Child Screening Questionairre for Neuromotor Development
Research published in the British Journal of Occupational Therapy (October 1988) has shown that a score of 7 or more 'yes' answers on the questionnaire below indicates that further investigation for underlying neuromotor immaturity is advised for children over 7 years of age.

If you have submitted a questionnaire with 7 or more 'Yes' answers but have not received a response within 48 hours, please email admin@theplayclinic.com and request a full information pack.
Caregiver(s) Name *
Email *
Child Name *
Child Date of Birth *
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DD
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YYYY
Quiz Questions
Is there any history of learning difficulties in your immediate family?*Your first question? *
1 point

Were there any medical problems during the pregnancy?*

 *
1 point

Was the birth process unusual or prolonged in any way? e.g. CS, forceps, etc*

 *

Was your child born early or late for term (more than 2 weeks early or more than 10 days late)?*

 *

Was your child's birth weight below 5lbs (pounds)?*

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Did your child have any difficulty feeding in the first weeks of life, or in keeping food down?*

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Was your child extremely demanding in the first 6 months of life?*

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Did your child miss out the 'motor stage' of crawling on his or her tummy and creeping on hands and knees?*

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Was your child late at learning to walk (16 months or later would be considered late)?*

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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?*

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Does your child suffer from allergies?*

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Did your child have an adverse reaction to any of his or her vaccinations?*

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Did your child suck his or her thumb beyond the age of 5 years?*

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Did your child continue to wet the bed, albeit occasionally, above the age of 5 years?*

 *

Does your child suffer from travel sickness?*

Clear selection

Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock?*

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Did your child have an unusual degree of difficulty learning to ride a bicycle?*

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Did your child suffer from frequent ear, nose, throat or chest infections at any time in development?*

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In the first 3 years of life, did your child suffer form any illnesses involving extremely high temperatures, delirium or convulsion?*

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Does your child have difficulty catching a ball, doing forward rolls/ somersaults and stand out as 'awkward' in PE classes?*

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Does your child have difficulty sitting still for even a short period of time?*

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If there is a sudden unexpected noise, does your child over-react?*

 *

Does your child have reading difficulties?*

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Does your child have writing difficulties?*

 *

Does your child have copying difficulties?*

 *

Has your child had a diagnosis?*

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