Questionnaire

Learning Clinic Child Screening Questionnaire

Research (published in the British Journal of Occupational Therapy 1998) has shown that a score of 7 or more “YES” answers on the questionnaire below indicates that futher investigation for underlying neuro-developmantal delay is advised for children over 7 years of age

  1. (required)
  2. (valid email required)
  3. Were there any medical problems during the pregnancy?

  4. Was the child born either before or after term (more than 2 weeks early or more than 10 days late)?

  5. Were there any complications at birth e.g CS, forceps, breech presentation?

  6. Was your baby small for term (birth weight below 5Lbs) ?

  7. Did your child have any difficulty in the first few weeks of life feeding, sucking or keeping down food?

  8. Was your child extremely demanding in the first 6 months of life?

  9. Did your child miss out on crawling?

  10. Was your child slow at learning to walk (normally 12 to 16 months) ?

  11. Did your child experience speech difficulties?

  12. Was your child prone to Ear/ Nose/ Throat problems?

  13. In the first 3 years of life, did your child have any serious illness or incidents involving high temperature and/or convulsions ?

  14. Did your child have an adverse reaction to any of his or her vaccinations?

  15. Does your child have allergies ?

  16. Did your child thumb suck beyond the age of 5 years?

  17. Did your child experience bedwetting after 5 years of age?

  18. Does your child suffer from travel sickness?

  19. Did your child have difficulty in learning to dress or tie shoelaces?

  20. Did your child have difficulty learning to read a clock face?

  21. Did your child have difficulty learning to ride a bike?

  22. Does your child have difficulty catching a ball?

  23. Does your child find it difficult to sit still or is easily distracted?

  24. If there was a sudden unexpected noise, does your child over-react?

  25. Does your child experience regular headaches?

  26. Does your child have reading difficulties?

  27. Does your child have writing difficulties?

  28. Does your child have copying difficulties?

  29. Does your child have difficulties organising school work or completing home work?

  30. Is there any history of reading difficulties in the family?

  31. Captcha


 





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