Rivermead Gate Medical Centre

01245 348688

Email: mseicb-me.rmgadmin@nhs.net

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Social communication skills questionnaire (Adults)

Please note that these forms are for registered patients of Rivermead Gate Medical Centre only.  Any form received for patients not registered at this Practice will be destroyed.

Date of birth(Required)

Social Communication / Interactions and Emotions

Please read the following questions about your life at present and select the most relevant answer, ‘yes’ or ‘no’. There is a section at the end of the questionnaire for you to add in or share any further information.
Do you find it comfortable initiating/starting a conversation?(Required)
Do you find it comfortable maintaining a two-way conversation?(Required)
Do you find making eye contact comfortable?(Required)
Is it easy for you to read what other people might think or feel from their facial expressions?(Required)
Are you able to easily understand the emotions of others?(Required)
Do you feel comfortable showing empathy towards others or feel confident knowing what to say when someone is upset?(Required)
Is it easy for you to understand your own emotions?(Required)
Is it easy for you to regulate and manage your emotions? (Differences in this may result in experiencing intense emotions that are then hard to regulate, such as anxiety)(Required)
Do you find it easy interpreting social cues? (Differences in this may lead to confusion/misunderstanding in social situations)(Required)
Do you find it easy/comfortable making friends?(Required)
Do you find it easy/comfortable developing close connections with people?(Required)
Do you currently have any friends?(Required)
Are you currently in a relationship/marriage?(Required)
Have you found it easy/comfortable developing romantic relationships with people?(Required)
Do you enjoy socialising with others?(Required)
Do you feel like you can be yourself when with others? (Differences with this can result in ‘masking’, adopting different personas or imitating behaviours of others)(Required)
When you do socialise, does this feel easy/comfortable/energising? (Differences with this can result in socialising feeling very tiring, often needing time alone after)(Required)
Do you feel comfortable in social situations, such as talking to strangers, talking on the phone, paying for items in shops etc?(Required)
Did you find it easy asking for help when you were at school?(Required)
Have you ever had a job/employment?(Required)
If you currently have a job or have had a job in the past, has this been easy for you to maintain?(Required)
If you work in a team, does it feel comfortable approaching colleagues to ask questions, discussing any difficulties, asking for help etc?(Required)
Are you able to identify when you may need medical assistance such as seeing a doctor?(Required)
Do you make appointments independently, such as doctor, dentist etc?(Required)
Do you seek support in difficult situations that may have occurred in your life?(Required)
Do you independently manage your finances?(Required)
Do you feel your executive functioning skills are similar to other people? (Executive functioning can include memory, planning, organisation, emotional control, flexible thinking etc?)(Required)

Routines and change

Please read the following questions about your life at present and select the most relevant answer, ‘yes’ or ‘no’. There is a section at the end of the questionnaire for you to add in or share any further information.
Have you found big changes in your life difficult, such as going to college/university/starting a new job etc?(Required)
Is it important for you to have set routines in your life?(Required)
If you do have set routines and these are disrupted, would you find this difficult to manage/would it result in you feeling disregulated?(Required)
Is it important for you to know what is happening in your day and at what time etc?(Required)
Do you find it difficult when there is a plan and this then changes?(Required)
Do you spend time researching/looking up new places to help you prepare for this?(Required)
Do you find it difficult if other people touch or move your personal belongings?(Required)
Do you ever like to eat the same foods repetitively?(Required)

Interests

Please read the following questions about your life at present and select the most relevant answer, ‘yes’ or ‘no’. There is a section at the end of the questionnaire for you to add in or share any further information.
Do you have any particular interests that take up a lot of your time and thoughts or are very important to you, such as gaming, music, history, animals, anime, arts and crafts etc?(Required)
Do you like to collect anything? Or did you collect anything when you were a child?(Required)
Do you ever like to watch the same films, TV series, programmes repetitively? Or do you play the same games repetitively?(Required)
Do you like to research about facts?(Required)

Sensory sensitivities

Please read the following questions about your life at present and select the most relevant answer, ‘yes’ or ‘no’. There is a section at the end of the questionnaire for you to add in or share any further information.
Do you find loud noises difficult?(Required)
Do you find busy places difficult/overwhelming?(Required)
Do you find certain types of clothing difficult to wear, due to how their textures feel?(Required)
Have you ever had difficulties with self-care, such as hair care, teeth brushing, showering etc, due to how they feel?(Required)
Do you avoid eating certain foods due to their textures?(Required)
Do you find yourself being bothered by repetitive sensory stimuli such as repetitive noises, movements etc?(Required)
Do you find yourself reacting strongly to certain smells that other people may not notice or be bothered about?(Required)
Do you have any stimming behaviours or mannerisms, such as hand and finger movements, leg jiggling etc?(Required)

Further information

Not for urgent medical help(Required)
Consent(Required)

Date published: 26th March, 2024
Date last updated: 4th July, 2024