LEARNING INSIGHTS® Facts and Questions

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ASSESSMENT ONLINE QUESTIONNAIRE (CHILD 4 -16 YEARS)

By completing ALL the following questions you will gain access to the scoring. You will be able to ascertain if your child may have learning difficulties which could be addressed by an Educational/Psychological or Socio/Emotional Assessment. Should you wish to have an assessment and report by Learning Insights then this will provide a full diagnosis and recommendation for your child's future educational and development needs. Following completion and scoring, if you want to proceed to the next step of discussing your child's needs, you should submit the completed questionnaire with payment as shown on the last page. If you would like to discuss this process in greater detail (including costs) then please contact Learning Insights on 0117 973 5628 or email at info@learninginsights.co.uk

Dr. Sharon Lloyd
Your child's Psychological Assessment will be carried out for you by Dr. Sharon Lloyd, a member of the Association of Educational Psychologists, and a professionally qualified, independent chartered consulting psychologist. You can download' a C.V. for Dr Lloyd in pdf format (requires Acrobat Reader) by clicking here.

ASSESSMENT ONLINE QUESTIONNAIRE (CHILD 4 -16 YEARS)
Enter a number in the corresponding box below, all questions need to be answered.

1. READING, WRITING AND SPELLING
	Not at all				Very
Is your child slow at either writing or spelling? If an older child, is their writing output a poor representation of their apparent ability?	1	2	3	4	5
Enter your score here »
	Not at all				Very
Is your child's writing messy/difficult to read/poorly formed?	1	2	3	4	5
Enter your score here »
	No			All the time
Is your child distractible/hard to get to do spelling or writing tasks?	1	2	3	4	5
Enter your score here »
	No				Very
Is your child bothered, worried or upset by their writing or reading? If your child is older, do they complain that they put in the effort but their marks don't show it?	1	2	3	4	5
Enter your score here »
	Likes it			Hates it
Does your child say he/she doesn't like school?	1	2	3	4	5
Enter your score here »
	Easily			With no ease
Can your child read new words? If an older child, do new words disrupt the fluency/fluidity of their reading and therefore interfere with comprehension?	1	2	3	4	5
Enter your score here »
	No			Yes a lot
Does your child seem to struggle with reading, either learning to read or with reading fast enough?	1	2	3	4	5
Enter your score here »
	Easily			Not at all
Can your child understand what they read? If your child is older, does this only come with considerable re-reading?	1	2	3	4	5
Enter your score here »
	Not at all			Very hard
Does your child find it hard to settle to homework/find it hard to work alone?	1	2	3	4	5
Enter your score here »

2. DOING THINGS
	Yes				Not at all
Is your child tidy and organized? If your child is older, is this only with significant effort?	1	2	3	4	5
Enter your score here »
	Yes				Not at all
Can your child understand social and non-verbal clues?	1	2	3	4	5
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	No				A lot
Does your child's behaviour worry you?	1	2	3	4	5
Enter your score here »
	No				Yes
Does your child show extreme responses to loud sounds, bright lights or crowded setting? IF an older child, do they avoid these settings?	1	2	3	4	5
Enter your score here »
	No				Yes
Does your child show an extreme sensitivity (liking - disliking) to certain types of fabrics or surfaces?	1	2	3	4	5
Enter your score here »
	Very well			Not well at all
How able is your child to sit and watch television?	1	2	3	4	5
Enter your score here »

3. PHYSICAL DEVELOPMENT
	No				Yes a lot
Is your child clumsy or accident prone?	1	2	3	4	5
Enter your score here »
	No				Yes a lot
Does your child fidget?	1	2	3	4	5
Enter your score here »
	Good				Very poor
How good is her/his eye/hand co-ordination?	1	2	3	4	5
Enter your score here »
	Good				Very poor
Is your child good at sport?	1	2	3	4	5
Enter your score here »
	Easy			Not easy at all
How easy was/is it for your child to learn to ride a bicycle?	1	2	3	4	5
Enter your score here »
	Not at all			Yes
Does your child drop things and/or trip, bump into things?	1	2	3	4	5
Enter your score here »

4. HEALTH
	Good				Very poor
How would you describe your child's health?	1	2	3	4	5
Enter your score here »
	No			Significantly
Does your child have health problems that interfere with schooling?	1	2	3	4	5
Enter your score here »
	Not at all			Very concerned
Are you concerned about your child's health in relation to their learning?	1	2	3	4	5
Enter your score here »

5. VISION AND HEARING
	Good				Very poor
Is his/her vision?	1	2	3	4	5
Enter your score here »
	Good				Very poor
Is his/her hearing?	1	2	3	4	5
Enter your score here »

6. PHYSICAL DEVELOPMENT
	Yes				Not at all
Are you generally able to understand your child efforts at talking?	1	2	3	4	5
Enter your score here »
	No				Yes a lot
Does your child seem to struggle to say what they mean?	1	2	3	4	5
Enter your score here »
	Yes				Not at all
Does your child usually understand what you are saying?	1	2	3	4	5
Enter your score here »
	Yes				No
Can your child follow instructions?	1	2	3	4	5
Enter your score here »
	No				Yes a lot
Are you aware that you have to be careful how you phrase or word something for your child to understand?	1	2	2	4	5
Enter your score here »
	No				Yes a lot
Does your child have difficulty producing speech sounds/words?	1	2	3	4	5
Enter your score here »
	No				Yes a lot
Does your child have difficulty finding the words they need to express themselves?	1	2	3	4	5
Enter your score here »

