Suspected Autism Referral Request

Section

Have you suffered from mental health problems such as depression and anxiety or any other mental health problems?
Have you been diagnosed with any learning difficulties (e.g. dyslexia)?
Do you have any physical health problems?
Do you have any past or present history of misusing alcohol or illicit substances?

Autism Spectrum Quotient Test (AQ10)

Please answer the questions below, rating yourself on each of the criteria shown using one of the answers provided.

I often notice small sounds when others do not
I usually concentrate more on the whole picture, rather than the small details
I find it easy to do more than one thing at once
If there is an interruption, I can switch back to what I was doing very quickly
I find it easy to ‘read between the lines’ when someone is talking to me
I know how to tell if someone listening to me is getting bored
When I’m reading a story I find it difficult to work out the characters’ intentions
I like to collect information about categories of things (e.g. types of car, bird, train, plant etc.)
I find it easy to work out what someone is thinking or feeling just by looking at their face
I find it difficult to work out people’s intentions
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