Raviv Practice London - Working Memory Questionnaire

Working Memory Questionnaire

† This questionnaire is designed to assess the level of your or your child's Working Memory capacity. Please complete and submit this questionnaire if you would like an informal assessment. We will contact you to discuss the issues in more detail.

Please select the response which applies to you or your child

Is easily distracted when working on or doing something that is not highly interesting.	Never Sometimes Frequently Unsure
Has trouble waiting his/her turn, for example in a conversation or when waiting in line to get help.	Never Sometimes Frequently Unsure
Struggles with reading comprehension and has to read through texts repeatedly to understand.	Never Sometimes Frequently Unsure
Struggles with problem solving that require holding information in mind, for example mental math calculations.	Never Sometimes Frequently Unsure
Is inconsistent in remembering math facts.	Never Sometimes Frequently Unsure
Struggles with completing tasks, especially multiple step tasks.	Never Sometimes Frequently Unsure
Has difficulty remembering long instruction given in several steps, for example following recipes, directions or school/work assignments.	Never Sometimes Frequently Unsure
Struggles to understand the context in a story or a conversation.	Never Sometimes Frequently Unsure
Has difficulties when planning and organizing something that needs to be done in separate steps.	Never Sometimes Frequently Unsure
Has difficulty staying focused during cognitive demanding tasks but attends well when cognitively demands are minimal.	Never Sometimes Frequently Unsure
Has difficulty integrating new information without prior knowledge.	Never Sometimes Frequently Unsure
When called on, forgets what he/she was planning to say	Never Sometimes Frequently Unsure
Has difficulty taking notes and listening at the same time.	Never Sometimes Frequently Unsure

Your name:	Required
Your location:	Required
Age of the person being assessed :	Required
Details of any other formal diagnosis :	Required
Your e-mail address:	Required
Your telephone number:	Required - For us to contact you.
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