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APQ questionnaire — data entry
Please fill in all fields. Collected data is pseudonymized and does not include the patient's name.
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Patient data
Patient code (assigned by the center)
Optional. Use the same code for the Pre and Post entries of the same patient to allow comparison. Must not contain the patient's name.
Date of birth (optional)
Age at time of test
Sex
Male
Female
Other / prefer not to say
Administration context
Phase *
Pre-treatment
Post-treatment
Center *
Rinaldi Fontani Institute — Firenze
Location type
City
Hospital
Clinic
Address
Other
Location (detail)
Compilation date *
Operator (optional)
Notes
Questionnaire items
COGNITIVE_SKILLS
Language production
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Language comprehension
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Attention / concentration
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Learning / memory
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Executive functions
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Personal autonomy
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Sphincteric control
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Night rest
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Sensory issues
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
MOTOR_SKILLS
Gross motor skills
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Fine motor skills
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
BEHAVIORAL_SKILLS
Non-verbal communication
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Voluntary eye movements - eye contact
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Adaptation to changes
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Ability to follow social rules in an interaction
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
Interest in socialization and social contact
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
BEHAVIORAL_SYMPTOMS
To what extent is the person free from self-injurious behaviours?
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
To what extent is the person free from aggressive behaviours towards others?
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
To what extent is the person free from agitation - hyperactivity?
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
To what extent is the person free from irritability - oppositional behaviour?
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
To what extent is the person free from stereotypies (spinning, rocking, hand-clapping, head-banging, echolalia, etc.)?
1 — Not at all
2 — A little
3 — Quite a lot
4 — Very much
I declare that I have read and understood the privacy notice and I consent to the processing of the collected data for the purposes stated therein.
(read the privacy notice)
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