The NutriGenetic Research Institute is conducting a research study to determine if genomic functional pathways are impaired in Autism Spectrum Disorder (ASD) and PANS/PANDAS. The purpose of this study is to investigate the possible correlation of genetic variants with those dealing with ASD and PANS/PANDAS and how that relates to the production of a free radicals, antioxidants, methylation, sulfation and the creation and usage of NADPH. Check out the video below to learn more!

 
 

To participate in this study, you must complete the following steps:

  1. Fill out this attached file and this form and send them to research@tolhealth.com

  2. Fill out the questionnaire below and hit submit

  3. Provide your 23andMe Version 4 raw data file, or an existing Your Genomic Resource raw data file. 23andMe Version 4 raw data files can be emailed to research@tolhealth.com no later than August 15th.

At no time will your name or health information be given out. You are free to use an alias to keep complete confidentiality. By participating in this study, you will be provided with a copy of your functional nutritional genetic report free of charge and will also be provided with the results of the research.

 

Questionnaire

Please fill out the form below. The rating scale is as follows:

0 = Not True 1 = Somewhat True 2 = Very True

Name of Participant *
Name of Participant
Date of Birth *
Date of Birth
Speech/Language/Communication
Knows own name
Responds to 'No' or 'Stop'
Can follow some commands
Can use one word at a time (No, Eat, Water, etc.)
Can use 2 words at a time (Don't want, Go home)
Can use 3 words at a time (Want more food)
Knows 10 or more words
Can use sentences with 4 or more words
Explains what he/she wants
Speech tends to be meaningful/relevant
Often uses several successive sentences
Carries on fairly good conversation
Has normal ability to communicate for his/her age
Sociability
Seems to be in a shell - you cannot reach him/her
Ignores other people
Pays little or no attention when addressed
Uncooperative and resistant
No eye contact
Prefers to be left alone
Shows no affection
Fails to greet parents
Avoids contact with others
Does not imitate
Dislikes being held/cuddled
Does not share or show
Does not wave goodbye
Disagreeable/not compliant
Temper tantrums
Lacks friends/companions
Rarely smiles
Insensitive to other's feelings
Indifferent to being liked
Indifferent if parent(s) leave
Sensory/Cognitive Awareness
Responds to own name
Responds to praise
Looks at people and animals
Looks at pictures and T.V.
Does drawing, coloring, art
Plays with toys appropriately
Appropriate facial expression
Understands stories on T.V.
Understands explanations
Aware of environment
Aware of danger
Shows imagination
Initiates activities
Dresses self
Curious, interested
Venturesome - explores
"Tuned in" - Not spacey
Looks where others are looking
Health/Physical/Behavior
Bed-wetting
Wets pants/diapers
Soils pants/diapers
Diarrhea
Constipation
Sleep problems
Eats too much/too little
Extremely limited diet
Hyperactive
Lethargic
Hits or injures self
Hits or injures others
Destructive
Sound-sensitive
Anxious/fearful
Unhappy/crying
Seizures
Obsessive speech
Rigid routines
Shouts or screams
Demands sameness
Often agitated
Not sensitive to pain
"Hooked" or fixed on certain objects/topics
Repetitive movements (stimming, rocking, etc.)