A Survey for Caregivers of Children With Autism You have been selected to participate in this survey based upon your lived experience as either a caregiver or professional who works with children with autism. Your responses will provide valuable information that only comes from those who have lived experience working with children with autism. Your input will inform the process of developing a comprehensive and interactive emergency preparedness guide for children with autism and their caretakers that focuses on emergency sheltering. This survey should take approximately 7 minutes to complete and all answers can be anonymous if you choose. Question Title * 1. Have you provided care to a child with Autism Spectrum Disorder (ASD)? No Yes Question Title * 2. In what capacity was your experience gained? Professional Personal Other (please specify) Question Title * 3. Have you cared for a child with ASD during a disaster? Yes No Question Title * 4. Have you cared for a child with ASD in a temporary mass shelter? No (If no, base future answers on what you would expect) Yes (If yes, base future answers off of lived experiences) Other (please specify) Question Title * 5. Do you have an up to date disaster preparedness plan that your child with ASD understands and has access to? Yes No Other (please specify) Question Title * 6. Scenario for the rest of the questions: You are caring for a child with ASD during a disaster in a temporary mass shelter during a natural disaster.Question: Below is a list of common stressors within a mass shelter that could have an impact on your child if exposed. Rank each stressor on the level of impact it would have on your kid. Use the scale: 0 (no impact) to 10 (severe impact) 0(no impact) 1 2 3 4 5 6 7 8 9 10 (Severe Impact) Bright Lights Bright Lights 0(no impact) Bright Lights 1 Bright Lights 2 Bright Lights 3 Bright Lights 4 Bright Lights 5 Bright Lights 6 Bright Lights 7 Bright Lights 8 Bright Lights 9 Bright Lights 10 (Severe Impact) Crowds Crowds 0(no impact) Crowds 1 Crowds 2 Crowds 3 Crowds 4 Crowds 5 Crowds 6 Crowds 7 Crowds 8 Crowds 9 Crowds 10 (Severe Impact) Loud or consistent Noise Loud or consistent Noise 0(no impact) Loud or consistent Noise 1 Loud or consistent Noise 2 Loud or consistent Noise 3 Loud or consistent Noise 4 Loud or consistent Noise 5 Loud or consistent Noise 6 Loud or consistent Noise 7 Loud or consistent Noise 8 Loud or consistent Noise 9 Loud or consistent Noise 10 (Severe Impact) Lack of Nutritional Options Lack of Nutritional Options 0(no impact) Lack of Nutritional Options 1 Lack of Nutritional Options 2 Lack of Nutritional Options 3 Lack of Nutritional Options 4 Lack of Nutritional Options 5 Lack of Nutritional Options 6 Lack of Nutritional Options 7 Lack of Nutritional Options 8 Lack of Nutritional Options 9 Lack of Nutritional Options 10 (Severe Impact) Change of Routine Change of Routine 0(no impact) Change of Routine 1 Change of Routine 2 Change of Routine 3 Change of Routine 4 Change of Routine 5 Change of Routine 6 Change of Routine 7 Change of Routine 8 Change of Routine 9 Change of Routine 10 (Severe Impact) An Unfamiliar Environment An Unfamiliar Environment 0(no impact) An Unfamiliar Environment 1 An Unfamiliar Environment 2 An Unfamiliar Environment 3 An Unfamiliar Environment 4 An Unfamiliar Environment 5 An Unfamiliar Environment 6 An Unfamiliar Environment 7 An Unfamiliar Environment 8 An Unfamiliar Environment 9 An Unfamiliar Environment 10 (Severe Impact) Forced socialization Forced socialization 0(no impact) Forced socialization 1 Forced socialization 2 Forced socialization 3 Forced socialization 4 Forced socialization 5 Forced socialization 6 Forced socialization 7 Forced socialization 8 Forced socialization 9 Forced socialization 10 (Severe Impact) Question Title * 7. Below is a list of common stressors that can occur within a mass shelter. Select the reaction(s) that your child may have to the corrilating stressor. Increased irritability Hiding Stimming Physical symptoms Run away Yelling Violent behavior Tantrum/Meltdown Emotional withdraw Bright Lights Bright Lights Increased irritability Bright Lights Hiding Bright Lights Stimming Bright Lights Physical symptoms Bright Lights Run away Bright Lights Yelling Bright Lights Violent behavior Bright Lights Tantrum/Meltdown Bright Lights Emotional withdraw Crowds Crowds Increased irritability Crowds Hiding Crowds Stimming Crowds Physical symptoms Crowds Run away Crowds Yelling Crowds Violent behavior Crowds Tantrum/Meltdown Crowds Emotional withdraw Loud or consistent Noise Loud or consistent Noise Increased irritability Loud or consistent Noise Hiding Loud or consistent Noise Stimming Loud or consistent Noise Physical symptoms Loud or consistent Noise Run away Loud or consistent Noise Yelling Loud or consistent Noise Violent behavior Loud or consistent Noise Tantrum/Meltdown Loud or consistent Noise Emotional withdraw Lack of Nutritional Options Lack of Nutritional Options Increased irritability Lack of Nutritional Options Hiding Lack of Nutritional Options Stimming Lack of Nutritional Options Physical symptoms Lack of Nutritional Options Run away Lack of Nutritional Options Yelling Lack of Nutritional Options Violent behavior Lack of Nutritional Options Tantrum/Meltdown Lack of Nutritional Options Emotional withdraw Change of Routine Change of Routine Increased irritability Change of Routine Hiding Change of Routine Stimming Change of Routine Physical