Email Address

Was this group helpful for your child and/or family as a whole?

If you found it helpful, in what ways was it most helpful?

If you did not find it helpful, in what ways can we improve the group for possible future presentations?

What was your child's favorite part of this group?

What was the most challenging part of this group for your child?

What types of groups would you like to see offered in the future? (please consider what topics should be offered, skill sets addressed, art projects offereed, the best timing of the group, etc.)

Did you see any changes or evidence that your child has been thinking about and/or is practicing any of the concepts introduced within the group? If so, in what way was this evident?

Would you like to be contacted about future groups/opportunties being offered by LAF?

Would you liek to be included in a group email with the intent of making connections and building a support nextwork of local parents of childn with ASD?

Pleas answer yes or no.

Since participating in this group, please rate your child's ability to appropriately perform the following tasks/skills as compared to his/her neuro-typical peers.

Please not that all this information will be kept confidential and is considered a part of your child's therapeutic record. Alyssa L. Millard, ATR and Lowcountry Autism Foundation (LAF) are bound by ethical standards to maintain this confidentiality. This information will not be shared with anyone outside of LAF without your specific consent and written permission.

You child's overall social skills

Eye contact

Ability to begin a conversation

Ability to sustain a conversation

Ability to end a conversation

Understanding of appropriate personal space

Ability to listen quietly when someone is speaking to them

Ability to focus on the topic of conversation

Ability to respond appropriately to topic at hand

Understanding appropriate touching

Developmentally appropriate understanding of friendships

Ability to correctly identify and label basic emotions

Ability to correctly identify and label their own emotions

Ability to correctly identify and label the emotions of others

Ability to appropriately express their own emotions

Ability to appropriately regulate their own emotions (ability to calm themselves)

Ability to empathize with others

Demonstrate an understanding of appropriate topics with appropriate people

Demonstrates creativity and imagination

Demonstrates concrete thinking

Demonstrates the ability to think more abstractly

Please rate your child's emotional levels with the following factors or stimuli.

Please not that all this information will be kept confidential and is considered a part of your child's therapeutic record. Alyssa L. Millard, ATR and Lowcountry Autism Foundation (LAF) are bound by ethical standards to maintain this confidentiality. This information will not be shared with anyone outside of LAF without your specific consent and written permission.

Loud noises

Quiet noises

Bright lights

Dim lights

Strong smells

Indistinct smells

Strong tastes

Indistinct tastes

Squeezing

Light touch

Sticky textures

Dry textures

Wet textures

Slimy textures

Hot temperatures

Mild/lukewarm temperatures

Cold temperatures

Score their regulation of these emotions and how much they effect participation in preferred activities and events.

Please not that all this information will be kept confidential and is considered a part of your child's therapeutic record. Alyssa L. Millard, ATR and Lowcountry Autism Foundation (LAF) are bound by ethical standards to maintain this confidentiality. This information will not be shared with anyone outside of LAF without your specific consent and written permission.

Anger

Disgust

Anxiety/worry

Fear

Excitement

Art Therapy Social Skills Group Post-Questionnaire

If you/your child have recently completed our Art Therapy group, please complete the following form:

PHONE: 843-800-7171