12 Ques: Tick appropriate Reasons for Communication Problems with Rheab Professional
Miscommunication, No Communication, Misunderstanding, Delayed Communication, Incorrect Communication Methods, Undecided
13 Ques: Are you interested in preparing books/ websites/ community network for better representation of mentally challenged children in civil society?
Strongly Agree Agree Undecided Strongly Disagree Disagree
14 Ques: Status of Sense of humour
Smiles Occasionally laughs Sad Silent Emotionless
15 Ques: How much money do u spend in a month on your special child?
<3000Rs 3-5000Rs5-7000Rs 7-10,000Rs >10,000
16 Ques: What do u like most about him
innocent love my biological bond Godliness Innocense Purity
17 Ques: How has he changed over the years
Little Psychological Change No Change only Biological Change Some
18 Ques: Does your child have any other disability other than mental illnesss?
Autism Physical disability Inability to read
19 Ques: On the Scale of 10, Please assess:
Collective Level of Excellence, Individual’s General Level of Excellence, Team Player Attitude, Career Guidance and Support, Professional Development, Human Resource Development
20 Ques: Any repeated problem faced by you…
21 Ques: Are we able to leverage maximum out of existing facilities in this sector?
Strongly Agree Agree Undecided Strongly Disagree Disagree
23 Ques: As parents do u have a Do you have a control on kind of projects you want to select? In other words are you satisfied with Plan
8 Ques:
9ning teams formation for particular project?
Strongly Agree Agree Undecided Strongly Disagree Disagree
24 If he could hear and understand you completely, what would you like to say?
convey my love
25 Where would you rate yourself (Out of 100) in managing your child?
<40, 40-60, 60-80 80-100 incompetent Best my child can get
26 If you have more than one child, is he/she also suffering from any disability?
Yes No
27 What is your perspective on reason for illness of your child?
Poor Care of Wife while Pregnancy Because of my husband Karmas of Past Birth
God’s wish My good deeds of this birth Genetic Accident Blessing
28 Ques: What is your greatest strength in survival of difficult days?
Religion Family Love for my Child My significant other half
29 Do you think movies like Black, Taare Zameen par has helped better understanding of our case?
Yes No
30 Ques: What does he needs (give options)
<40% | 40-55% | 56-70% | 71-85% | No Comments
31 Rate the your top 3 important reasons while selecting school for your child?
Time, Cost, Scope, Risk Quality Stakeholder, Progress
32 Ques: If you could say something to you, what would you like to hear from him?
I love you Nothing
33 Any specific suggestion/changes you would like to see in our country?
34 Ques: What should society do about such children?
Make a special place for them Government should fund/support
35 Ques: Is our society sensitive towards such children?
Strongly agree agree disagree strongly disagree undecided no comments
36 Ques: What makes him laugh?
My presence TV touch smell playing
37 Ques: What makes him cry?
My absence, Loud Noise Undecided
38 Ques: His favourite music/sound?
TV Jingles Clapping
39 Ques What is his favourite food
Sweet, Sour, Buiscuits, Chocolate, OR ______parents can also give option
40 Ques: What was Is your most touching movement with him
(give detailed answer)
41 Ques: At what age did u realized his illness
<12 Months 1-2 years 2-3 Years 4+years
42 Ques: How did u realised his illness
Comparison with other children From an experienced parent from professionals from school teachers From doctor
43 Ques: any accidents / unwanted event happened with him?
0-3 3-5 5+
44 Ques: What accidents happened most
he got lost fits cries a lot
45 Ques: Select keywords that are applicable to him
Silent Speechless Divine My child Bundle of Love Burden
46 Ques: Would you like to have him as your child again
Strongest Yes Yes No Undecided
47 Ques: How has he affected your life?
Full of Challenges Full of Love Interesting
48 Ques: How would you describe your relationship with him
divine, difficult, Challenging nameless
49 Ques: Tick the top 3 challenges that you have faced while raising your special child
Communication
50 Ques: How would you rate professionals in this field caring/supporting enough?
Strongly agree agree disagree strongly disagree undecided no comments
52 Ques: Select from following adjectives that describe such kids
53 Ques: Your funniest or most memorable event with him
(detailed answer type)
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End of Survey
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