All About Me Form: Child
This is a form to be filled in with important information about a child with autism or an intellectual disability. When complete, the form includes information including the person’s name, communication preferences, likes, dislikes, and important contacts’ information. This can then be a useful tool for efficiently and effectively providing an individual with support.
All About My Child Form
- Child’s demographics:
- Child’s Full Name, Child’s Nickname, Child’s Birthdate
- Child’s communication preferences:
- How does my child communicate, Commonly used language, terms or phrases my child says and what they mean, Go to phrases we use in our family and what they mean
- Things to know about a child:
- Things my child likes. For example: people, foods, clothing, TV/movies, music, hobbies, high interest topics, etc., Things my child doesn’t like. For example: certain people, being touched, weather, sounds, words/phrases, babies, color yellow, clothing, etc., Things they are afraid of, Things that might trigger an outburst, Things that calm them down. For example: songs, books, movies, items, places to go to calm down, etc., Coping Strategies that may work for my child, How to best introduce new people/items/locations etc.
- Important contacts for a child:
- Important Family/Friends Contact Information, Supports Coordinator/Case Manager/Teacher/Special Ed Supervisor Contact Information
- Medical information for a child:
- Child’s Primary Care Doctor Contact Information, Child’s Psychiatrist Contact Information, Medications/Dosages Being Taken/What are they for
This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.