Was your child delayed with any of their childhood milestones - crawling, walking?

Yes

No

Does your child startle easily?

Yes

No

Does your child struggle to focus?

Yes

No

Is your child impulsive?

Yes

No

Does your child have poor handwriting?

Yes

No

Does your child struggle to make friends or maintain friendships?

Yes

No

Does your child have heightened sensitivity to textures of clothing?

For example: dislikes tags, seams or certain materials

Yes

No

Does you child sometimes miss the joke?

Yes

No

Is your child fidgety?

Yes

No

Is your child clumsy/ uncoordinated/ physically awkward?

Yes

No

Does your child struggle with emotional regulation?

Yes

No

Does your child avoid being hugged, eye contact?

Yes

No

Has your child developed tics?

These 'tics' may be repetitive movements, speech patterns or sounds

Yes

No

Does your child struggle with learning?

Yes

No

Does your child often fall ill? Or suffer from asthma, allergies, or food sensitivities?

Yes

No

Has your child been diagnosed with a neurodevelopmental disorder? *

Autism, Aspergers, ADHD, Oppositional Defiance Disorder, Sensory processing Disorder, Dyslexia

Yes

No

Do you consent to being contacted about your results? *

Yes

No