Before You Book- fill out this form Autism WheelWe’d love to have you join our Autism First Aid CourseLet’s start with your nameName Please rate each of the following by selecting a number from 1 to 10, with 1 being very true for you and 10 being not true at all. FidgetsI need to fidget or stim in order to regulate myself. I fidget constantly. 1 2 3 4 5 6 7 8 9 10 Eye ContactI struggle to make eye contact & am overwhelmed when people expect that from me. 1 2 3 4 5 6 7 8 9 10 FixationsI have special interests that I am totally obsessed with, which means I can’t focus on other things. 1 2 3 4 5 6 7 8 9 10 Sensory NeedsI have sensory issues with noise, touch, smell, or other things. 1 2 3 4 5 6 7 8 9 10 AnxietyI worry a lot & it can stop me from doing things I really want to do. 1 2 3 4 5 6 7 8 9 10 Social SkillsI struggle to read other people’s behavior & often don’t know how to respond, or I can appear rude or weird. 1 2 3 4 5 6 7 8 9 10 Behaviour SkillsI can have meltdowns, or act out if I am overwhelmed or unsure. I have severe meltdowns lasting hours. 1 2 3 4 5 6 7 8 9 10 SpeechI can struggle with finding the right words; some people find me hard to understand. 1 2 3 4 5 6 7 8 9 10Finish
