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IAN Research IAN Research Reports IAN Research Questions Parental Depression History Questionnaire Intro Basic Family Information Child with ASD Questionnaire Social Responsiveness Scale (SRS) Social Communication Questionnaire (SCQ) Treatment List Questionnaire for Each Treatment Weight and Height Intro Weight and Height Questionnaire Mother Basic Medical History Questionnaire Father Basic Medical History Questionnaire Sibling Without ASD Questionnaire Child with ASD - First Diagnosis Child with ASD - Current Diagnosis Child with ASD - Regression Child with ASD - Fragile X Child with ASD - Seizures Child with ASD - Mental Retardation Child with ASD - Motor Delay Child with ASD - ADHD Diagnosis Child with ASD - Anxiety Child with ASD - Bipolar Disorder Child with ASD - Depression Child with ASD - Attention and Mood Issues by ASD Child with ASD - Type of School Child with an ASD - Previous Research Participant? Mother - Education Mother - Learning Disability Mother - Speech Delay Mother - Speech Therapy Mother - Special Education Mother - ADHD Mother - Anxiety Mother - Bipolar Disorder Mother - Depression Father - Education Father - Learning Disability Father - Speech Delay Father - Speech Therapy Father - Special Education Fathers - ADHD Father - Anxiety Father - Bipolar Disorder Father - Depression Sibling - Speech Delay Sibling - Speech Therapy Sibling - Special Education Sibling - ADHD Sibling - Anxiety Sibling - Bipolar Disorder Sibling - Depression Understanding Research Government Initiatives Autism Spectrum Disorder Research User Guide for IAN Research Participants Research Studies Studies No Longer Recruiting

Basic Family Information - Demographics

When joining the IAN Research Project, the first step a parent of a child with an Autism Spectrum Disorder (ASD) takes is completing a Consent Form.  The Consent Form explains the IAN Research Project in detail.  It is also where we gather basic demographic information from families.

The fields a parent is asked to fill in are:

  1. Display Name
    This is the name a participant wants to appear on the entry screens in IAN Research to designate him or herself. It can be anything - a formal name, nickname, or made-up name.  (Note: it is not same as the Display Name used in the IAN Community as an anonymous identity for the Discussion Forums.)
  2. First Name
  3. Middle Name
  4. Last Name with Suffix
  5. Gender
  6. Ethnicity
    Hispanic or Latino or Not Hispanic or Latino
  7. Race
    Check all that apply: White, Black/African American, Native Hawaiian or Pacific Islander, Asian, American Indian or Alaskan Native, Other, and Unknown.
  8. Street Address
  9. City
  10. State
  11. Zipcode
  12. Home Phone Number
  13. When did you begin living at this address?
    Month and Year
  14. Have you been diagnosed with an Autism Spectrum Disorder?
     Yes or No - tells us whether the parent him or herself has ever been diagnosed with an ASD.
  15. If Yes to ASD question above, please select your first ASD diagnosis received from a professional (i.e. physician, psychologist, psychiatrist).
    Choices are: Autism or Autistic Disorder, Asperger's Syndrome, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder (CDD), Pervasive Developmental Disorder (PDD), Autism Spectrum Disorder (ASD).

As a parent adds their children to their Family Profile, they will be asked to fill in a similar Consent Form (with demographic information) for each one.
Kennedy Krieger InstituteAutism Speaks