Raviv Practice London - Auditory Processing Questionnaire

Auditory Processing Disorder Questionnaire

† This questionnaire is designed to assess the level of your child's Auditory Processing disorder. Most children will only exhibit some of the symptoms. Please complete and submit this questionnaire if you would like an informal assessment.

Please select the response which applies to your child

Misunderstands what is said	Never Sometimes Frequently Unsure
Requests that information or instructions be repeated	Never Sometimes Frequently Unsure
Appears to not hear properly or to be a selective listener	Never Sometimes Frequently Unsure
Experiences difficulty with phonics	Never Sometimes Frequently Unsure
Experiences difficulty with reading	Never Sometimes Frequently Unsure
Has difficulty putting thoughts onto paper during writing.	Never Sometimes Frequently Unsure
Experiences difficulty with comprehension	Never Sometimes Frequently Unsure
Experiences difficulty with problem solving or abstract concepts.	Never Sometimes Frequently Unsure
Appears confused by multiple, lengthy or quickly presented verbal instructions.	Never Sometimes Frequently Unsure
Performs better one on one.	Never Sometimes Frequently Unsure
Experiences difficulty understanding in noisy environments	Never Sometimes Frequently Unsure
Either unusually sensitive or unresponsive to noise / sounds	Never Sometimes Frequently Unsure
Appears to be easily distractable	Never Sometimes Frequently Unsure
Experiences difficulty paying attention in the classroom	Never Sometimes Frequently Unsure
Difficulty expressing/explaining information or paraphrasing	Never Sometimes Frequently Unsure
Provides slow or delayed responses	Never Sometimes Frequently Unsure
Experiences difficulty understanding the point or focus of group activities	Never Sometimes Frequently Unsure
Takes a long time to complete classroom work and/or homework	Never Sometimes Frequently Unsure
Is teased or left out of activities by peers	Never Sometimes Frequently Unsure
Unusually tired after school	Never Sometimes Frequently Unsure
Experiences behaviour problems	Never Sometimes Frequently Unsure
Low confidence and / or self-esteem	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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