Child Screening Questionnaire

Research (published in The British Journal of Occupational Therapy, October 1998) has shown that a score of 7 or more ‘yes’ answers on the questionnaire below indicates that further investigation for underlying neuro-developmental delay is advised for children over 7 years of age.

Enter the following details and a representative of INPP will contact you in due course:

Your Details

Valid Please enter your name.
Valid Please enter a valid email address.Required.
Valid Please enter your phone number (Mobile or Home).

Your Address

Valid Please enter the first line of your address.
Valid Not required
Valid Please enter your town.
Valid Please enter your county.
Valid Please enter a valid postcode, Eg: CH1 2LR.

Your Child's Details

Valid Please enter your childs name.
Valid Please enter a valid date (DD/MM/YYYY).Please enter a valid date (DD/MM/YYYY).

Please enter below any additional information that you think may be relevant regarding the possible diagnosis of your child, including any previous diagnosis info:



Is there any history of learning difficulties in your immediate family? Valid Please select an option.
Were there any medical problems during the pregnancy? Valid Please select an option.
Was the birth process unusual or prolonged in any way? E.g. CS, Forceps, etc. Valid Please select an option.
Was your child born early or late for term (more than 2 weeks early or more than 10 days late)? Valid Please select an option.
Was your child's birth weight below 5lbs (pounds)? Valid Please select an option.
Did your child have any difficulty feeding in the first weeks of life, or in keeping food down? Valid Please select an option.
Was your child extremely demanding in the first 6 months of life? Valid Please select an option.
Did your child miss out the 'motor stage' of crawling on his or her tummy and creeping on hands and knees? Valid Please select an option.
Was your child late at learning to walk (16 months or later would be considered late)? Valid Please select an option.
Was your child late at learning to talk (2-3 word phrases at 18 months or later would be considered late)? Valid Please select an option.
Did your child have difficulty in learning to dress himself or herself, for example, do up buttons or tie shoelaces beyond the age of 6-7 years? Valid Please select an option.
Does your child suffer from allergies? Valid Please select an option.
Did your child have an adverse reaction to any of his or her vaccinations? Valid Please select an option.
Did your child suck his or her thumb beyond the age of 5 years? Valid Please select an option.
Did your child continue to wet the bed, albeit occasionally, above the age of 5 years? Valid Please select an option.
Does your child suffer from travel sickness? Valid Please select an option.
Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock ? Valid Please select an option.
Did your child have an unusual degree of difficulty learning to ride a bicycle? Valid Please select an option.
Did your child suffer from frequent ear, nose, throat or chest infections at any time in development? Valid Please select an option.
In the first 3 years of life, did your child suffer from any illnesses involving extremely high temperatures, delirium or convulsion? Valid Please select an option.
Does your child have difficulty catching a ball, doing forward rolls/somersaults and stand out as 'awkward' in PE classes? Valid Please select an option.
Does your child have difficulty sitting still for even a short period of time? Valid Please select an option.
If there is a sudden unexpected noise, does your child over-react? Valid Please select an option.
Does your child have reading difficulties? Valid Please select an option.
Does your child have writing difficulties? Valid Please select an option.
Does your child have copying difficulties? Valid Please select an option.
Has your child had a diagnosis? Valid Please select an option.

Please only submit the questionnaire if you are resident in the UK or intend to travel to the UK for further assessment.

Submit to INPP for Help