PARENT SURVEY

We are interested in surveying parents of adult children with developmental disabilities to find out what they would like to know, if anything, about new genetic tests that may be available for an individual with a developmental disability. Your responses will be kept confidential and you may skip any question that you prefer not to answer. Thank you!

Question Title

* 1. What is your relationship to the adult child with a developmental disability?

Biological Mother

Biological Father

Adoptive Mother

Adoptive Father

Question Title

* 2. Has your adult child been diagnosed with Prader-Willi, Fragile X or Down Syndrome?

Yes, Prader-Willi

Yes, Fragile X

Yes, Down Syndrome

Question Title

* 3. Please complete the following table:

	Biological or Adoptive Child	Year of Birth	Gender	Does this child have a developmental disability?	If yes, type of disability (1):	If yes, type of disability (2):
1st Child	1st Child Biological or Adoptive Child menu	1st Child Year of Birth menu	1st Child Gender menu	1st Child Does this child have a developmental disability? menu	1st Child If yes, type of disability (1): menu	1st Child If yes, type of disability (2): menu
2nd Child	2nd Child Biological or Adoptive Child menu	2nd Child Year of Birth menu	2nd Child Gender menu	2nd Child Does this child have a developmental disability? menu	2nd Child If yes, type of disability (1): menu	2nd Child If yes, type of disability (2): menu
3rd Child	3rd Child Biological or Adoptive Child menu	3rd Child Year of Birth menu	3rd Child Gender menu	3rd Child Does this child have a developmental disability? menu	3rd Child If yes, type of disability (1): menu	3rd Child If yes, type of disability (2): menu
4th Child	4th Child Biological or Adoptive Child menu	4th Child Year of Birth menu	4th Child Gender menu	4th Child Does this child have a developmental disability? menu	4th Child If yes, type of disability (1): menu	4th Child If yes, type of disability (2): menu
5th Child	5th Child Biological or Adoptive Child menu	5th Child Year of Birth menu	5th Child Gender menu	5th Child Does this child have a developmental disability? menu	5th Child If yes, type of disability (1): menu	5th Child If yes, type of disability (2): menu
6th Child	6th Child Biological or Adoptive Child menu	6th Child Year of Birth menu	6th Child Gender menu	6th Child Does this child have a developmental disability? menu	6th Child If yes, type of disability (1): menu	6th Child If yes, type of disability (2): menu
7th Child	7th Child Biological or Adoptive Child menu	7th Child Year of Birth menu	7th Child Gender menu	7th Child Does this child have a developmental disability? menu	7th Child If yes, type of disability (1): menu	7th Child If yes, type of disability (2): menu
8th Child	8th Child Biological or Adoptive Child menu	8th Child Year of Birth menu	8th Child Gender menu	8th Child Does this child have a developmental disability? menu	8th Child If yes, type of disability (1): menu	8th Child If yes, type of disability (2): menu
9th Child	9th Child Biological or Adoptive Child menu	9th Child Year of Birth menu	9th Child Gender menu	9th Child Does this child have a developmental disability? menu	9th Child If yes, type of disability (1): menu	9th Child If yes, type of disability (2): menu
10th Child	10th Child Biological or Adoptive Child menu	10th Child Year of Birth menu	10th Child Gender menu	10th Child Does this child have a developmental disability? menu	10th Child If yes, type of disability (1): menu	10th Child If yes, type of disability (2): menu

Question Title

* 4. Please indicate the diagnosis if known for your child with a developmental disability.

1st Child

2nd Child

3rd Child

4th Child

5th Child

6th Child

7th Child

8th Child

9th Child

10th Child