In support of one our main public policy priorities, Autism New Jersey is looking to collect data from parents who have children with autism who exhibit severe challenging behavior. We are acutely aware of the service gap that exists for children and adults who experience challenging behavior.  We are strongly advocating for a statewide adoption of an Applied Behavior Analysis (ABA) treatment approach and an increase in existing program capacity.  We strive to help help families every step of the way.  Your responses to this survey will be de-identified and used in our discussions with legislators and state officials as we work to bring attention to this under-served segment of the autism community.  We thank you in advance for your contribution.

* 1. Your child's age

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i We adjusted the number you entered based on the slider’s scale.

* 2. Your child's gender

* 3. Your home zip code

* 4. Please indicate which of the listed challenging behaviors your child currently exhibits.

* 5. Please indicate how frequently your child exhibits challenging behavior.

* 6. Please indicate the current status of your child's challenging behavior.

* 7. Where does your child currently live?

* 8. If your child does currently live at home, do you and the other members of your family feel safe?

* 9. If your child does currently live at home, does your child's challenging behavior prevent you and your family from attending family, social, or other events?

* 10. Does your child currently receive Applied Behavior Analysis (ABA) services from a Board Certified Behavior Analyst (BCBA)?

* 11. If your child is currently receiving or has previously received ABA services, please indicate how effective the services were.

* 12. Has your child ever been hospitalized due to his/her challenging behavior?

* 13. Have you or any other member of your family ever received medical treatment for injuries caused by your child’s challenging behavior?

* 14. Please describe your child on his/her best day.

* 15. Please describe your child on his/her most challenging day.

* 16. Personal Information (optional)

* 17. What are your long term goals for your child?

For more information about Autism New Jersey's public policy initiatives, click here.  If you have questions about services or anything related to challenging behavior, please call us at 800.4.AUTISM.

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