PRE-CARE QUESTIONNAIRE

A Checklist for Parents

This checklist is designed to help parents or teachers access whether a child might be having problems with his or her auditory system (hearing, auditory processing or auditory integration).

Check off any item that describes the child's behavior or history. If you check off many items, consider reading the posted information on Auditory Integration Therapy or scheduling an Auditory Assessment for the child.

• Has a history of hearing loss.
• Does not learn well through use of the auditory channel.
• Has a history of ear infection(s).
• Cannot always relate what is heard to what is seen.
• Frequently misunderstands what is said.
• Forgets what is said in a few minutes.
• Daydreams -- attention drifts -- not with it at times.
• Experiences problems with sound discrimination.
• Notices sounds before others do.
• Constant humming or audible self-talk.
• Does not comprehend many words, not grasping verbal concepts appropriate for age/grade level.
• Is considered to have autism, dyslexia, pervasive developmental disorder, Central Auditory Processing Disorder, Asperger's Syndrome or attention deficit hyperactivity disorder (ADHD).
• Does not pay attention (listen) to instruction 50% or more of the time.
• Demonstrates below average performance in one or more academic area(s).
• Has difficulty following verbal directions -- often necessary to repeat instructions.
• Cannot attend to auditory stimuli for more than a few seconds.
• Says "Huh?" and "What?" at least five or more times per day.
• Has a short attention span.
• Easily distracted by background noise.
• Has "startle" response to sudden sound or movement.
• Gives unusual descriptions of sounds, auditory stimulation or sensation.
• Needs frequent "quiet time" to regain mental energy and composure.
• Has a language problem (morphology, syntax, vocabulary, phonology).
• Has an articulation (phonology) problem.