Questionnaire for patients with ASD
Dear Parent or Guardian,
We have compiled a set of questions for patients with learning difficulties, ASD and/or Autism. This will help SYDPD evaluate far better your child’s needs at the dentist. Could you please fill in the form and either email it to us or bring at your first appointment.
- Briefly what is your child’s dental history like?
- Does he/she have any current pain or problems that you are aware of?
- Does your child have any other medical conditions?
- What is communication like?
- Are visual aids, social or picture boards used for your child to help communication and explain what will happen?
- Does your child have particular things he/she is interested in?
- Does he/she have any particular dislikes? Is he/she sensitive to noise, light, touch, tasted, smells?
- Is tooth brushing an issue? What toothpaste do you use?
- Is he restrictive in foods he/she eats?
- Does your child have a reward system that you use with him/her?
- How important is routine, how easily does your child accept changes?
- Does your child have trouble having a haircut? What strategies have you used to help your child be able to sit for a haircut?
- Is there anything else you can tell me about your child that might help in his/her visit to the dentist?
You may download these questions by selecting this link.