Detection of the occurrence of increased sensitivity to environmental conditions (thermal, visual, acoustic, air quality) of people with autism spectrum.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

During the filling in remember to fill in all the question with the following symbol:

This survey is conducted in the course of the SENSHOME project. In this project, a new smart home design to support autonomy and self-reliance of people with autism spectrum disorder (ASD) will be developed. A smart sensor network (microphones, temperature sensors, light sensors) should be implemented as normal as possible to recognize critical events, improve the comfort and well-being (regulation of room conditions like temperature, humidity or acoustics) and improve energy savings. In the development process of the smart home design concept, different environments – private houses and flats or assisted living – will be considered. The survey has been prepared by Free University of Bozen who is responsible for it.

Collected personal data in the framework of this survey will be anonymized and used only project internal for scientific purposes. The project team is bound to confidentiality. All data is handled in accordance with the provisions of general data protection regulation. Any questions or other requests can be adressed to senshome@unibz.it, Free University of Bozen-Bolzano, at any time. The Free University of Bozen will be the data repository.

Specify who is filling in this survey *

Caregiver, psychologist, nurse

Parent

Person with Autism Spectrum (self-evaluation)

Other:

If you are a parent or a caregiver filling in about the perception of a person with Autism Spectrum, please always keep in mind the reaction and sensitivity of this person and always referring to him/her. If you are responsible of more than one person with autism it is possible to fill more than one questionnaire.

Please specify the age of the individual with autism at the time of compilation: *

7-9 years

10-17 years

18-29 years

30-39 years

40-49 years

50 + years

Please specify the gender of the individual with autism: *

Male

Female

Other:

Please specify nation and province of the individual with autism: *

Please specify the housing typology of living of the individual with autism: *

Full-time in an assisted living facility (ALF)

Partially in an assisted living facility (ALP)

Apartment/Flat (APT)

Single Family House (HOU)

Other:

Please specify the Level of the Autism Spectrum in accordance to the DSM-5: *

Level 1 request support: difficulty initiating social interactions organization and planning problems can hamper independence

Level 2 request substantial support: social interactions limited to narrow special interests frequent restricted/repetitive behaviors

Level 3 request very substantial support: deficits in verbal and non verbal social communication skills.great distress/difficulty changing actions or focus

Please specify which comorbidities are present: *

No comorbidities

Attention deficit hyperactivity disorder (ADHD)

Intellectual disabilities (IQ)

Obsessive-compulsive disorder (OCD)

Depressive disorder (Dep)

Anxiety disorder (Anx)

Other:

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Free University of Bolzano. Report Abuse

Forms