Icl - Integrated Centre for Learning

ICL - INTEGRATED CENTRE FOR LEARNING

LEANNE DUNNETT – ILT Practitioner (Neurodevelopment)

Tel: 083 793 1397 Email:

Greetings

Please take your time and complete the following document as comprehensively as possible. We do understand that this may take up a lot of your time, but all the information is crucial for our understanding of the client. It will be a great help in guiding us to know how best to help.

Child/client’s name: ......

Date of birth :…………………………………Age: (Year:months)...... Grade at school: ......

Date of appointment: ...... Name of person completing form……………......

Relationship to child/client......

Major areas of concern……………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

Summary of prior assessments relevant to this evaluation: …………………………………………………………………………………………………………………………..……

…………………………………………………………………………………………………………………………………

Family structure (Please indicate)

Intact / Single parent / Divorced / Remarried / Other

Is the child an adopted child? ______If YES, at what age did the child join the family?
Is the child a foster child? ______If YES, at what age did the child join the family?
Number of children in family

Name / Gender / Age / Grade / Progress at school

Hereditary illness in the family: ………………………………………………………………………………….

Where were parents working before conception? …………………………………………………………………………………………………………….
Was either parent in contact with heavy metals or chemicals before conception, during pregnancy or in the child’s early childhood?

………………………………………………………………………………………………………………………

State any problems during pregnancy (e.g. serious illness, emotional tension, imminent abortion):

…………………………………………………………………………………………………………………………

Was it a planned pregnancy? (Y/N)…………………………..
Did the mother experience any viral infection (e.g. influenza, measles) during the second trimester (3-6 months) of pregnancy?......
Name any difficulties with previous pregnancies…………………………………………………………….
Did you lay new carpets in your house while you were pregnant?......
Did you paint any part of your house or office while you were pregnant?......
Was the mother bedridden for any period during the pregnancy?...... When?...... How long?...... Why?......
Did the mother smoke or consume any alcohol during pregnancy? (Y/N)
Was the mother subjected to ‘passive smoke’ during the pregnancy? (Y/N)
Did the mother use any recreational drugs during the pregnancy? (Y/N)………………………Specify…………………………………………………………………………….
Age of mother at birth…………
Was the baby premature? (Y/N)……… How much?......
Birth weight of baby………………
Birth process (please indicate with a cross)

Normal / Caesarean Section
Without drugs / Elective
With drugs / Emergency
Epidural / Epidural
Forceps / Full anesthesia
Suction
Short delivery
Long delivery

Was labour induced or spontaneous?......

Was it a breech or headfirst birth?......
Other aspects during and after the birth (please indicate with an x)
Lack of oxygen
Foetal distress
Cord around neck
Jaundice
ICUDurationReason
Was the baby breastfed?......
How long was the breastfeeding?......
Time when solids were introduced……………………………….
Any reactions to any of the solid foods………………………………..
If not breastfed, what substitute was used?......
Any reaction to the products used?......
How was the child’s sucking?......
Has the child had any significant illnesses or diseases? …………… Details:…………………………………………….……………………………..

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………..…………………………………….

How was the child during infancy? Calm Cried a lot Colic Restless Bad sleeper Other

(indicate with X)

Allergies

Past:GlutenDairyMaizeEggsPollenAnimal danderHouse dustMoulds Oranges

Other:

Present:

Type of treatment for allergies:

Is the child on any medication at present? If YES, name and dosage of medication:………………………………………………………….……………….
Is the child on any supplements at present? If YES, give the reason for the supplement and the name of the supplement:………………………………
Is the child in contact with animals and/or pets regularly? If YES, how often is deworming done?......

How would you describe your child’s motor development? EarlyLateNormal
At what age could your child do the following?

