Form Page | Gloucestershire Health and Care NHS Foundation Trust

Speech and language

Does your child have difficulties communicating, compared to other children?(Required)

These are a few examples, you may see others in your child:

Started talking later than children born at a similar time
Talk in an unusual way (eg mumbling, exaggerated or flat tone, an American accent, very loud or quiet)
Struggle to understand simple, age-appropriate instructions
Communicate with single words or 2-3 word phrases
Never use gestures such as hand or head movements to express themselves
Takes things literally e.g. not understanding common phrases such as 'it's raining cats and dogs'

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties in understanding and using verbal and non-verbal language.

Read more about speech and language guidance and advice (opens in new tab).

Based on your response, your child may have difficulties in understanding and using verbal and non-verbal language.

Read more about speech and language guidance and advice (opens in new tab).

Based on your response, your child may have occasional difficulties in understanding and using verbal and non-verbal language.

Read more about speech and language guidance and advice (opens in new tab).

Attention, impulsivity and hyperactivity

Does your child have difficulty concentrating, sitting still or do they act impulsively, compared to other children?(Required)

These are a few examples, you may see others in your child:

Find it hard to sit still
Struggle to concentrate, even on activities they enjoy
Act impulsively and/or without thinking including risky behaviour e.g. running into the road

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties in maintaining attention and controlling impulsivity and hyperactivity. Some of the behavioural strategies, guidance and tools recommended for ADHD may be helpful (opens in new tab).

Based on your response, your child may have difficulties in maintaining attention and controlling impulsivity and hyperactivity. Some of the behavioural strategies, guidance and tools recommended for ADHD may be helpful (opens in new tab).

Based on your response, your child may have occasional difficulties in maintaining attention and controlling impulsivity and hyperactivity. Some of the behavioural strategies, guidance and tools recommended for ADHD may be helpful (opens in new tab).

Emotional regulation

Does your child have difficulty recognising, regulating and/or responding to their emotions in a way that's appropriate for their age, compared to other children?(Required)

These are a few examples, you may see others in your child:

Seem to over or under react to things
Often have meltdowns or shutdowns where they become completely overwhelmed by a situation and unable to cope
Hit out at or hurt others or themselves e.g. biting, kicking, punching

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties in controlling their emotions. You may find behavioural strategies, guidance and tools for emotional regulation helpful (opens in new tab).

Based on your response, your child may have difficulties in controlling their emotions. You may find behavioural strategies, guidance and tools for emotional regulation helpful (opens in new tab).

Based on your response, your child may have occasional difficulties in controlling their emotions. You may find behavioural strategies, guidance and tools for emotional regulation helpful (opens in new tab).

Coordination, balance motor planning and fine motor skills

Does your child seem to have difficulties with their physical coordination, compared to other children?(Required)

These are a few examples, you may see others in your child:

Struggle to jump, hop, skip or catch a ball
Finds riding a bike or scooter difficult
Often have problems doing up buttons or zips, or tying shoe laces
Find it hard to hold a pen or pencil, or drawing and writing

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties with fine motor skills. You may find guidance and advice on motor skills helpful (opens in new tab).

Based on your response, your child may have difficulties with fine motor skills. You may find guidance and advice on motor skills helpful (opens in new tab).

Based on your response, your child may have occasional difficulties with fine motor skills. You may find guidance and advice on motor skills helpful (opens in new tab).

Sensory levels

Does your child either seem unusually interested in OR distressed by noises, colours, smells or textures, compared to other children?(Required)

These are a few examples, you may see others in your child. If they are unusually interested in sensory experiences, they might:

Need a firm touch
Seek out strong smells and tastes
Seek out loud noises
Enjoy running around and spinning
Have a distinct preference for particular textures

If they are distressed by sensory experiences, they might:

Cover their ears to block out sounds
Only eat certain food due to its texture or colour
Get upset by different textures, such as labels on clothing or seams

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant sensory processing differences. You may find guidance and advice on sensory processing helpful (opens in new tab).

