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in case anyone is interested...

" Why is it that everytime I think I know the answers, someone goes and changes

the questions?? " - Fox Mulder

STUDENT AT S.I. TECHNICAL HS NEEDS OUR HELP

Dear Parents,

I received a call from a wonderful student at S.I. Technical H.S. She has

reached out to the Autism Foundation of New York because she has chosen to do a

research paper about autism. If you feel comfortable completing this survey,

please do so as soon as possible. All replies are to be sent directly to:

Ariana Cannavo

Staten Island Technical High School

at the following e-mail address: Mjmobl726@...

Thank you for taking the time to help this student. As a parent of a child with

autism, I find it to be very encouraging that high school students (our future

teachers, scientists, physicians, etc.) are looking into the causes of autism.

Maureen Kavanaugh

Outreach Coordinator

* The Autism Foundation of NY e-mail list is confidential. It will not be

shared or sold to other sources.

********************************************************************************\

****

Dear Parent,

I am a student at Staten Island Technical High School. I am doing a research

project on the cause of autism. My teacher suggested that I hand out a survey. I

do realize that the number of people affected by autism is growing each year. I

think it is very important that a cure be found as soon as possible. I want to

thank you for helping me in this project. My goal is not to offend your privacy,

but hopefully to gain an insight into autism and contribute to the ultimate

understanding and cure of this condition.

1. Did you have a normal pregnancy?

Yes/No

2. Were you using any prescription drugs while pregnant?

Yes/No

3. Was the birth a cesarean section?

Yes/No

4. Was the child healthy at birth?

Yes/No

5. Was the child given any drugs after birth?

Yes/No

6. Did you take drugs, consume alcohol, etc. while pregnant?

Yes/No

If so… which? ____________

7. When were the symptoms first noticed? What was the age of your child?

________

8. Were vaccinations taken before symptoms were noticed?

Yes/No

9. Does you child have any other serious medical problems?

Yes/No

10. How serious is your child's case of autism?

_________

11. Has the case become worse or better over time?

Yes/No

12. Was your child seriously injured at any time?

Yes/No

13. Did anything dramatic happen in his/her life at any time?

Yes/No

14. Did your child have any other serious illnesses before autism was detected?

Yes/No

15. Do you have any other children? Are they autistic?

__________ ____________

16. Are there other cases of autism in your family?

Yes/No

17. Are there any serious illnesses in your family?

Yes/No

18. Is your child a twin, triplet, etc.?

Yes/No

If so… _______

19. Does your child still receive vaccinations?

Yes/No

20. Was your child vaccinated in a single dose?

Yes/No

21. What observations, if any, did you make about changes in your child's

awareness and overall development after vaccination?

____________________________________________________

22. Were symptoms noticed before vaccination?

____________________________________________________

23. Does your child have any allergies?

Yes/No

24. Do you personally think there may be a link between autism and the

vaccinations?

Yes/No

25. Were there any complications during your pregnancy?

Yes/No

26. Were there any complications at birth?

Yes/No

27. Were there any complications during delivery?

Yes/No

28. Does your child have any physical disabilities?

Yes/No

29. Did your child reach all normal milestones prior to any diagnosis of autism?

Yes/No

30. Did your child reach all normal milestones at age 1? ________

at age 2? __________

at age 3? __________

31. Does your child have any allergies to food, pets, household items

(detergents, etc.), milk/dairy?

Yes/No

If so…__________________

32. Did your child take any antibiotics?

If so- how many up to age 1? ________

age 2 __________

age 3 __________

How often were they given?

___________________

33. When was your child first diagnosed?

__________

34. Did any doctors or specialists ever tell you that your child did not have

autism?

Yes/No

35. Do you have an opinion as to the cause of autism?

If so… _________________________________________________

_______________________________________________________

In your child specifically?

If so… _________________________________________________

Please add any additional comments you feel may be helpful…

Thank you very much for your time. I am very grateful for your contribution to

this project and to my better understanding of this condition.

Sincerely,

Ariana Cannavo

Staten Island Technical High School

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