Suspected difficulties
Please answer the questions about your child. Please think about how your child usually behaves. If you have seen your child do the behavior a few times, then please answer no . Please put yes or no for each question.
M-CHAT-RTM (Autism Questionnaire)
- If you point to something across the room, will your child look at it?
( eg if you show a toy or animal, does the child look at the toy or animal?)
- Have you ever wondered if your child might be deaf?
- Does your child role play or pretend play?
( eg does he pretend to drink from an empty glass, pretend to talk on the phone, or pretend to feed a doll or stuffed animal?)
- Does your child like to climb on things?
( e.g. furniture, playground equipment, stairs)
- Does your child make unusual finger movements near their eyes?
( eg does the child move his fingers near his eyes?)
- Does your child point with one finger to ask for something or to ask for help?
( eg is he showing a snack or a toy that he can’t reach?)
- Is your child pointing with one finger to show you something interesting?
( eg showing a plane in the sky or a large truck on the road)
- Is your child interested in other children?
( eg does your child watch other children, smile at them or go to them?)
- Does your child show you things by bringing them to you or holding them up to show you – not to help but to share?
( eg showing you a flower, a stuffed animal or a toy truck)
- Does your child respond when you call their name?
( eg when you say his name, does he look up, talk or babble or stop what he’s doing?)
- When you smile at your child, does he smile back?
- Is your child irritated by everyday noises?
( eg does your child scream or cry to noise such as a vacuum cleaner or loud music?)
- Is your child walking?
- Does your child look you in the eye when you talk to them or play with them or when you dress them?
- Does your child copy you, imitate what you do?
( eg waving hello, clapping, making funny noises when you do too)
- If you turn your head to look at something, does your child look around to see what you see?
- Is your child trying to get you to look at them?
( eg does your child look at you for praise or say “look” or “look at me”?)
- Does your child understand when you tell him to do something?
( eg without pointing, can your child understand “put the book on the chair” or “bring me the blanket”?)
- If something new happens, does your child look you in the face to see how you feel about it?
( eg if he hears a strange or funny noise or sees a new toy, will he turn to look at you?)
- Does he like physical activities?
( eg swing it or swing it on your knee?
Dyspraxia Questionnaire
- He is afraid to go up or down stairs
- He has difficulty recognizing simple everyday objects that are in his pocket or hidden
- Shows discomfort in object textures
- He doesn’t remember or understand what we ask him
- Difficulty learning new concepts
- It is difficult for him to engage in motor games
- Poor drawing skills
- More talking than performing an activity
- He has difficulty coordinating his movement
- Difficulty with activities of daily living (eg putting on/taking off clothes, personal hygiene)
Dysgraphia Questionnaire
- Does he hold the pencil with an improper grip?
- Does he constantly turn the paper as he writes or draws?
- Does he hold the pencil too tightly or too loosely?
- Forms the letters by mirroring or reversing them
- Are words or letters not properly spaced?
- Does he capitalize and lowercase the same word, eg child?
- Does he take too long to write a word or sentence?
- Ugly picture of writing due to smudges?
- Are the letters not stepping on the lines?
- Does he start drawing or writing from the right?