Based on your response, your child may have sensory processing differences. You may find guidance and advice on sensory processing helpful (opens in new tab).

Based on your response, your child may have occasional sensory processing differences. You may find guidance and advice on sensory processing helpful (opens in new tab).

Flexibility and adaptability

Does your child seem distressed by changes to routines or environments, compared to other children?(Required)

These are a few examples, you may see others in your child:

A teacher is off sick or a road is closed
They find it difficult to move from one activity, room or environment to another
Using a different cereal bowl or sitting in a different chair

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties with flexibility and adaptability. You may find guidance and advice on repetitive behaviours and transitions helpful (opens in new tab).

Based on your response, your child may have difficulties with flexibility and adaptability. You may find guidance and advice on repetitive behaviours and transitions helpful (opens in new tab).

Based on your response, your child may have occasional difficulties with flexibility and adaptability. You may find guidance and advice on repetitive behaviours and transitions helpful (opens in new tab).

Social communication and interaction

Does your child seem to interact with others in a way that's different for their age or the situation, compared to other children?(Required)

These are a few examples, you may see others in your child:

Choose to play alone even if there are other children around
Make comments about people which are socially inappropriate for their age, eg 'they smell funny'
Often appears not to hear or not to listen to other

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties with social communication and interaction. You may find behavioural strategies, guidance and tools for social interaction helpful (opens in new tab).

Based on your response, your child may have difficulties with social communication and interaction. You may find behavioural strategies, guidance and tools for social interaction helpful (opens in new tab).

Based on your response, your child may have occasional difficulties with social communication and interaction. You may find behavioural strategies, guidance and tools for social interaction helpful (opens in new tab).

Sleep

Does your child have difficulty with sleep, compared to other children?(Required)

These are a few examples, you may see others in your child:

Find it hard to go to sleep
Wake up a lot in the night
Wake extremely early
Need lots of help to get to sleep

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant difficulties with sleeping. You may find behavioural strategies, guidance and tools for sleep helpful (opens in new tab).

Based on your response, your child may have difficulties with sleeping. You may find behavioural strategies, guidance and tools for sleep helpful (opens in new tab).

Based on your response, your child may have occasional difficulties with sleeping. You may find behavioural strategies, guidance and tools for sleep helpful (opens in new tab).

Toileting

Does your child have any difficulty going to the toilet, compared to other children?(Required)

These are a few examples, you may see others in your child:

Struggle with potty training or continue to have 'accidents' when older
Find going for a poo difficult
Play with their poo or spread it on things around them
Have difficulty recognising when they need to go to the toilet

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional bladder or bowel difficulties. You may find behavioural strategies, guidance and tools for toileting helpful (opens in new tab).

Based on your response, your child may have bladder or bowel difficulties. You may find behavioural strategies, guidance and tools for toileting helpful (opens in new tab).

Based on your response, your child may have occasional bladder or bowel difficulties. You may find behavioural strategies, guidance and tools for toileting helpful (opens in new tab).

Selective eating

Will your child only eat a limited range of foods, compared to other children?(Required)

These are a few examples, you may see others in your child:

They are very picky about what they eat, this may be due to texture or colour, or a reason they can’t explain
They refuse all foods from one or more food groups, for example vegetables
They are scared to try new foods

This is true for my child all of the time

This is true for my child most of the time

This is true for my child some of the time

This is not true for my child

Based on your response, your child may have significant functional difficulties with selective eating. You may find behavioural strategies, guidance and tools for addressing eating difficulties helpful (opens in new tab).

Based on your response, your child may have difficulties with selective eating. You may find behavioural strategies, guidance and tools for addressing eating difficulties helpful (opens in new tab).

Based on your response, your child may have occasional difficulties with selective eating. You may find behavioural strategies, guidance and tools for addressing eating difficulties helpful (opens in new tab).