F OCUS ON I NDIVIDUAL L EARNING

	INPP Child Screening Questionnaire
	The Institute for Neuro-Physiological Psychology INPP established in 1975 by Peter Blythe PhD INPP pioneered research into NeuroDevelopmental Delay (NDD) and its impact on specific learning difficulties including dyslexia, dyspraxia, ADD, ADHD & DAMP

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.

If 7 or more positive answers are scored on the questionnaire you may wish to consider making an appointment for an Initial Consultation to discuss your child's problems in greater detail.

1.	Is there any history of learning difficulties in your immediate family?	no yes
2.	Were there any medical problems during the pregnancy?	no yes
3.	Was the birth process unusual or prolonged in any way?	no yes
4.	Was your child born early or late for term (more than 2 weeks early or more than 10 days late)?	no yes
5.	Was your child's birth weight below 5 lbs (pounds)?	no yes
6.	Did your child have any difficulty feeding in the first weeks of life, or in keeping food down?	no yes
7.	Was your child extremely demanding in the first 6 months of life?	no yes
8.	Did your child miss out the 'motor stage' of crawling on his or her tummy and creeping on hands and knees?	no yes
9.	Was your child late at learning to walk (16 months or later would be considered late)?	no yes
10.	Was your child late at learning to talk (2-3 word phrases at 18 months or later would be considered late)?	no yes
11.	Did your child have difficulty in, for example, learning to dress himself or herself, do up buttons or tie shoelaces beyond the age of 6-7 years?	no yes
12.	Does your child suffer from allergies?	no yes
13.	Did your child have an adverse reaction to any of his or her vaccinations?	no yes
14.	Did your child suck his or her thumb beyond the age of 5 years?	no yes
15.	Did your child continue to wet the bed, albeit occasionally, above the age of 5 years?	no yes
16.	Does your child suffer from travel sickness?	no yes
17.	Did your child find it very difficult to learn to tell the time from a traditional (as opposed to digital) clock?	no yes
18.	Did your child have an unusual degree of difficulty learning to ride a bicycle?	no yes
19.	Did your child suffer from frequent ear, nose, throat or chest infections?	no yes
20.	In the first 3 years of life, did your child suffer from any illnesses involving extremely high temperature, delirium or convulsion?	no yes
21.	Does your child have difficulty catching a ball, and stand out as 'awkward' in PE classes?	no yes
22.	Does your child have difficulty sitting still for even a short period of time?	no yes
23.	If there is a sudden unexpected noise, does your child over-react?	no yes
24.	Does your child have reading difficulties?	no yes
25.	Does your child have writing difficulties?	no yes
26.	Does your child have copying difficulties?	no yes

If you have scored 7 or more 'yes' answers please contact June at Focus On Individual Learning, Singapore to discuss the results

In this case please print the questionaire and send it to June with your contact details

Please print this form and either send it to:

Focus On Individual Learning

408a River Valley Road

Singapore 248306

Or, if you wish to submit via email, enter your Name and Email address below and click the submit button.

Name [Required]:
EMail [Required]:
Please indicate your interest below.
	I would like to make an appointment for an Initial Consultation to discuss my child	no yes
	I would like to arrange a Neuro-Physiological Movement assessment	no yes
	I am interested in a General Discussion Session	no yes
Child's Name:
Child's Date of Birth:
Home Tel(s):
Mobile(s):
Details of concerns:

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Email June for Information
Fax: +(65)67383240

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