Preliminary Questionnaire

Research* for children over seven years of age has shown that answering YES on seven or more of the questions below indicates that further investigation for underlying neuro-developmental delay is advisable.

  • For adults please answer the questions as if you were your 10-year-old self. You may need to consult your own parents for some of the answers.

  

  1. Is there any history of learning difficulties in your immediate family?                 

  2. Were there any medical problems during the pregnancy?

  3. Was the birth process unusual or prolonged in any way?

  4. Was your child born early or late for term (more than two weeks early or more than 10 days late)?

  5. Was the birth process unusual or prolonged in any way?

  6. Was your child’s birth weight below 5 lbs?

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

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

  9. Did your child miss out on the "motor stage" of crawling on his or her tummy and creeping on hands and knees)?

  10. Was your child late at learning to walk (16 months or later would be considered late)?

  11. Was your child late at learning to talk (2-3 word phrases at 18 months or later would be considered late)?

  12. Did your child have difficulty in, for example, learning to dress himself or herself, do up buttons or tie shoelaces beyond the age 6 – 7 years?

  13. Does your child suffer from allergies?

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

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

  16. Did your child continue to wet the bed, albeit occasionally, above the age of 5 years?

  17. Does your child suffer from travel sickness?

  18. Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock?

  19. Did your child have an unusual degree of difficulty learning to ride a bicycle?                                

  20. Did your child suffer from frequent ear, nose, throat or chest infections?

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

  22. Does your child have difficulty catching a ball, and stand out as ‘awkward’ in PE classes?

  23. Does your child have difficulty sitting still for even a short period of time?

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

  25. Does your child have reading difficulties?

  26. Does your child have writing difficulties?

  27. Does your child have copying difficulties? 

 

  • published in The British Journal of Occupational Therapy, October 1998

 

Contact Moni to arrange for a free 30 mins phone discussion to see if this therapy is suitable for you or your child 

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