Activity / Age / How (if other than the norm)
Sit
Crawl
Walk
Feed self
Dress self
Toilet trained
Riding a tricycle
Sleep in own room
Riding a bicycle

Did the child’s speech develop normally?...... (Y/N)
Is/was orthodontic treatment indicated? ...... (Y/N)
Was the child a quiet baby or did a variety of baby sounds occur?......
Indicate the rate of the child’s language development

EarlyNormalSlightly delayedSeverely delayed

At what age was the child able to express him/herself clearly?......
Please indicate any of the following if applicable to the child:

Does not pay attention (listen) to instruction 50% or more of the time
History of hearing loss
Is bothered by high pitched noises
Needs loud music to be able to concentrate on homework
Speaks in a loud voice
Hums or makes ‘white noises’
Demonstrates below average performance in one or more academic areas
Has difficulty following verbal directions – often necessary to repeat instructions
Cannot always relate what is heard to what is seen
Cannot attend to auditory stimuli for more than a few seconds
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
Is considered to have autism, dyslexia, pervasive developmental disorder, Central Auditory Processing Disorder, Asperger’s Syndrome or Attention Deficit Hyperactivity Disorder (ADD or ADHD)
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
Has a language problem
Has an articulation (pronunciation) problem
Has a history of ear infectionsLeft earRight earBoth

How many times

Ages when it occurred

Date of last infection

Did the ears drain during infection?

Grommets?

How many times?

Are the grommets still in the ear?

Has the child’s hearing been tested, and if YES, at what age and what were the results? ……………………………………………………………………

Are there any voice problems and if YES, please indicate:
Does the child experience any swallowing problems:
Does the child suffer from chronic upper respiratory problems (e.g. sinus, bronchitis) or has s/he suffered from these in the past?

School attended / Age / Duration / Comments on progress

Would you say that the child was ready for school?......
Were developmental or other concerns experienced during preschool years?......

……………………………………………………………………………………………………………………

If YES, indicate the nature of the concern at preschool:………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………

Has the child received any form of therapy for the above mentioned concern(s)? (Y/N)…………..

If YES, mention the type and duration of the therapy…………………………………………………………………………………...…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Are any health problems experienced by the child? (Y/N)…………….
If YES to the above, please specify:…………………………………………………………………………………………………….…………

………………………………………………………………………………………………………………………………………………………………………………

How frequently has the child taken courses of antibiotics?......
Were probiotics given with the antibiotics? (Y/N)………………..
Please complete the following table (pg 7) by circling the appropriate point score for the questions you answer with a YES response:

Tick which of the following applies to the child:

Excessive thirst
Chronic fatigue
Dry or rough skin
Dry hair
Loss of hair or dandruff
Eczema, asthma or joint aches
Dyslexia, or learning difficulties
Hyperactivity
Depression or manic depression (mood swings)
Urinates a lot – always needing the toilet
Soft, brittle nails
Night blindness/bad sight at night
Headaches/strain on eyes
Reading problems

