house, how does this go?(Required)
Does the child often complain that people are getting at him/her/them or picking on him/her/them?(Required)
Does the child complain that people are putting him/her/them down, or not respecting their opinion?(Required)
Does the child blame others (parents, peers) for failures/distress/pain?(Required)
Does the child appear to find it easy to tell when someone is sad or angry?(Required)
Does the child recognise different tones of voice, for example when someone is angry or upset?(Required)
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Play and Imagination

What kind of toys did the child choose to play with when younger?(Required)
As a younger child, did he/she/they like to(Required)
If the child plays with other children, do these children have to play by his/her/their rules?(Required)
What happens if the other children want to play the game differently?(Required)
What does he/she/they play with or enjoy doing now during their spare time?(Required)
Does the child have any particular interests that take up a lot of their time?(Required)
Could this interest be described as an obsession?(Required)
Does (or did) the child have favourite TV programmes or YouTube/Tik Tok clips that they watch over and over again?(Required)
Does (or did) he/she/they enjoy dressing up, role play or pretending to be a character?(Required)
When they are role playing does he/she/they really seem to believe they have become the character?(Required)
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Routines and Resistance (Inflexibility of thought)

Does the child need to know exactly what is going to be happening every day?(Required)
Does the child function better if he/she/they has a plan for the day (even if this is their own plan)?(Required)
Is there anything the child insists on doing every day or in the same way every time?(Required)
If the child wanted to have, or do something, would they find it hard to move on from asking or talking about it?(Required)
Can this sometimes lead to them not being able to talk about anything else or engage in repetitive questioning about it?(Required)
What happens if the child is told ‘no’ or is not allowed to do/have something they want?(Required)
What happens if a plan has to change suddenly at the last minute?(Required)
If someone upsets the child, can they hold a grudge/do they find it hard to forgive and move on?(Required)
If the child disagrees with someone’s opinion would they find it hard not to tell them, even if that person was a person in authority (a doctor or teacher for example)?(Required)
If the child feels they have been treated unfairly, does this continue to bother them for a long time?(Required)
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Emotions and Behaviour

Has the child experienced an Adverse Childhood Event (ACE). Examples of this might be the loss of a significant person within the family through divorce or death, witnessing domestic violence, or periods of instability/uncertainty during childhood.(Required)
Has the child experienced, or is currently experiencing, great distress about attending school?(Required)
Does the child actively resist all demands and boundaries placed on them?(Required)
Does the child subtly avoid having to do what they have been asked (e.g., they may ‘almost do something’ or deliberately do it wrong?(Required)
Does the child make excuses for why they are unable to comply with instructions? (e.g. ‘my legs don’t work’, or ‘I can’t move, I am stuck to the floor’(Required)
Does the child ever miss out on activities they enjoy because they are unable to get ready or leave the house?(Required)
Does the child have sudden intense emotional reactions?(Required)
Is it always clear what the triggers are for these intense reactions?(Required)
Do you have concerns about aggression towards others?(Required)
Can the child accept praise?(Required)
Does the child show affection towards family members(Required)
Does the child feel excited about birthdays and Christmas?(Required)
Does the child tell lies?(Required)
Does the child steal from others?(Required)
Does the child have difficulty sharing with others (possessions or attention)?(Required)
Does the child respond well to traditional parenting techniques such as rewards and consequences for good/inappropriate behaviour?(Required)
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Mental Health and Wellbeing

Has the child self-harmed ?(Required)
Has the child expressed suicidal thoughts?(Required)
Has the child ever made a serious attempt on their own life?(Required)
Are there concerns about the child's eating patterns?(Required)
Do you have concerns about the child's self-esteem?(Required)
Has the young person ever been in trouble with the police?(Required)
Please select the most applicable incident with the police(Required)
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Sensory Issues

Do unexpected loud noises bother the child?(Required)
Do they find it difficult to concentrate when it is noisy?(Required)
Does the child ever complain that food or other smells are too strong, and make them feel sick?(Required)
Does the child eat a varied diet?(Required)
Have they ever expressed a significant dislike for certain textures of food, such as meat, lumpy mashed potato or yoghurt with ‘bits’ in?(Required)
Do they prefer to wear loose clothing?(Required)
Do labels in clothes irritate them?(Required)
Does the child react very badly when people brush up against them or touch them unexpectedly?(Required)
Does the child appear agitated or restless if he or she has to sit still for too long?(Required)
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Self-care and Independence

Is the child aware of the need to maintain personal hygiene?(Required)
Are there any difficulties with continence?(Required)
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About your Child / Young Person

Name of Child / Young Person(Required)
Please select your Child / Young Person's age range(Required)

IS YOUR CHILD UNDER FIVE?

If 'yes', then please don't complete this screening. Help for Psychology are not able to assess children under the age of five, unless they have previously been formally seen by a Paediatrician. We would also require written evidence that the referral is supported, and that other underlying medical conditions have been explored.

Children between the age of three and five, who have been seen by a Paediatrician can only be assessed face-to-face in our Norwich clinic, and parents need to be aware that several separate appointments might be needed, including a review appointment, and that this may affect the cost of the assessment. Please contact us via email at [email protected] for further information, where we can advise on the appropriate next steps.

Name of Parent or Legal Guardian(Required)
Parent or Legal Guardian's Email(Required)
Is there another Parent or Legal Guardian you wish to have access to this information?(Required)
Name of additional Parent or Legal Guardian(Required)
Additional Parent or Legal Guardian's Email(Required)
Parent or Legal Guardian confirmation(Required)
I confirm that I am the Parent or Legal Guardian of the child / young person referenced in this screening service and provide consent for this data to be reviewed by Help for Psychology Services where necessary.
Parent or Legal Guardian consent(Required)
You are happy for Help for Psychology Services to store your Child / Young Person's screening data for no more than a period of 30 days. We hold the data should you wish to book any of our services in order for our team to prepare for your first appointment. After 30 days have passed, the data will be deleted from our files and you may need to resubmit a new screening form.

How did you hear about us?

Please select where you heard about Help for Psychology and our services from(Required)
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Brochure Response sent:
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Brochure Response sent:
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Brochure Response sent:
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Brochure Response sent:
This field is for validation purposes and should be left unchanged.