A Web Project of KKI
IAN Logo
Community
IAN ID:  
Forgot ID?
Password:  
  Forgot Password?
Join
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

FATHER BASIC MEDICAL HISTORY QUESTIONNAIRE

Parents taking part in the IAN Research project answer a series of questions via the Internet from the comfort of their own homes and at their own convenience. They can stop the process at any time, starting again when they are ready. (This is a wonderful feature, as parents of children with ASDs experience many interruptions in their daily lives!)

Data collected from thousands of parents --stripped of identifying information-- will be shared with autism researchers seeking answers to crucial questions.

The Father Basic Medical History questionnaire asks fathers of children with an ASD about their background and family history. It takes approximately 5 minutes to complete.

Please note: items which appear as orange and underlined are linked to Research Results --an explanation of that particular question's importance together with a graph showing our results so far. 

Parent Educational History

  1. What is the highest level of education you have completed?
  2. Have you ever been diagnosed with a learning disability?
  3. Have you ever been diagnosed with a language delay or speech problems?
  4. Have you ever received speech or language therapy?
  5. Have you ever received special education services (other than speech or language therapy)?

Parent Medical History

  1. Have you ever been diagnosed with Fragile X or been told that you are a carrier for Fragile X?
  2. Have you ever been diagnosed with Tuberous Sclerosis?
  3. Have you ever been diagnosed with Seizures/Epilepsy?
  4. Have you ever been diagnosed with Mental Retardation?
  5. Have you ever been diagnosed with or received treatment for Depression?
  6. Have you ever been diagnosed with or received treatment for Bipolar Disorder (Manic/Depressive Disorder)?
  7. Have you ever been diagnosed with or received treatment for Attention Deficit/Hyperactivity Disorder (AD/HD) or Attention Deficit Disorder (ADD)?
  8. Have you ever been diagnosed with or received treatment for an Anxiety Disorder?
  9. Have you ever been diagnosed with or received treatment for Schizophrenia?

Autoimmune Disorders

  1. Have you ever been diagnosed with Hashimoto’s Thyroiditis (underactive thyroid)?
  2. Have you ever been diagnosed with Graves’ Disease (overactive thyroid)?
  3. Have you ever been diagnosed with Lupus?
  4. Have you ever been diagnosed with Multiple Sclerosis?
  5. Have you ever been diagnosed with Rheumatoid Arthritis?
  6. Have you ever been diagnosed with Insulin-dependent (Type I) Diabetes?
  7. Have you ever been diagnosed with Inflammatory Bowel Disease?


Kennedy Krieger InstituteAutism Speaks