F OCUS ON I NDIVIDUAL L EARNING


Auditory Integration Training

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). An Adult's Checklist is also available.

Check off any item that describes the child's behavior or history. If you check seven or more items, read about Auditory Integration Therapy and consider scheduling an auditory assessment for the child.

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

Please indicate your interest below.

If you have scored 7 or more 'yes' answers please contact June at Focus On Individual Learning, Singapore to discuss the results

In this case please print the questionaire and send it to June with your contact details.

  Name [Required]:
EMail [Required]:
  I would like to make an appointment for an Initial Consultation to discuss auditory processing for my child:
Child's Name:
School:
Home Tel(s):
Mobile(s):
Details of concerns:

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