During the two years before the child was born, was the mother bothered by recurrent vaginitis, menstrual irregularities, premenstrual tension, fatigue, headaches, depression, digestive disorders or ‘feeling bad all over’? (Score 0 if no problems were experienced, 10 if mild, 20 if moderate and 30 if severe) / 0 / 10 / 20 / 30
Was the child bothered by thrush? (Score 0 if no thrush was experienced, 10 if mild, 20 if moderate and 30 if severe) / 0 / 10 / 20 / 30
Was the child bothered by frequent nappy rashes in infancy? (Score 0 if nappy rash was seldom if ever experienced, 10 if mild, 20 if moderate, 30 if severe) / 0 / 10 / 20 / 30
During infancy, was the child bothered by colic and irritability lasting more than 3 months? (Score 0 if no colic was experienced, 10 if occasional or mild, 20 if moderate and 30 if consistent and severe) / 0 / 10 / 20 / 30
Are his/her symptoms worse on damp days or in damp or mouldy places? (Score 0 if weather does not affect symptoms, 10 if mild differences are noticed, 20 if moderate effect and 30 if the symptoms worsen considerably) / 0 / 10 / 20 / 30
Has the child been bothered by recurrent or persistent ‘athlete’s foot’ or chronic infections of his skin or nails? (Score 0 if no athlete’s foot has been experienced, 20 if occasionally and 30 if regularly or on several occasions) / 0 / 20 / 30
Has the child been bothered by recurrent hives, eczema or other skin problems? (Score 0 if none of these have ever been experienced; 10 if skin problems have been experienced or if they have been constantly present) / 0 / 10
Has the child had 4 or more courses of antibiotic drugs during the past year, or has s/he received continuous ‘prophylactic’ courses of antibiotic drugs? (Score 0 if no antibiotics have been prescribed during the past year or if the child has received no continuous courses of these medications; Score 20 if 4 courses have been prescribed or if the child has regularly had prescriptions; score 30 if the child has more or less constantly been on such medications) / 0 / 20 / 30
Has the child had 8 or more courses of ‘broad-spectrum’ antibiotic (such as amoxicillin, Keflex, Septra, Bactrum or Cecior) during the past three years? (Score 0 if the answer is no, and 40 if the answer is yes) / 0 / 40
Has the child experienced recurrent ear problems either recently or in the past? (Score 0 if no ear problems have ever been experienced; 20 if the child has a history of ear infections and/or has suffered at least one severe infection). / 0 / 20
Has the child had grommets inserted? (Score 0 if the answer is no, 10 if the answer is yes.) / 0 / 10
Is the child bothered by learning problems (even though his early developmental history was normal?) (Score 0 if the answer is no; score 10 if the answer is yes) / 0 / 10
Has the child been labeled ‘hyperactive’? (Score 0 if the answer is no, score10 if the answer is yes but the child is considered mildly hyperactive and 20 if moderately or severely hyperactive.) / 0 / 10 / 20
Does the child have a short attention span? (Score 0 for a ‘no’ answer and 10 for a ‘yes’ answer) / 0 / 10
Is the child persistently irritable, unhappy and hard to please? (Score 0 for a ‘no’ answer and 10 for a ‘yes’) / 0 / 10
Has the child been bothered by persistent or recurrent digestive problems, including constipation, diarrhea, bloating or excessive gas? Score 0 if these symptoms have never occurred, 10 if they occur occasionally or mildly, 20 if moderate and 30 if severe.) / 0 / 10 / 20 / 30
Has the child had persistent nasal congestion, cough and/or wheezing? (Score 0 for a ‘no’ answer and 10 for a ‘yes’) / 0 / 10
Is the child unusually tired or unhappy or depressed? (Score 0 if the child is never unusually tired or depressed, 10 if the child seems to suffer fairly regularly and 20 if the child seems to be mostly experiencing fatigue and depression) / 0 / 10 / 20
Has the child been bothered by recurrent headaches, abdominal pain, or muscle aches? Score 0 if the child only suffers very occasionally from these, 10 if fairly regularly and 20 if very regularly and/or severely. / 0 / 10 / 20
Does the child crave sweets? (Score 0 for a ‘no’ answer and 10 for a ‘yes’ answer) / 0 / 10
Does exposure to perfume, insecticides, petrol or other chemicals provoke moderate to severe symptoms? (Score 0 for ‘no’ and 10 for ‘yes’) / 0 / 10
Does tobacco smoke really bother the child? (Score 0 for ‘no’ and 10 for ‘yes’) / 0 / 10
Do you feel that your child isn’t well, yet diagnostic tests and studies haven’t revealed the cause? (Score 0 for ‘no’ and 10 for ‘yes’) / 0 / 10

Please indicate issues (past and present) in terms of severity, 1 being not an issue and 10 being a major issue.

