Anonymous Health and Neurological Survey for Autistic Individuals by Julie Bjelland, LMFT 
When answering, please check the box if you have ever had these symptoms (even if you no longer do).

Thank you for participating in this survey. The purpose is to better understand the health challenges faced by autistic individuals. Your responses are anonymous and will only be used to help us understand the experiences of autism.


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Do you identify as autistic? *
What is your gender? *
What is your age? *

In general, how would you rate your overall health throughout your lifetime?

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Do you frequently experience any of the following gastrointestinal issues? (Please check all that apply)"

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Do you experience difficulties with sleep?

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Have you been diagnosed with or do you believe you might have any of the following conditions? (Please check all that apply)

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Do you have any of the following immune-related conditions? (Please check all that apply)

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Have you been diagnosed with or suspect you might have any metabolic or endocrine disorders? (Please check all that apply)

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Research suggests that Ehlers-Danlos Syndrome (EDS) and other connective tissue disorders are more common in autistic individuals. EDS is a group of disorders that affect connective tissues, characterized by skin hyper-extensibility, joint hyper-mobility, and tissue fragility.

Do you think you might have or have you received a diagnosis of Ehlers-Danlos Syndrome (EDS)?

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Reading (Dyslexia): Do you find reading or understanding written text challenging? This can include difficulties with recognizing words, understanding what you read, or remembering information from texts.

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Mathematics (Dyscalculia): Do you experience challenges with math, known as dyscalculia, such as understanding numbers, performing calculations, or using money?

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Writing (Dysgraphia): Do you have difficulties with writing tasks, often referred to as dysgraphia, such as handwriting, organizing your thoughts on paper, or spelling?

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Planning and Organization (Executive Functioning Difficulties): Do you find it challenging to organize tasks, manage your time, or start and complete projects, which might be related to executive functioning difficulties?

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Spatial and Motor Skills (Nonverbal Learning Differences): Do you find it difficult to navigate physical spaces, coordinate movements, or interpret visual information, often associated with nonverbal learning differences?

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Understanding Nonverbal Cues (Social Communication Difficulties): Is it challenging for you to understand nonverbal signals such as facial expressions, body language, or the spatial arrangement of objects, which might be part of social communication difficulties?

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Processing Auditory Information (Auditory Processing Disorder): Do you find it hard to understand spoken instructions, differentiate sounds, or communicate effectively in noisy environments, potentially due to auditory processing issues?

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Have you ever been diagnosed with or suspect you have an autoimmune disorder?

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Do you experience chronic pain?

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Are there any other learning differences or challenges you experience that you would like to mention? Please specify

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Have you ever been diagnosed with epilepsy or experienced seizures?

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Mast cell activation syndrome (MCAS) involves an excessive release of substances from mast cells, which are part of the immune system. This condition can cause various symptoms including skin rashes, itching, abdominal pain, heart palpitations, and difficulty breathing. Do you experience any of the following symptoms that may suggest issues with mast cell activation? Please select all that apply.
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Do you experience any of the following frequently? *
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Is there anything else you think should have been added here that wasn't?   *
Education, research, consultations, assessments, and an Autistic Women's Group I host are available. For more information, please visit AutisticHSP.com. If you have any questions, feel free to contact me. To receive the results of this survey, make sure you are signed up for my newsletter. I'm also creating an extensive autism guide and will announce that in my newsletter as well. What do you want me to include in it? *
Is there anything else you would like to say to me? *
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