7. COMPREHENSION
	Easily				Not at all
Does your child seem to grasp what is going on more broadly?	1	2	3	4	5
Enter your score here »
	Usually			Rarely
Does your child seem to understand when things are explained in the usual way?	1	2	3	4	5
Enter your score here »
	Never			Always
Does your child need extra coaching or explanation in order to understand what is being explained or is happening?	1	2	3	4	5
Enter your score here »

8. FRIENDSHIPS AND SELF-ESTEEM
	Easily				Not at all
Does your child make/keep friends?	1	2	3	4	5
Enter your score here »
	Usually				Rarely
Does your child have friends?	1	2	3	4	5
Enter your score here »
	Never			Always
Is your child isolated/often alone?	1	2	3	4	5
Enter your score here »
	Mostly				Not at all
Does your child behave like other children?	1	2	3	4	5
Enter your score here »
	Well			Not at all
How does your child relate to adults?	1	2	3	4	5
Enter your score here »
	Good			Very poor
Rate your child's self-esteem, how they feel about themselves	1	2	3	4	5
Enter your score here »
	Yes			Not at all
Is your child happy to go to school?	1	2	3	4	5
Enter your score here »
	Yes				Not at all
Is your child aware of what is appropriate to do socially?	1	2	3	4	5
Enter your score here »

9. EMOTIONAL ADJUSTMENT
	Happy			Not at all happy
How happy would you say your child was at this time?	1	2	3	4	5
Enter your score here »
	Well				Not at all
How well does your child get on in the family?	1	2	3	4	5
Enter your score here »
	Well				Not at all
How well does your child get on with other children at school?	1	2	3	4	5
Enter your score here »
	Well				Not at all
How well does your child get on with other children in the neighbourhood?	1	2	3	4	5
Enter your score here »
	Well				Not at all
How well is s/he motivated to go to school?	1	2	3	4	5
Enter your score here »
	Normal			Very different
Please indicate how you see your child's social and emotional development	1	2	3	4	5
Enter your score here »
	Good			Very poor
How would you describe your child's general mood in school?	1	2	3	4	5
Enter your score here »
	Not at all			Extremely
Would you describe your child as timid or withdrawn?	1	2	3	4	5
Enter your score here »

10. MEMORY
	Good			Very poor
How would you describe your child's memory overall?	1	2	3	4	5
Enter your score here »
	Good			Not good at all
How is s/he at remembering immediate information?	1	2	3	4	5
Enter your score here »
	Good			Not good at all
How effective is her/his long term memory?	1	2	3	4	5
Enter your score here »
	Good				Very poor
How effective is your child at attending or concentrating?	1	2	3	4	5
Enter your score here »
	Good				Very poor
How effective is your child at remembering where they have put things?	1	2	3	4	5
Enter your score here »

11. BEHAVIOUR Please indicate your child's typical behaviour when not at school
	Good				Very poor
Structured situations (organized games, mealtimes, shopping, bedtimes)	1	2	3	4	5
Enter your score here »
	Good				Very poor
Unstructured situations (unsupervised play, alone in room or in garden)	1	2	3	4	5
Enter your score here »
	Not impulsive			Very
Impulsiveness	1	2	3	4	5
Enter your score here »
	Not at all				A lot
Hyperactivity	1	2	3	4	5
Enter your score here »
	Good			Very poor
Coping with change	1	2	3	4	5
Enter your score here »
	None			Very evidently
Strong fears	1	2	3	4	5
Enter your score here »
	Low			Very high
How would you describe your child's anxiety level?	1	2	3	4	5
Enter your score here »
	No			Very
Would you describe your child as depressed?	1	2	3	4	5
Enter your score here »
	Good			Very poor
How would you describe your child's anger management?	1	2	3	4	5
Enter your score here »

INTERPRETATION OF SCORES

If you scored mainly 1's, 2's and 3's then it is likely that no assessment is required.
If you scored mainly 3's and 4's in any one section then you may need to have your child assessed.
If you have ticked any of the 5's you need to have a telephone consultation about your child's profile please refer to the instructions below.

If you have decided that you would like a telephone consultation you now need to complete a remittance advice which is available on hitting the SUBMIT button below. Just to remind you, your online questionnaire is automatically submitted to us at Learning Insights and you will be asked to download a remittance advice with your address and contact details (if you cannot download this you can simply put this information on a piece of paper) and send it to us with payment of £75.00 to Learning Insights at the address shown.

On receipt we will contact you by telephone and provide a 30 minute (or however long it takes) consultation with you. This fee will be refunded against any assessment and report we may subsequently carry out for you. (Click here for a description of a typical assessment)

You do not make any commitment to us for an assessment because of this follow up. It is designed to help you find the right resources to meet your needs. Of course we are always willing and available to see a child should it be required, but you are equally free to seek an assessment elsewhere.

Some people can still feel worried about a child even though the questionnaire has shown there are no strong indications of a need for an assessment. If this applies to you then you can still contact us to discuss any outstanding worries you may have. This is part of the service we offer, and is also covered by the fee you pay to access a consultation.

If you are ready to proceed with the consultation request, fill in your details below and then hit the SUBMIT button - your questionnaire will be downloaded to us and you will be given a Remittance Advice to complete and post.

* indicates required field.

Your Name *
Your Child's Name *
Child's Age *
Address 1 *
Address 2
Postcode *
Telephone *
Best time to call *
Your Email *

PLEASE NOTE: When you have submitted this form you will be redirected to a page where you can print off a remittance advice form. If you want to proceed with an assessment you will need to print the form out, then fill it out and sent it back to us with your payment.

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The British Psychological Society

40 Kings Parade Avenue, Clifton,
Bristol BS8 2RB

Phone us: From the UK: 0117 973 5628
From outside the UK: +44 117 973 5628

Email us: info@learninginsights.co.uk

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