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 968 2870 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
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	Not at all				Very
Is your child's writing messy/difficult to read/poorly formed?	1	2	3	4	5
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	No			All the time
Is your child distractible/hard to get to do spelling or writing tasks?	1	2	3	4	5
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	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
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	Likes it			Hates it
Does your child say he/she doesn't like school?	1	2	3	4	5
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	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
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	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
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	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
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	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
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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
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	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
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	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
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	No				Yes
Does your child show an extreme sensitivity (liking - disliking) to certain types of fabrics or surfaces?	1	2	3	4	5
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	Very well			Not well at all
How able is your child to sit and watch television?	1	2	3	4	5
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3. PHYSICAL DEVELOPMENT
	No				Yes a lot
Is your child clumsy or accident prone?	1	2	3	4	5
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	No				Yes a lot
Does your child fidget?	1	2	3	4	5
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	Good				Very poor
How good is her/his eye/hand co-ordination?	1	2	3	4	5
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	Good				Very poor
Is your child good at sport?	1	2	3	4	5
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	Easy			Not easy at all
How easy was/is it for your child to learn to ride a bicycle?	1	2	3	4	5
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	Not at all			Yes
Does your child drop things and/or trip, bump into things?	1	2	3	4	5
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4. HEALTH
	Good				Very poor
How would you describe your child's health?	1	2	3	4	5
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	No			Significantly
Does your child have health problems that interfere with schooling?	1	2	3	4	5
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	Not at all			Very concerned
Are you concerned about your child's health in relation to their learning?	1	2	3	4	5
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5. VISION AND HEARING
	Good				Very poor
Is his/her vision?	1	2	3	4	5
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	Good				Very poor
Is his/her hearing?	1	2	3	4	5
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6. PHYSICAL DEVELOPMENT
	Yes				Not at all
Are you generally able to understand your child efforts at talking?	1	2	3	4	5
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	No				Yes a lot
Does your child seem to struggle to say what they mean?	1	2	3	4	5
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	Yes				Not at all
Does your child usually understand what you are saying?	1	2	3	4	5
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	Yes				No
Can your child follow instructions?	1	2	3	4	5
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	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
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	No				Yes a lot
Does your child have difficulty producing speech sounds/words?	1	2	3	4	5
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	No				Yes a lot
Does your child have difficulty finding the words they need to express themselves?	1	2	3	4	5
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7. COMPREHENSION
	Easily				Not at all
Does your child seem to grasp what is going on more broadly?	1	2	3	4	5
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	Usually			Rarely
Does your child seem to understand when things are explained in the usual way?	1	2	3	4	5
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	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
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8. FRIENDSHIPS AND SELF-ESTEEM
	Easily				Not at all
Does your child make/keep friends?	1	2	3	4	5
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	Usually				Rarely
Does your child have friends?	1	2	3	4	5
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	Never			Always
Is your child isolated/often alone?	1	2	3	4	5
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	Mostly				Not at all
Does your child behave like other children?	1	2	3	4	5
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	Well			Not at all
How does your child relate to adults?	1	2	3	4	5
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	Good			Very poor
Rate your child's self-esteem, how they feel about themselves	1	2	3	4	5
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	Yes			Not at all
Is your child happy to go to school?	1	2	3	4	5
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	Yes				Not at all
Is your child aware of what is appropriate to do socially?	1	2	3	4	5
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9. EMOTIONAL ADJUSTMENT
	Happy			Not at all happy
How happy would you say your child was at this time?	1	2	3	4	5
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	Well				Not at all
How well does your child get on in the family?	1	2	3	4	5
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	Well				Not at all
How well does your child get on with other children at school?	1	2	3	4	5
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	Well				Not at all
How well does your child get on with other children in the neighbourhood?	1	2	3	4	5
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	Well				Not at all
How well is s/he motivated to go to school?	1	2	3	4	5
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	Normal			Very different
Please indicate how you see your child's social and emotional development	1	2	3	4	5
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	Good			Very poor
How would you describe your child's general mood in school?	1	2	3	4	5
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	Not at all			Extremely
Would you describe your child as timid or withdrawn?	1	2	3	4	5
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10. MEMORY
	Good			Very poor
How would you describe your child's memory overall?	1	2	3	4	5
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	Good			Not good at all
How is s/he at remembering immediate information?	1	2	3	4	5
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	Good			Not good at all
How effective is her/his long term memory?	1	2	3	4	5
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	Good				Very poor
How effective is your child at attending or concentrating?	1	2	3	4	5
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	Good				Very poor
How effective is your child at remembering where they have put things?	1	2	3	4	5
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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
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	Good				Very poor
Unstructured situations (unsupervised play, alone in room or in garden)	1	2	3	4	5
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	Not impulsive			Very
Impulsiveness	1	2	3	4	5
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	Not at all