Measure of Foundational Abilities - Preschool
Directions:

Please answer the following questions based on this student's typical behavior during the past month. Use the following rating scale :

Never: the behavior never or almost never happens
Occasionally: the behavior happens some of the time
Frequently: the behavior happens much of the time
Always: the behavior always or almost always happens
Email address *
Name of Preschooler *
Your answer
Name of Parent/Caregiver *
Your answer
Date of Birth of Preschooler *
MM
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Balance, Gross & Fine Motor Control
Consistently walks on tiptoes *
Avoids movement activities (swings, climbing, playground activities) *
Bumps into people/objects; gets too close to others; is unaware of personal space *
Exhibits poor endurance, is weak and tires easily, avoids physical activity *
Seems clumsy, awkward, or accident prone *
Demonstrates poor eye-hand coordination *
Has difficulty with combining or remembering next movement in a sequence *
Avoids playing with toys that require increased dexterity (fine motor manipulation *
Has difficulty catching things *
Exhibits poor balance and falls easily, avoids balance-related activities (scooter, teeter totter *
Demonstrates a poor sense of rhythm, timing *
Has difficulty learning fine motor tasks, such as using crayons, building blocks or scissors *
Has difficulty learning new motor activities (tricycle, swimming, throwing, catching, climbing *
Sensory
Seems bothered by textures on body (i.e. sticky items, clothing fabrics/tags) *
Resists dressing or seems uncomfortable in certain clothes; has preferences for clothing textures *
Avoids messy play; does not like face, hands, or feet to be dirty *
Avoids many foods and/or foods with varying textures, such as fruit in yogurt or nuts in a candy bar *
Bothered by background noise (i.e., humming of lights, computers, fans) *
Bothered by loud and/or unexpected sounds, such as door closing loudly, flushing toilet, fire alarm, vacuum *
Doesn't like being touched/over responds to unexpected touch/bumps. *
Doesn't notice pain or has a slow response to pain when hurt *
Plays too roughly; hurts others inadvertently *
Constantly on the move; seeks intense, crashing or rough play *
Avoids sustained eye contact *
Doesn't seem to notice external sensory stimuli (touch, smells, noise) *
Has an activity level that seems unusually high *
Has an activity level that seems unusually low *
Social Emotional
Seems irritable, short-tempered *
Is easily overwhelmed, frustrated by daily activities *
Appears emotionally intense in most activities *
Has frequent mood fluctuations *
Seems easily upset/hurt; takes a long time to recover *
Does not transition smoothly from one activity to another (going from reading group to recess, etc.) *
Has difficulty making and keeping friends *
Lacks confidence with new environments and new tasks *
Is not affectionate, not touching or hugging *
Avoids social situations; prefers to be alone *
Seems overly possessive with belongings; doesn't share well *
Responds with exaggerated emotion to external sensory stimuli *
Auditory / Language
Has difficulty following what others are saying *
Says “What?” or “Huh?”, needs instructions repeated, prefers visual cues *
Has a delayed response with reacting to speech/directions *
Dislikes shrill sounds, or popping sounds, such as intercom, fire alarms *
Has difficulty determining from what direction a sound is coming *
Confuses similar sounding words, such as 'mouth' and 'mouse' *
Is difficult to understand; doesn’t speak clearly; mumbles *
Speaks with monotone voice *
Has difficulty identifying and distinguishing between different sounds or letters *
Has difficulty rhyming words *
Needs hands-on or visual instructions along with verbal *
Is unable to recall the number of letters, numbers, or words in a series equivalent to his/her peers *
Has difficulty responding to simple questions (who, what, where) *
Has difficulty listening to short stories and is unable to maintain attention to favorite ones *
Is unable to remember two to three verbal instructions at a time to complete a sequence or task *
Is unable to complete two unrelated commands (e.g., "Put your book away and stand in line.") *
Organization / Attention / Cognitive
Has difficulty getting/finding back pack, jacket, materials to take home *
Needs frequent redirection and/or refocusing toward task at hand *
Gazes into space/appears to be in own world *
Has difficulty self-regulating actions and/or emotions *
Is easily distracted; not able to stay on task (shorter attention span than peers) *
Has difficulty shifting attention from one activity or object to another (more so than peers) *
Has a tendency to ramble, can't "get to the point" *
Sleep
Needs parent in the room to fall asleep *
Lies awake for half an hour or more before falling asleep *
Awakens more than once during the night *
Cannot get back to sleep easily *
Has fitful sleep cycles (tosses, turns, restless) *
Moves to someone else's bed during the night (parent, sibling, etc.) *
Awakens during the night and is sweating, screaming and/or inconsolable *
Seems hard to wake up in the morning *
Wakes up grouchy, irritable, fussy and mood persists throughout the day *
Feels sleepy and struggles to remain alert during day *
Has this child experienced any traumatic events, changes in main caregivers, surgeries, abuse or neglect? *
Has this child ever been diagnosed with a developmental issue like but not limited to... PTSD, Autism, ADHD, Processing Issues or Learning Disabilities? *
Is this child currently receiving or received in the past any therapy services? Check all the apply *
Required
What are you hoping to accomplish at Tame Your Tiger Brain Training? *
Your answer
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