Assessment

Assessment

  • *Child’s Name

    *Birth date :

    Complaint

    *Choose the type of Assesment

    • We carefully selected our assessments based on expertise and internationally recognized standards. ✅ Because each assessment provides a different perspective for understanding and analysis, combining multiple assessments allows us to gain a more comprehensive and accurate picture. This approach helps us better understand the concerns and challenges at a deeper level, enabling us to develop a clearer home-based intervention plan with more precise goals and recommendations that are tailored to the individual's specific needs.

      • Sensory Evaluation/Assessment

        This assessment is designed to evaluate how a child, adolescent, or adult processes sensory input in daily life, and to identify sensory-related difficulties that may affect behavior, attention, emotional regulation, learning, sleep, social participation, and independence.

        The questionnaire measures several key areas, including:

        • Responses to sound, touch, movement, smells, lights, and food

        • Level of distraction or discomfort from the surrounding environment

        • Excessive sensory seeking behaviors (movement, touch, stimulation)

        • Emotional and self-regulation when exposed to sensory input

        • Impact of sensory processing on attention, behavior, and daily functioning

        • Understanding sensory strengths and challenges

        Age Range:

        Available in multiple versions depending on age, starting from birth through adulthood.

        The appropriate version is selected based on the individual’s age to ensure accurate results.

        After the Assessment:

        You will receive:
        • A detailed analysis of the results

        • Identification of the individual’s sensory profile pattern

        • Explanation of behaviors or daily challenges linked to sensory processing

        • Practical strategies for home / school / work settings

        • Clear and simplified therapeutic recommendations

        Why It Matters:

        This assessment helps understand the person more deeply — like a “key” that explains how they interact with the world around them, while giving parents or professionals a practical guide for adapting the environment to suit their sensory needs.

        Validity Period:

        Results are commonly considered a useful reference for approximately 6 months, depending on age, developmental changes, and progress over time.

        *Choose Age group:


        Infant Sensory Profile (Birth – 6 Months)

        To Be Completed by the Caregiver

        *Relationship to the Child


        Background Information

        *Was the child born prematurely?

        * How many weeks?

        *Birth order


        Instructions for Parent:


        Please read each statement and select the response that best describes how often your child shows the behavior:

        • Almost Always→ 90% or more of the time
        • Frequently→ about 75%
        • Half the Time→ about 50%
        • Occasionally→ about 25%
        • Almost Never→10% or less

        If the behavior has not been observed, please select "Does not apply."
        Additional comments can be provided at the end of each section


        General Processing

         

        *Stays quiet and calm in an active setting compared to other babies.

        *Unaware of people coming in or leaving the room.

        *Needs the same routine to stay content and calm.

        *Acts in a way that interferes with family schedules and plans.

        *Requires help to get to sleep.

        *Is irritable compared to other babies.

        *Sleeps more than other babies.

        *Only pays attention when I touch my baby (and hearing is OK).

        Additional comments


        Auditory Processing

         

        *Enjoys making mouth sounds (for example, blowing raspberries, making noises with lips, humming).

        *Ignores me when I am talking.

        *Becomes upset by sudden everyday sounds.

        *Becomes more animated and engaged around music, talking, or sound toys.

        Additional comments


        Visual Processing

         

        *Misses eye contact with me during everyday interactions.

        *Looks away from faces or toys

        *Looks away or becomes restless in noisy settings or with noisy toys.

        *Blinks a lot when objects or people come close to face.

        Additional comments


        Touch Processing

         

        *Becomes upset when having nails trimmed.

        *Needs to be swaddled or wrapped to relax.

        *Is startled by texture differences (for example, on grass, on carpet, on blankets).

        Additional comments


        Movement Processing

         

        *Enjoys rhythmical activities (for example, swinging, rocking, car rides).

        *Resists having head tipped back during bathing.

        *Cries or fusses with movement

        *Needs more head support when being held compared to other babies.

        Additional comments


        Oral Sensory Processing

         

        *Struggles to close mouth when feeding from the breast or bottle (for example, doesn’t latch on).

        *Enjoys making oral movements or sounds

        Additional comments


        Toddler Sensory Profile (7–35 Months)

        To Be Completed by the Caregiver

        *Relationship to the Child


        Background Information

        *Was the child born prematurely?

        * How many weeks?

        *Birth order


        Instructions for Parent:


        Please read each statement and select the response that best describes how often your child shows the behavior:

        • Almost Always→ 90% or more of the time
        • Frequently→ about 75%
        • Half the Time→ about 50%
        • Occasionally→ about 25%
        • Almost Never→10% or less

        If the behavior has not been observed, please select "Does not apply."
        Additional comments can be provided at the end of each section


        General Processing

         

        *Needs the same routine to stay content and calm.

        *Acts in a way that interferes with family schedules and plans.

        *Resists playing among other children.

        *Resists playing among other children.

        *Takes longer than same-aged children to respond to questions or actions.

        *Withdraws from situations.

