Suspected difficulties

Please answer the questions about your child. Please think about how your child usually behaves. If you have seen your child do the behavior a few times, then please answer  no . Please put  yes  or  no  for each question.

M-CHAT-RTM (Autism Questionnaire)

  1. If you point to something across the room, will your child look at it?
    eg  if you show a toy or animal, does the child look at the toy or animal?)
  1. Have you ever wondered if your child might be deaf?
  1. Does your child role play or pretend play?
    eg  does he pretend to drink from an empty glass, pretend to talk on the phone, or pretend to feed a doll or stuffed animal?)
  1. Does your child like to climb on things?
    e.g.  furniture, playground equipment, stairs)
  1. Does your child make unusual finger movements near their eyes?
    eg  does the child move his fingers near his eyes?)
  1. Does your child point with one finger to ask for something or to ask for help?
    eg  is he showing a snack or a toy that he can’t reach?)
  1. Is your child pointing with one finger to show you something interesting?
    eg  showing a plane in the sky or a large truck on the road)
  1. Is your child interested in other children?
    eg  does your child watch other children, smile at them or go to them?)
  1. Does your child show you things by bringing them to you or holding them up to show you – not to help but to share?
    eg  showing you a flower, a stuffed animal or a toy truck)
  1. Does your child respond when you call their name?
    eg  when you say his name, does he look up, talk or babble or stop what he’s doing?)
  1. When you smile at your child, does he smile back?
  1. Is your child irritated by everyday noises?
    eg  does your child scream or cry to noise such as a vacuum cleaner or loud music?)
  1. Is your child walking?
  1. Does your child look you in the eye when you talk to them or play with them or when you dress them?
  1. Does your child copy you, imitate what you do?
    eg  waving hello, clapping, making funny noises when you do too)
  1. If you turn your head to look at something, does your child look around to see what you see?
  1. Is your child trying to get you to look at them?
    eg  does your child look at you for praise or say “look” or “look at me”?)
  1. Does your child understand when you tell him to do something?
    eg  without pointing, can your child understand “put the book on the chair” or “bring me the blanket”?)
  1. If something new happens, does your child look you in the face to see how you feel about it?
    eg  if he hears a strange or funny noise or sees a new toy, will he turn to look at you?)
  1. Does he like physical activities?
    eg  swing it or swing it on your knee?

Dyspraxia Questionnaire

  1. He is afraid to go up or down stairs
  2. He has difficulty recognizing simple everyday objects that are in his pocket or hidden
  3. Shows discomfort in object textures
  4. He doesn’t remember or understand what we ask him
  5. Difficulty learning new concepts
  6. It is difficult for him to engage in motor games
  7. Poor drawing skills
  8. More talking than performing an activity
  9. He has difficulty coordinating his movement
  10. Difficulty with activities of daily living (eg putting on/taking off clothes, personal hygiene)

Dysgraphia Questionnaire

  1. Does he hold the pencil with an improper grip?
  2. Does he constantly turn the paper as he writes or draws?
  3. Does he hold the pencil too tightly or too loosely?
  4. Forms the letters by mirroring or reversing them
  5. Are words or letters not properly spaced?
  6. Does he capitalize and lowercase the same word, eg child?
  7. Does he take too long to write a word or sentence?
  8. Ugly picture of writing due to smudges?
  9. Are the letters not stepping on the lines?
  10. Does he start drawing or writing from the right?