Parent questionnaire

Turn Concerns Into a Structured Record

Answer based on the child's typical behavior over the last three months. This tool supports observation and professional communication, not diagnosis.

Before You Begin

Scoring: 0 = almost never, 1 = sometimes, 2 = often, 3 = almost always. Consider home, school, outdoor, and public settings.

If there is developmental regression, seizure-like activity, major hearing or vision concern, frequent self-injury/aggression, severe feeding, or severe sleep difficulty, consult a clinician first.

Result

Suggested Next Steps

    Bring to Consultation

    • Top 3 difficult settings: home, school, outdoors, or public places.
    • Triggers: sound, touch, movement, smell, crowds, waiting, or transitions.
    • What helps the child calm or participate.
    • When it started, how long it lasts, and whether it affects daily function.
    Edit Answers