INPP Screening Questionnaire
Email *
Telephone number
Your name
Your child's name
Your child's date of birth
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
Clear selection
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?
Clear selection
Any additional information
What is 2 x 3? *
A copy of your responses will be emailed to the address you provided.
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