Self Screening questionnaire

Click on the box if the question is relevant in the case of your child.

If you have checked a total of 6 or more boxes then it would be worthwhile contacting me.

Is there a history of learning, co-ordination or behavioural  difficulties in your family?

Were there any medical problems during the pregnancy?

Was the birth process unusual or prolonged?

Was your child born early or late for term (more than 2 weeks early or late)?

Was your child's birth weight below 5 lbs ?

Did your child have any difficulty feeding in the first weeks of life?

Was your child extremely demanding in the first 6 months of life, needing little sleep?

Did your child miss the crawling on  tummy and creeping on hands and knees?

Was your child late at learning to walk (16 months or later)?

Was your child late at learning to talk ?

Did your child have difficulty in learning to dress, to do up buttons or tie shoelaces ?

Does your child suffer from allergies?

Did your child suck his or her thumb beyond the age of 5 years?

Did your child continue to wet the bed above the age of 5 years?

Does your child suffer from travel sickness?

Did your child find it very difficult to learn to tell the time from a traditional clock?

Did your child find it very difficult learning to ride a two wheeled bicycle?

Did your child suffer from frequent ear, nose and throat infections?

In the first 3 years of life, did your child suffer from any illnesses involving extremely high
temperature, delirium or convulsion?

Does your child have difficulty catching a ball?

Does your child have difficulty sitting still in the classroom, or the home?

Does your child tend to over-react to sudden unexpected noises ?

Does your child have reading difficulties?

Does your child have writing difficulties?

Does your child have difficulties copying from the board?

Is your child the classroom 'chatterbox'?

Does your child constantly 'butt in'?

Does your child find it difficult to wait in turn?

Does your child have difficulties following a series of instructions?

Does your child have problems with concentration?

Is your child very impulsive, finding it hard to stay within the rules of the home or school?

Does your child regularly have dark rings under the eyes after school?

Does your child appear to go 'hyper' after sugar, or need sugar regularly?

Do you think that your child is difficult to manage?