Clothing / Present
Frequency / Severity / Past
Issue / Comments
1. Appears to be bothered by clothing in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Is bothered by tags in shirts / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Is bothered by seams in socks / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Does not like stiff fabrics / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Wears long sleeves or does not remove jacket / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Refuses to wear synthetics, e.g. polyester / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Other: / 1 2 3 4 5 6 7 8 9 10 / yes / no
Motion / Present
Frequency / Severity / Past
Issue / Comments
1. Suffers from motion sickness in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Falls asleep in moving vehicle / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Does not enjoy merry-go-round / swings / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Wants to continue swinging, spinning, etc. / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Engages in a lot of jumping / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Avoids most movement / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Runs rather than walks / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Bumps into things / people in path / 1 2 3 4 5 6 7 8 9 10 / yes / no
9. Exhibits balance problems / 1 2 3 4 5 6 7 8 9 10 / yes / no
10. Engages in head banging, hand flapping, etc. / 1 2 3 4 5 6 7 8 9 10 / yes / no
11. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Foods / Present
Frequency / Severity / Past
Issue / Comments
1. Is a fussy eater in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Dislikes chewy foods / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Dislikes foods or juices due to texture / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Dislikes mixtures of textures in foods / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Dislikes most vegetables / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Eats a lot of sweets / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Eats a lot of salt / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Eats a lots of margarine, mayonnaise, fried foods / 1 2 3 4 5 6 7 8 9 10 / yes / no
9. Drinks lot of cola, coffee, regular tea / 1 2 3 4 5 6 7 8 9 10 / yes / no
10. Eats a lot of chocolate / 1 2 3 4 5 6 7 8 9 10 / yes / no
11. Has lot of milk, yoghurt / 1 2 3 4 5 6 7 8 9 10 / yes / no
12. Drinks at least 4 cups of water daily / 1 2 3 4 5 6 7 8 9 10 / yes / no
13. Takes supplements (please include list) / 1 2 3 4 5 6 7 8 9 10 / yes / no
14. Has food allergies (specify) / 1 2 3 4 5 6 7 8 9 10 / yes / no
15. Other:______/ 1 2 3 4 5 6 7 8 9 10 / yes / no
16. / 1 2 3 4 5 6 7 8 9 10 / yes / no
Lights / Present
Frequency / Severity / Past
Issue / Comments
1. Is bothered by lights in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Appears bothered by lights in supermarkets / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Appears uncomfortable with fluorescent lights / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Wants to wear a cap with a visor / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Plays under tables, in “tents” / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Prefers bright lights to dim lights / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Sneezes upon entering bright sunlight / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Grooming / Present
Frequency /Severity / Past
Issue / Comments
1. Appears uncomfortable in water / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Gets upset when needs to leave water / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Gets hysterical when washing hair / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Is extremely bothered by wet clothes / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Seems uncomfortable when dirty, sandy, etc. / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Does not appear to notice food on face / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Complains about face washing / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Complains about hair combing / brushing / 1 2 3 4 5 6 7 8 9 10 / yes / no
9. Complains about nail cutting / 1 2 3 4 5 6 7 8 9 10 / yes / no
10. Complains about haircuts / 1 2 3 4 5 6 7 8 9 10 / yes / no
11. Complains about tooth brushing / 1 2 3 4 5 6 7 8 9 10 / yes / no
12. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Human touch / Present
Frequency / Severity / Past
Issue / Comments
1. Does not like light touch / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Seeks deep touch / hugs / compression / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Is ticklish / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Hits, pushes, kicks others / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Has difficulty quitting rough-house play / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Needs to sit on, snuggle up to, other / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Complains about pain (falls, cuts, etc.) / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Sounds / Present
Frequency / Severity / Past
Issue / Comments
1. Is bothered by sound in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Is bothered by high-pitched sound / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Is bothered by loud sound / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Is startled by unexpected sound / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Speaks in a loud voice / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Hums or makes “white noise” / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Tunes out conversations or directions / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Odours / Present
Frequency / Severity / Past
Issue / Comments
1. Is bothered by strong odours / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Brings food to nose to smell before tasting / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Smells most objects / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Smells people’s hair and clothes / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Is bothered by food cooking or in cafeteria / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Appears insensitive to odour in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Has stuffed nose, is mouth breather / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Other / 1 2 3 4 5 6 7 8 9 10 / yes / no
Sleep / Present
Frequency / Severity / Past
Issue / Comments
1. Requires being rocked to go to sleep / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Upon awakening, has difficulty walking, eating / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Has trouble falling asleep in general / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Has trouble sleeping with background noise / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Has trouble sleeping with lights on / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Needs music / tapes to fall asleep / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Has trouble falling asleep in the dark / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Awakens frequently in the night (Reason?) / 1 2 3 4 5 6 7 8 9 10 / yes / no
9. Falls out of bed / 1 2 3 4 5 6 7 8 9 10 / yes / no
10. Moves in bed quite a lot while sleeping / 1 2 3 4 5 6 7 8 9 10 / yes / no
11. Sleepwalks / 1 2 3 4 5 6 7 8 9 10 / yes / no
12. Needs other person in bed in order to sleep / 1 2 3 4 5 6 7 8 9 10 / yes / no
13. Dislikes top sheet / cover on bed / 1 2 3 4 5 6 7 8 9 10 / yes / no
14. Other: / 1 2 3 4 5 6 7 8 9 10 / yes / no
Development Milestones / Present
Frequency / Severity / Past
Issue / Comments
1. Difficulty / delay sucking / 1 2 3 4 5 6 7 8 9 10 / yes / no
2. Difficulty / delay rolling over / 1 2 3 4 5 6 7 8 9 10 / yes / no
3. Difficulty / delay sitting up, pulling self up / 1 2 3 4 5 6 7 8 9 10 / yes / no
4. Difficulty / delay crawling / 1 2 3 4 5 6 7 8 9 10 / yes / no
5. Difficulty / delay walking / 1 2 3 4 5 6 7 8 9 10 / yes / no
6. Difficulty / delay talking / 1 2 3 4 5 6 7 8 9 10 / yes / no
7. Difficulty / delay dressing self / 1 2 3 4 5 6 7 8 9 10 / yes / no
8. Difficulty / delay feeding self / 1 2 3 4 5 6 7 8 9 10 / yes / no
9. Difficulty / delay going up or down stairs / 1 2 3 4 5 6 7 8 9 10 / yes / no
10. Difficulty / delay drawing or writing / 1 2 3 4 5 6 7 8 9 10 / yes / no
11. Difficulty / delay in reading / 1 2 3 4 5 6 7 8 9 10 / yes / no
12. Difficulty / delay deciding hand dominance / 1 2 3 4 5 6 7 8 9 10 / yes / no
13. Difficulty / delay playing ball sports / 1 2 3 4 5 6 7 8 9 10 / yes / no
14. Difficulty / delay with rhythm activities / 1 2 3 4 5 6 7 8 9 10 / yes / no
15. Other:______/ 1 2 3 4 5 6 7 8 9 10 / yes / no
1 2 3 4 5 6 7 8 9 10 / yes / no

