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

Fill in the following information about a child’s demographics:

Child’s Full Name, Child’s Nickname, Child’s Birthdate

Fill in the following information about a 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

Fill in the following top 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.

Fill in the following important contacts for a child:

Important Family/Friends Contact Information, Supports Coordinator/Case Manager/Teacher/Special Ed Supervisor Contact Information

Fill in the following 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

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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.