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?



Have you been diagnosed as having Asperger Syndrome?
DELETE THE OPTION THAT IS NOT APPLICABLE TO YOU
YES
NO

If NO, Please would you complete the Autism Quotient for Adults at
http://www.maxineaston.co.uk/research/AQ.pl
and enter your score below.



Has your partner been diagnosed as having Asperger Syndrome?
DELETE THE OPTION THAT IS NOT APPLICABLE TO YOU

YES
NO



Have you had any children with your partner?
DELETE THE OPTION THAT IS NOT APPLICABLE TO YOU

YES
NO



Have any of the children been diagnosed with an Autistic Spectrum Disorder (ASD)?
DELETE THE OPTION THAT IS NOT APPLICABLE TO YOU

YES
NO



I believe my mental health has suffered due to being in this relationship?
CHOOSE ONE AND DELETE THE OPTIONS THAT ARE NOT APPLICABLE TO YOU

Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree



If you feel your mental health has suffered (or improved) 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
Phobias
Breakdown
Mental health improved
Other (please specify)



I believe my physical health has suffered due to being in this relationship?
CHOOSE ONE AND DELETE THE OPTIONS THAT ARE NOT APPLICABLE TO YOU

Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree



If you feel your physical health has suffered (or impoved) 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
Fibromyalgia
Chronic Fatigue Syndrome
Exhaustion
Migraine
Physical health improved
Other (please specify)



If you and your partner have ever been for relationship counselling, can you describe the experience and the outcome/s? Please be as specific as possible.






Are you happy for me to contact you again in the future regarding any follow up studies?
DELETE THE OPTION THAT IS NOT APPLICABLE TO YOU

YES
NO



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