symptoms Change of Routine Run away Change of Routine Yelling Change of Routine Violent behavior Change of Routine Tantrum/Meltdown Change of Routine Emotional withdraw An Unfamiliar Environment An Unfamiliar Environment Increased irritability An Unfamiliar Environment Hiding An Unfamiliar Environment Stimming An Unfamiliar Environment Physical symptoms An Unfamiliar Environment Run away An Unfamiliar Environment Yelling An Unfamiliar Environment Violent behavior An Unfamiliar Environment Tantrum/Meltdown An Unfamiliar Environment Emotional withdraw Forced socialization Forced socialization Increased irritability Forced socialization Hiding Forced socialization Stimming Forced socialization Physical symptoms Forced socialization Run away Forced socialization Yelling Forced socialization Violent behavior Forced socialization Tantrum/Meltdown Forced socialization Emotional withdraw Other (please specify) Question Title * 8. Below is a list of common reactions to stressors. Select the intervention(s) that would be helpful in mitigating the correlating reaction.(Scroll to the right for more reaction options) Physical pressure Quiet environment Dark environment Personal space Explanations of circumstance Counseling Stim device Food of choice Electronics (TV/games) Personal items (i.e. toys, blankets..) Increased irritability Increased irritability Physical pressure Increased irritability Quiet environment Increased irritability Dark environment Increased irritability Personal space Increased irritability Explanations of circumstance Increased irritability Counseling Increased irritability Stim device Increased irritability Food of choice Increased irritability Electronics (TV/games) Increased irritability Personal items (i.e. toys, blankets..) Hiding Hiding Physical pressure Hiding Quiet environment Hiding Dark environment Hiding Personal space Hiding Explanations of circumstance Hiding Counseling Hiding Stim device Hiding Food of choice Hiding Electronics (TV/games) Hiding Personal items (i.e. toys, blankets..) Stimming Stimming Physical pressure Stimming Quiet environment Stimming Dark environment Stimming Personal space Stimming Explanations of circumstance Stimming Counseling Stimming Stim device Stimming Food of choice Stimming Electronics (TV/games) Stimming Personal items (i.e. toys, blankets..) Physical symptoms Physical symptoms Physical pressure Physical symptoms Quiet environment Physical symptoms Dark environment Physical symptoms Personal space Physical symptoms Explanations of circumstance Physical symptoms Counseling Physical symptoms Stim device Physical symptoms Food of choice Physical symptoms Electronics (TV/games) Physical symptoms Personal items (i.e. toys, blankets..) Run away Run away Physical pressure Run away Quiet environment Run away Dark environment Run away Personal space Run away Explanations of circumstance Run away Counseling Run away Stim device Run away Food of choice Run away Electronics (TV/games) Run away Personal items (i.e. toys, blankets..) Yelling Yelling Physical pressure Yelling Quiet environment Yelling Dark environment Yelling Personal space Yelling Explanations of circumstance Yelling Counseling Yelling Stim device Yelling Food of choice Yelling Electronics (TV/games) Yelling Personal items (i.e. toys, blankets..) Violent behavior Violent behavior Physical pressure Violent behavior Quiet environment Violent behavior Dark environment Violent behavior Personal space Violent behavior Explanations of circumstance Violent behavior Counseling Violent behavior Stim device Violent behavior Food of choice Violent behavior Electronics (TV/games) Violent behavior Personal items (i.e. toys, blankets..) Tantrum/Meltdown Tantrum/Meltdown Physical pressure Tantrum/Meltdown Quiet environment Tantrum/Meltdown Dark environment Tantrum/Meltdown Personal space Tantrum/Meltdown Explanations of circumstance Tantrum/Meltdown Counseling Tantrum/Meltdown Stim device Tantrum/Meltdown Food of choice Tantrum/Meltdown Electronics (TV/games) Tantrum/Meltdown Personal items (i.e. toys, blankets..) Emotional withdraw Emotional withdraw Physical pressure Emotional withdraw Quiet environment Emotional withdraw Dark environment Emotional withdraw Personal space Emotional withdraw Explanations of circumstance Emotional withdraw Counseling Emotional withdraw Stim device Emotional withdraw Food of choice Emotional withdraw Electronics (TV/games) Emotional withdraw Personal items (i.e. toys, blankets..) Physical withdraw Physical withdraw Physical pressure Physical withdraw Quiet environment Physical withdraw Dark environment Physical withdraw Personal space Physical withdraw Explanations of circumstance Physical withdraw Counseling Physical withdraw Stim device Physical withdraw Food of choice Physical withdraw Electronics (TV/games) Physical withdraw Personal items (i.e. toys, blankets..) Other (please specify) Question Title * 9. Considering the answers in the table, fill in the blanks below with up to 5 items that were or would be beneficial to mitigating stress for a child with ASD in a mass shelter. (i.e. weighted blanket, and headphones) 1 2 3 4 5 Question Title * 10. Provide up to 3 preparedness tips would you suggest for a caregiver of a child with ASD if having to seek emergency mass shelter 1 2 3 Question Title * 11. For those who have cared for a child with ASD in a mass shelter:What knowledge or resources do you wish you had before entering the shelter? Done