Problem checklist

Problem Checklist

Direction: Put a check if the problem listed below are commonly experiences in eced children and identify if it physical, emotional, intellectual, social and spiritual problem.

	Aggressive		Anxiety
	Social competency		Depression
	Attention deficit		Fear/ anxiety
	Whining		Poor eating habits
	Hitting, biting		Interrupting
	Temper tantrums		Shyness
	Learning disability		Sleeping problems
	Rocking back and forth		Finger flicking
	Bullying		Autism
	ADHD		Aspergers
	Growth deficiency		Language problems
	Dwarfism		Social withdrawal
	Acalculia		Hallucinations
	Paranoia		Lying
	Threatening		School problems
	Delayed sexual dev’t		Impaired thinking
	Disorientation		Cognitive impairement

    Checklist of Common Symptoms 

How often does your child experience the following symptoms?

.

 

            Place a checkmark in the column that best describes your child.

.

How frequently does this happen?	Never  0	A little  1	Sometimes  2	A  lot  3	Always  4
1. Headaches with reading or writing
2. Words slide together or get blurry when reading
3. Reads below grade level
4. Loses place while reading
5. Head tilt or closes an eye when reading
6. Hard to copy from the board
7. Doesn’t like reading or writing
8. Leaves out small words when reading
9. Hard to write in a straight line
10. Burning, itching, or watery eyes
11. Hard to understand what he/she has read
12. Holds book very close
13. Hard to pay attention when reading
14. Hard to finish assignments on time
15. Gives up easily (says “I can’t” before trying)
16. Bumps into things, knocks things over
17. Homework takes too long
18. Daydreams
19. In trouble for being off task at school

Number of total marks in each column	____	____	____	____	____
Multiply total marks in each column by:	x 0	x 1	x 2	x 3	x 4
Score for each column	____	____	____	____	____

            Total Score for all columns _______________