What are the child’s favourite foods?......

......

What foods does the child resist eating (i.e. has to be forced!):……………………………………………………………

………………………………………………………………………………………………………………………………………

What foods will the child not eat at all?......

……………………………………………………………………………………………………………………………………..

Is the child underweight normal weightoverweightseverely overweight

How often does the child eat at restaurants:…………………………………
How often does the child eat ‘take out’ food:…………………………………

What ‘take out’ foods does the child normally order?......

How much water does the child drink in a normal school day?...... ml

How many fizzy cooldrink does the child drink? Daily Weekly

Please give an example of the child’s daily diet in the table below:

Breakfast / Morning snack / Lunch / Afternoon snack / Dinner/supper

Plot each characteristic on the scale, either high or low or in-between, as it applies to the child:

Activity Level

i.e. The amount of physical motion shown during the day

Low123456789 High

Persistence

i.e. The extend of continuation of behavior with or without interruption

Low123456789 High

Distractibility

i.e. The ease of being interrupted by sound, light, or unrelated behaviours

Low123456789 High

Initial Reaction

i.e. Responses to novel situations, whether approaching or withdrawing

Withdrawing 2 3 4 5 6 7 8 Approaching

Adaptability

i.e. The ease of changing behavior in a socially desirable or appropriate direction

Low123456789 High

Mood

i.e. The quality of emotional expression, positively or negatively

Positive 1 2 3 4 5 6 7 8 9 Negative

Intensity

i.e. The amount of energy shown in emotional expression

Low123456789 High

Sensitivity

i.e. The degree to which the child reacts to light, sound, emotions, etc.

Low123456789 High

Regularity

i.e. The extent to which patterns of eating, sleeping, elimination, etc. are consistent or inconsistent from day to day