This information is optional. It is not stored and used only for inclusion on the assessment result printout.
Child's First Name:
Child's Surname:
Age:
Does your child:
Hold their pencil awkwardly so that good pencil control is difficult?
Find it difficult to perform drawing/colouring as long as their peers (get pain/tired)?
Find it difficult to stay (or understand the need to stay) inside the lines when colouring?
Avoid pencil skills or not persist as long as peers?
Have trouble working out HOW to draw (e.g. asks adults to draw for them) or WHAT to write?
Hold scissors and/or paper awkwardly when cutting?
Find it difficult to cut through different cutting textures (e.g. cardboard, paper, cellophane)?
Avoid cutting activities or not persist as long as peers?
'Snip' the paper rather than 'cut' along the line?
Struggle to stay on the line (thick line for 3-4 yr olds) when cutting?
Use their whole hand rather than fingertips to hold/use small objects (e.g. Duplo, puzzle piece)?
Find it difficult to hold and control cutlery (when cutting play-doh or food)?
Need prompting to look at the details when doing a puzzle, activity sheet or drawing/copying a picture?
Lack consistent use of one dominant hand for object manipulation or task performance?
Find it difficult to open lunch boxes, bags, or pencil cases; do up buttons or zips?
Find it difficult to maintain static (still) positions for an extended period of time (so that they frequently move: e.g. rolling on the floor or changing sitting positions)?
Seem careless, clumsy, rougher than intended in play, or slow to react (eg dodging moving swing or ball)?
Need to watch peers before attempting the task (to learn how to do it)?
Have difficulty riding a bike/scooter, 'walking the plank' or climbing an A-Frame?
Take longer than typical to master new skills (e.g. swimming, riding)?
Tire quickly or have a slumped posture (at the table, on the matt, or in play)?
Look like they are putting in more effort than typical to physical play or positions?
Avoid physical play (eg falling frequently, being silly or refusing when tasks are difficult)?
Only participate in physical play for short periods or only in short spurts?
Look clumsy, seem overly cautious on the playground/in play, lack co-ordination or trip frequently?
Find it difficult to refine/modify skill performance even with practice (eg throwing/kicking longer to reach target)?
Avoid bat and/or ball skills (or look awkward and stiff in movements)?
Display limited tolerance/persistence for learning new skills?
Require step by step instructions and explicit modelling of movements to succeed?
Find it hard to combine 2 movements together (e.g. step and throw) with good control and consistency?
Require extensive help to fall asleep (e.g. rocking/patting/adult lying with them)?
Take a long time to calm after becoming 'wound up' or distressed?
Display excessive dislike of food textures/temperature/teeth cleaning/hair brushing?
Find it difficult to tolerate certain clothing articles/fabrics/tags/shoes?
Have trouble tolerating changes in routine so that they seek routine and/or constant reassurance about change of routine (or need advanced warning of change)?
Seek out movement so much it interferes with tasks (eg spins, fidgets, can't sit still)?
Seem lazy/lethargic/day-dreamy/hard to motivate/in their own world or constantly 'on-the-go', find it hard to wait/are physically active?
Require constant reminders to stay on task (because they appear too distracted, lazy or flit between tasks without engaging with many)?
Avoid large groups of people (playground, classroom, parties) / prefer solitary play?
Get 'wound up' in busy (noisy) environments (eg shopping centres, kids parties)?
Have difficulty beginning a task and/or sustaining performance independently (so they rely on adult prompts)?
Have difficulty problem solving independently when confronted by a challenge (may give up easily, get frustrated or refuse)?
Require tasks to be broken down and demonstrated one step at a time?
Have difficulty transferring a learnt skill from task to task (eg puzzles, block building, obstacle courses)?
Find it difficult to retain learnt skills if not continually practiced?
Have difficulty collecting materials for a task (e.g. scissor, paper, AND glue for cut & paste project)?
Have difficulty packing/unpacking their preschool bag or knowing how to pack away a mess?
Lose track of personal items (e.g. sweater, lunch box)?
Fail to correctly generate and sequence the steps in a task (cut & paste activity, obstacle course)?
Have difficulty following day-to-day routines that are well known to them (story time, wash hands, then fruit time)?
Show poor task persistence (e.g. gets very frustrated when can't complete a task)?
Have difficulty starting and continuing with independent play in a broad range of activities?
Locating familiar items in the environment (e.g. shoes, pyjamas, favourite toys)?
Have difficulty completing multiple verbal instructions independently?
Have difficulty remembering everyday requirements (e.g. making bed or cleaning teeth before bed)?
Have difficulty correctly sequencing task performance (e.g. dressing: underwear not jeans on first)?
Need more help physically performing tasks than age appropriate (e.g. dressing, toileting, cleaning teeth, brushing hair)?
Have difficulty identifying/remembering the steps required in familiar tasks (e.g. 'get ready for kindy' means make bed, have breakfast, clean teeth)?
Take an excessively long time to initiate or perform a task (e.g. putting on shoes, getting dressed, eating meal)?
Look like they 'just can't get it together' (disorganised thinking)?