Research (published in The British Journal of Occupational Therapy, October 1998) has shown that a score of 7 or more ‘yes’ answers on the questionnaire below indicates that further investigation for underlying neuro-developmental delay is advised for children over 7 years of age.
| Is there any history of learning difficulties in your immediate family? |
YesNo |
| Were there any medical problems during the pregnancy? |
YesNo |
| Was the birth process unusual or prolonged in any way? E.g. Caesarean Section, Forceps, etc |
YesNo |
| Was your child born early or late for term (more than 2 weeks early or more than 10 days late)? |
YesNo |
| Was your child's birth weight below 5lbs (pounds)? |
YesNo |
| Did your child have any difficulty feeding in the first weeks of life, or in keeping food down? |
YesNo |
| Was your child extremely demanding in the first 6 months of life? |
YesNo |
| Did your child miss out the 'motor stage' of crawling on his or her tummy and creeping on hands and knees? |
YesNo |
| Was your child late at learning to walk (16 months or later would be considered late)? |
YesNo |
| Was your child late at learning to talk (2-3 word phrases at 18 months or later would be considered late)? |
YesNo |
| Did your child have difficulty in learning to dress himself or herself, for example, do up buttons or tie shoelaces beyond the age of 6-7 years? |
YesNo |
| Does your child suffer from allergies? |
YesNo |
| Did your child have an adverse reaction to any of his or her vaccinations? |
YesNo |
| Did your child suck his or her thumb beyond the age of 5 years? |
YesNo |
| Did your child continue to wet the bed, albeit occasionally, above the age of 5 years? |
YesNo |
| Does your child suffer from travel sickness? |
YesNo |
| Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock? |
YesNo |
| Did your child have an unusual degree of difficulty learning to ride a bicycle? |
YesNo |
| Did your child suffer from frequent ear, nose, throat or chest infections at any time in development? |
YesNo |
| In the first 3 years of life, did your child suffer from any illnesses involving extremely high temperatures, delirium or convulsion? |
YesNo |
| Does your child have difficulty catching a ball, doing forward rolls/somersaults and stand out as 'awkward' in PE classes? |
YesNo |
| Does your child have difficulty sitting still for even a short period of time? |
YesNo |
| If there is a sudden unexpected noise, does your child over-react? |
YesNo |
| Does your child have reading difficulties? |
YesNo |
| Does your child have writing difficulties? |
YesNo |
| Does your child have copying difficulties? |
YesNo |
| Has your child had a diagnosis? |
YesNo |
Has someone referred you to us? |
YesNo |
