Is Your Child in the Spectrum

Questionnaire

My child can follow directions in a noisy environmentMy child dislikes or avoids group sportsMy child has visual difficulty (loses place while reading)My child has difficulty organizing daily life tasksMy child is awkward or clumsyMy child is accident prone and bumps into people or objectsMy child has poor balanceMy child has poor endurance and gets tired easily, even avoiding physical activityMy child slumps when he/she sits in a chair on the floor, using arms and hands to help support him/herMy child has difficulty learning new motor activitiesMy child makes disruptive noises or soundsMy child has difficulty sitting stillMy child is constantly on the go, seeking intense crashing or rough playMy child doesn't seem to notice noise or smellsMy child is unaware of hunger, heat, coldMy child ignores the need to use the toiletMy child avoids eye contactMy child doesn't feel painMy child doesn't notice when he/she is being touchedMy child avoids climbing, swinging, playing in the playgroundMy child is bothered by loud noiseMy child is bothered by playground activitiesMy child is bothered by textures on his/her face or handsMy child is bothered by having his/her nails cut and/or hair combed

All fields are required.