FASD DIAGNOSIS SURVEY

We appreciate you helping with this information. We keep it easy - 12 QUESTIONS - 5 MINUTES

Together our voices make a difference for our children and the next generation. Parenting Complex Children surveys are designed to promote understanding of the individuals we provide love and care.

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* 1. What is the FASD Diagnosis that your child has?

Fetal Alcohol Syndrome (FAS)

Partial Fetal Alcohol Syndrome (pFAS)

Neurobehavioral Disorder associated with prenatal alcohol exposure (ND-PAE)

Alcohol Related Neurodevelopmental Disorder (ARND)

Alcohol Related Birth Defects (ARBD)

Other (please specify)

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* 2. Where did you get your diagnosis?

At an FASD Clinic

At at Genetics Clinic

From a Neurologist

From a Developmental Pediatrician

Other (please specify)

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* 3. How long did it take from the time you suspected until the time of Diagnosis?

One month to Six Months

Six Months to One Year

One Year to Two Years

More than Two Years Less Than Five Years

Over Five Years

We do not have a Diagnosis yet.

Other (please specify)

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* 4. What was the first diagnosis before you found an FASD diagnosis?

Attention Deficit Hyperactivity Disorder ADHD, Attention Deficit Deficit (ADD)

Autism Spectrum Disorder (ASD)

Sensory Integration Disorder (SPD)

Developmental Delay, Intellectual Disability, Global Developmental Delay

Bipolar Disorder (BD)

Oppositional Defiance Disorder (ODD)

Severe Emotional Disturbance (SED)

Learning Disability

Other (please specify)

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* 5. At what age did you finally find your child's diagnosis? List the diagnosis age and sex of the child in the box.

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* 6. What was it that made you first realize that you needed to seek an FASD diagnosis.

Behavior

Learning Challenges

Hyperactivity and Emotional Regulation Issues

Knowledge that your child had been prenatally exposed

Diagnosis of other siblings having FASD

Knowledge that mother drank while pregnant

Other (please specify)

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* 7. How hard was it to find a diagnosis?

Easy

Moderately Difficult

Extremely Difficult

We still have not found a diagnosis.

Other (please specify)

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* 8. What was the best thing that happened because you were able to find a diagnosis?

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* 9. What things has helped your child the most because of getting a diagnosis?

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* 10. Caregiver Status

Biological parent

Adoptive parent

Foster parent

Kinship parent-Grandparent, Relative parent

Guardianship caregiver

Other (please specify)

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* 11. In what country are you located? If you are in other countries other than the US and Canada leave the name of the country in the comment field.

United States

Canada

Other (please specify)

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* 12. If you have more than one child with an FASD please take the survey again. It will allow more than once for those who have additional children/adults.

Please leave any comments you would like about obtaining a diagnosis.

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* 1. What is the FASD Diagnosis that your child has?

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* 2. Where did you get your diagnosis?

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* 3. How long did it take from the time you suspected until the time of Diagnosis?

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* 4. What was the first diagnosis before you found an FASD diagnosis?

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* 5. At what age did you finally find your child's diagnosis? List the diagnosis age and sex of the child in the box.

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* 6. What was it that made you first realize that you needed to seek an FASD diagnosis.

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* 7. How hard was it to find a diagnosis?

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* 8. What was the best thing that happened because you were able to find a diagnosis?

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* 9. What things has helped your child the most because of getting a diagnosis?

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* 10. Caregiver Status

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* 11. In what country are you located? If you are in other countries other than the US and Canada leave the name of the country in the comment field.

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* 12. If you have more than one child with an FASD please take the survey again. It will allow more than once for those who have additional children/adults.Please leave any comments you would like about obtaining a diagnosis.

* 12. If you have more than one child with an FASD please take the survey again. It will allow more than once for those who have additional children/adults.

Please leave any comments you would like about obtaining a diagnosis.