research@maxineaston.co.uk
The Perspective of an Adult with Asperger Syndrome in a Relationship
INFORMATION SECTION
It would be helpful if you would complete all sections. If you do not wish to answer any of the questions, please leave them blank.
ALL INFORMATION REMAINS STRICTLY CONFIDENTIAL.
THIS SECTION REFERS TO YOU
Name:
Address:
Email address:
(Leave any of the three above blank if you wish to remain anonymous)
Your Age:
Your sex:
Marital status:
Your highest academic level of achievement:
i.e. GCSE, Degree, PHD
Your Occupation:
THIS SECTION REFERS TO YOUR PARTNER
Partner's age:
Partner's sex:
Partner's highest academic level of achievement:
i.e. GCSE, Degree, PHD
Partner's occupation:
THIS SECTION REFERS TO YOUR RELATIONSHIP
How many years have you been with your partner?
If married, how long have you been married?
If separated or divorced, how long have you been apart?
IN THE FOLLOWING QUESTIONS PLEASE DELETE THOSE THAT ARE NOT APPLICABLE
Has your partner been diagnosed as having Asperger Syndrome?
YES
NO
Have you been diagnosed as having Asperger Syndrome?
YES
NO
Have you had any children with your partner?
YES
NO
Have any of the children been diagnosed with an Autistic Spectrum Disorder (ASD)?
YES
NO
Do you or your partner have any relatives diagnosed with an ASD?
YES
NO
If YES who? (Please be specific)
In retrospect and with the knowledge you have now, would you still have had a relationship with your partner?
YES
NO
I believe my mental health has suffered due to being in this relationship?
Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree
I believe my physical health has suffered due to being in this relationship?
Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree
If your relationship has broken down, do you feel it was a consequence of you having Asperger syndrome?
YES
NO
Are you happy for me to contact you again in the future regarding any follow up studies?
YES
NO
The Perspective of an adult with Asperger Syndrome in a Relationship.
QUESTIONNAIRE SECTION
Name (Optional)
Please answer the questions as honestly as possible and in as much detail as you feel able to. If there are any questions you do not wish to answer, please leave blank. If you would like to add further information that you may feel is relevant, please attach additional sheets to the questionnaire.
ALL INFORMATION WILL REMAIN STRICTLY CONFIDENTIAL.
1. What first attracted you to your partner?
2. In the beginning of your relationship, did you feel there were similarities between you, such as common interests, beliefs, and sense of humour? Please be specific.
3. Describe the level of trust you have for your partner.
4. To the best of your knowledge has your partner always been faithful?
5. Describe the level of self-disclosure you are able to share with your partner?
6. Do you feel you understand your partner?
7. Do you feel valued by your partner?
8. How would you describe the relationship that is shared by you and your partner?
9. Have there been sexual problems between you and your partner? Please be as specific as you feel you can.
10. If you and your partner have children living with you, do you think Asperger syndrome has had an effect on your parenting style?
11. Have there been communication problems between you and your partner that you feel have had an effect on the relationship? Please be specific.
12. Have there been problems in non-verbal communication, i.e. reading body language and facial expressions? (Please be as specific as you feel you can).
13. Does you have any hobbies or specific interests that you feel have had an effect on your relationship? If yes please be as specific as you feel you can.
14. Do you have any fixed routines which you feel have had an effect on your relationship? If yes please be as specific as you feel you can.
15. Do you have problems socialising and have these had an effect on your relationship?
16. Have there been problems in the running of the financial side of the relationship?
17. Have you or your partner ever been verbally aggressive towards one another?
18. Have you or your partner ever been physically aggressive towards one another?
19. If you and your partner have ever been for relationship counselling, can you describe the experience and the outcome? Please be as specific as you feel you can.
20. What do you feel have been the benefits of having AS within the relationship?
21. What do you feel have been the disadvantages in having AS in the relationship?
22. Do you feel your mental health has suffered as a consequence of having Asperger syndrome and being in a relationship?
DELETE THE OPTIONS THAT ARE NOT APPLICABLE TO YOU
Depression
Stress
Self Neglect
Anxiety
Suicidal thoughts
Self-harm
Breakdown
Other (please specify)
Please describe in detail these and any other conditions you feel you have been affected by
23. Do you feel your Physical health has suffered as a consequence of having Asperger syndrome and being in a relationship?
DELETE THE OPTIONS THAT ARE NOT APPLICABLE TO YOU
Eating disorders
Immune Deficiency Disorder
Panic attacks
Insomnia
Skin Disorders
Muscular problems
Fibromyalia
Chronic Fatigue Syndrome
Exhaustion
Migraine
Other (please specify)
Please describe in detail these and any other conditions you feel you have been affected by.
If you wish to add any further information please do so and send with this Questionnaire.
Thank you for taking the time to complete this questionnaire.
©Maxine Aston