        *Has an unpredictable sleeping pattern.

        *Has an unpredictable eating pattern.

        *Is easily awakened.

        *Misses eye contact with me during everyday interactions.

        *Gets anxious in new situations.

        Additional comments


        Second: Auditory Processing

         

        *Only pays attention if I speak loudly.

        *Only pays attention when I touch my baby (and hearing is OK).

        *Startles easily at sound compared to same-aged children.

        *Is distracted in noisy settings.

        *Ignores sounds, including my voice.

        *Becomes upset or tries to escape from noisy settings.

        *Takes a long time to respond to own name.

        Additional comments


        Third: Visual Processing

         

        *Enjoys looking at moving or spinning objects (for example, ceiling fans, toys with wheels).

        *Enjoys looking at shiny objects.

        *Is attracted to TV or computer screens with fast-paced, brightly colored graphics.

        *Startles at bright or unpredictable light (for example, when moving from inside to outside).

        *Is bothered by bright lights

        *Is more bothered by bright lights than other same-aged children.

        *Pushes brightly colored toys away.

        *Fails to respond to self in the mirror.

        Additional comments


        Fourth: Touch Processing

         

        *Becomes upset when having nails trimmed.

        *Resists being cuddled.

        *Is upset when moving among spaces with very different temperatures (for example, colder, warmer).

        *Withdraws from contact with rough, cold, or sticky surfaces (for example, carpet, countertops).

        *Bumps into things, failing to notice objects or people in the way.

        *Pulls at clothing or resists getting clothing on.

        *Enjoys splashing during bath or swim time.

        *Becomes upset if own clothing, hands, or face are messy.

        *Becomes anxious when walking or crawling on certain surfaces (for example, grass, sand, carpet, tile).

        *Withdraws from unexpected touch.

        Additional comments


        Fifth: Movement Processing

         

        *Enjoys physical activity (for example, bouncing, being held up high in the air).

        *Enjoys rhythmical activities (for example, swinging, rocking, car rides).

        *Takes movement or climbing risks.

        *Becomes upset when placed on the back (for example, at changing times).

        *Seems accident-prone or clumsy.

        *Fusses when moved around (for example, walking around, when being handed over to another person).

        Additional comments


        Sixth: Oral Sensory Processing

         

        *Shows a clear dislike for all but a few food choices.

        *Drools.

        *Prefers one texture of food (for example, smooth, crunchy).

        *Uses drinking to calm self.

        *Gags on foods or drink.

        *Holds food in cheeks before swallowing.

        *Has difficulty weaning to chunky foods.

        Additional comments


        Seventh: Behavioral Response Processing

         

        *Has temper tantrums.

        *Is clingy.

        *Stays calm only when being held.

        *Is fussy or irritable.

        *Is bothered by new settings.

        *Becomes so upset in new settings that it's hard to calm down.

        Additional comments


        from your point of view , What are your child’s strengths?

        What concerns you the most or worries you about your child?

        Child Sensory Profile 2 (Ages 3–14Years)

        To Be Completed by the Caregiver

        *Relationship to the Child


        Instructions for Parent:


        Please read each statement and select the response that best describes how often your child shows the behavior:

        • Almost Always→ 90% or more of the time
        • Frequently→ about 75%
        • Half the Time→ about 50%
        • Occasionally→ about 25%
        • Almost Never→10% or less

        If the behavior has not been observed, please select "Does not apply."
        Additional comments can be provided at the end of each section


        Auditory Processing

         

        *Responds negatively to unexpected or loud noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer).

        *Holds hands over ears to protect ears from sound.

        *Has trouble completing tasks when the radio is on.

        *Is distracted or has trouble functioning if there is a lot of noise around.

        *Can't work with background noise (for example, fan, refrigerator).

        *Appears to not hear what you say (for example, does not "tune-in" to what you say, appears to ignore you).

        *Doesn't respond when name is called but you know the child's hearing is OK.

        *Enjoys strange noises/seeks to make noise for noise's sake.

        Additional comments


        Second: Visual Processing

         

        *Prefers to be in the dark.

        *Expresses discomfort with or avoids bright lights (for example, hides from sunlight through window in car).

        *Happy to be in the dark.

        *Becomes frustrated when trying to find objects in competing backgrounds (for example, a cluttered drawer).

        *Has difficulty putting puzzles together (as compared to same age children).

        *Is bothered by bright lights after others have adapted to the light.

        *Covers eyes or squints to protect eyes from light.

        *Looks carefully or intensely at objects/people (for example, stares).

        *Has a hard time finding objects in competing backgrounds (for example, shoes in a messy room, favorite toy in the "junk drawer").

