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* 1. What is your relationship to a child on the autism spectrum?

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* 2. Depending on your answer to Question 1, the phrase “your child” in subsequent questions will refer to your own child/adolescent, or child/adolescent family member, or child/adolescent client with a diagnosis of an autism spectrum disorder.


Has your child ever been denied admission to a program because of his or her diagnosis of autism spectrum disorder (including PDD-NOS, Asperger’s, or autism-like behaviors)?

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* 3. Does your child participate in an after-school program?

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* 4. Has your child been negatively impacted by not being able to participate in after school programs?

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* 5. If your child is attending after-school care, do you believe that the staff understands his/her disability?

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* 6. What was your biggest concern in placing your child in an after-school program? (check all that apply)

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* 7. For families with one or more children on the autism spectrum, what is largest barrier to you and your family participating in community activities and programs? (check all that apply)

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* 8. Have you had to spend more money for in-home care because your child could not participate in an after-school program?

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* 9. Has your career been affected negatively because you could not make childcare arrangements?

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* 10. If you are a stay-at-home parent, would you go back to work if you had an appropriate, dependable after-school placement for your child?

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