INPP Screening Questionnaire
Email address *
Telephone number
Your answer
Your name
Your answer
Your child's name
Your answer
Your child's date of birth
Your answer
Is there any history of learning difficulties in your immediate family? *
1 point
Were there any medical problems during the pregnancy? *
1 point
Was your child born early or late for term? [More than 2 weeks early or more than 10 days late] *
1 point
Was the birth process unusual or prolonged in any way? eg. Caesarian, forceps etc. *
1 point
Was your child's birth weight below 5 lbs (pounds)? *
1 point
Did your child have any difficulty feeding in the first weeks of life, or in keeping food down? *
1 point
Was your child extremely demanding in the first 6 months of life? *
1 point
Did your child miss out the 'motor stage' of crawling on his/her tummy and creeping on hands and knees? *
1 point
Was your child late at learning to walk? [16 months or later would be considered late]
1 point
Did your child have difficulty in learning to dress beyond the age of 6-7 years? eg. doing up buttons or tying shoelaces. *
1 point
Does your child suffer from allergies? *
1 point
Did your child have an adverse reaction to any of his or her vaccinations? *
1 point
Did your child suck his or her thumb beyond the age of 5 years? *
1 point
Did your child continue to wet the bed, albeit occasionally, above the age of 5 years? *
1 point
Does your child suffer from travel sickness? *
1 point
Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock? *
1 point
Did your child have an unusual degree of difficulty learning to ride a bicycle? *
1 point
Did your child suffer from frequent ear, nose, throat or chest infections at any time in development? *
1 point
In the first 3 years of life, did your child suffer from any illnesses involving extremely high temperatures, delirium or convulsion? *
1 point
Does your child have difficulty catching a ball, doing forward rolls/somersaults and stand out as 'awkward' in PE classes? *
1 point
Does your child have difficulty sitting still for even a short period of time? *
1 point
If there is a sudden unexpected noise, does your child over-react? *
1 point
Does your child have reading difficulties? *
1 point
Does your child have writing difficulties? *
1 point
Does your child have copying difficulties? *
1 point
Has your child had a diagnosis?
Any additional information
Your answer
What is 2 x 3? *
Your answer
A copy of your responses will be emailed to the address you provided.
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