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Diagnostic Checklist Form E-2 and Research Questionnaire Form E-3

Diagnostic Checklist Form E-2 and Research Questionnaire Form E-3
A high-priority goal of the Autism Research Institute (ARI) is the development of improved methods of diagnosing children with severe behavior disorders, since most medical research is highly dependent upon accurate diagnostic methods. Our Diagnostic Checklist, Form E-2, has been designed for this purpose. In addition, the Form E-2 checklist asks parents to rate the effectiveness of various interventions they have tried on their son/daughter. Information on the effectiveness of interventions is compiled on a regular basis and is shared with families and professionals throughout the world.

Form E-2 is available on request in English, French, Spanish, Portuguese, German, Italian, Hebrew, Japanese, Turkish and Serbo-Croation. Our files contain information on over 35,000 children from more than 60 countries. Our service to researchers depends in part on our having a comprehensive bank of up-to-date information about children with these severe disorders. Your help in completing the E-2 checklist and submitting them to ARI will be greatly appreciated.

Diagnosis. The responses on Form E-2 are entered into a computer which calculates a diagnostic score. The score along with its interpretation is sent to the person or agency submitting the checklist. In addition, a file number is assigned to each child for data recording and analysis, and to ensure confidentiality. There is no charge for this service.  It usually takes a week to get your report back.

Form E-3, a supplement to Form E-2, contains additional questions which are designed to explore a number of leads which have been uncovered in our search for the causes of severe behavior disorders in children. Form E-3 is sent to families upon completion of Form E-2. Note: there is no score derived from Form E-3; and therefore, there is no individualized report. An interesting and informative paper about autism is sent to the person or agency submitting a completed E-3 form as a token of our appreciation. Additionally, the information about your child will be kept permanently in our computer databank, so that it will be possible to contact you if future research produces relevant diagnostic or treatment implications.

If you would like to complete the Diagnostic Checklist Form E-2, you can download and print the checklist (Adobe pdf file), and then mail it to the Autism Research Institute, 4182 Adams Ave., San Diego, CA 92116.

Download the PDF file

You can also order the checklist from the ARI Information Request Form.

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