        Additional comments


        Third: Vestibular Processing

         

        *Becomes anxious or distressed when feet leave the ground

        *Dislikes activities where head is upside down (for example, somersaults, roughhousing)

        *Avoids playground equipment or moving toys (for example, swing set, merry-go-round)

        *Dislikes riding in a car

        *Holds head upright, even when bending over or leaning (for example, maintains a rigid position/posture during activity)

        *Becomes disoriented after bending over sink or table (for example, falls or gets dizzy)

        *Seeks all kinds of movement and this interferes with daily routines (for example, can’t sit still, fidgets)

        *Seeks out all kinds of movement activities (for example, being whirled by adult, merry-go-rounds, playground equipment, moving toys)

        *Twirls/spins self frequently throughout the day (for example, likes dizzy feeling)

        *Rocks unconsciously (for example, while watching TV)

        *Rocks in desk/chair/on floor

        Additional comments


        Fourth: Touch Processing

         

        *Avoids getting "messy" (for example, in paste, sand, finger paint, glue, tape).

        *Expresses distress during grooming (for example, fights or cries during haircutting, face washing, fingernail cutting).

        *Prefers long-sleeved clothing when it is warm or short sleeves when it is cold.

        *Expresses discomfort at dental work or toothbrushing (for example, cries or fights).

        *Is sensitive to certain fabrics (for example, is particular about certain clothes or bedsheets).

        *Becomes irritated by shoes or socks.

        *Avoids going barefoot, especially in sand or grass.

        *Reacts emotionally or aggressively to touch.

        *Withdraws from splashing water.

        *Has difficulty standing in line or close to other people.

        *Rubs or scratches out a spot that has been touched.

        *Touches people and objects to the point of irritating others.

        *Displays unusual need for touching certain toys, surfaces, or textures (for example, constantly touching objects).

        *Decreased awareness of pain and temperature.

        *Doesn't seem to notice when someone touches arm or back (for example, unaware).

        *Avoids wearing shoes; loves to be barefoot.

        *Touches people and objects.

        *Doesn't seem to notice when face or hands are messy.

        Additional comments


        Fifth: Multisensory Processing

         

        *Gets lost easily (even in familiar places).

        *Has difficulty paying attention.

        *Looks away from tasks to notice all actions in the room.

        *Seems oblivious within an active environment (for example, unaware of activity).

        *Hangs on people, furniture, or objects even in familiar situations.

        *Walks on toes.

        *Leaves clothing twisted on body.

        Additional comments


        Sixth: Oral Sensory Processing

         

        *Gags easily with food textures or food utensils in mouth.

        *Avoids certain tastes or food smells that are typically part of children's diets.

        *Will only eat certain tastes.

        Give examples:

        *Limits self to particular food textures/temperatures.

        Give examples:

        *Picky eater, especially regarding food textures.

        *Routinely smells nonfood objects.

        *Shows strong preference for certain smells.

        Give examples:

        *Shows strong preference for certain tastes.

        Give examples:

        *Craves certain foods.

        Give examples:

        *Seeks out certain tastes or smells.

        Give examples:

        *Chews or licks on nonfood objects.

        *Mouths objects (for example, pencil, hands).

        Additional comments


        Modulation

         

        Seventh: Endurance/Tone Processing

         

        *Moves stiffly.

        *Tires easily, especially when standing or holding particular body position.

        *Locks joints (for example, elbows, knees) for stability.

        *Seems to have weak muscles.

        *Has a weak grasp.

        *Can't lift heavy objects (for example, weak in comparison to same age children).

        *Props to support self (even during activity).

        *Poor endurance / tires easily.

        *Appears lethargic (for example, has no energy, is sluggish).

        Additional comments


        Eighth: Modulation Related to Body Position and Movement

         

        *Seems accident-prone.

        *Hesitates going up or down curbs or steps (for example, is cautious, stops before moving).

        *Fears falling or heights.

        *Avoids climbing/jumping or avoids bumpy/uneven ground.

        *Holds onto walls or banisters (for example, clings).

        *Takes excessive risks during play (for example, climbs high into a tree, jumps off tall furniture).

        *Takes movement or climbing risks during play that compromise personal safety.

        *Turns whole body to look at you.

        *Seeks opportunities to fall without regard to personal safety.

        *Appears to enjoy falling.

        Additional comments


        Ninth: Modulation of Movement Affecting Activity Level

         

        *Spends most of the day in sedentary play (for example, does quiet things).

        *Prefers quiet, sedentary play (for example, watching TV, books, computers).

        *Seeks sedentary play options.

        *Prefers sedentary activities.

        *Becomes overly excitable during movement activity.

        *"On the go".

        *Avoids quiet play activities.

        Additional comments


        Tenth: Modulation of Sensory Input Affecting Emotional Responses

         

        *Needs more protection from life than other children (for example, defenseless physically or emotionally).

        *Rigid rituals in personal hygiene.

        *Is overly affectionate with others.

        *Doesn't perceive body language or facial expressions (for example, unable to interpret).

        Additional comments


        Elevinth: Modulation of Visual Input Affecting Emotional Responses and Activity Level

         

        *Avoids eye contact.

        *Stares intensely at objects or people.

        *Watches everyone when they move around the room.

        *Doesn't notice when people come into the room.

        Additional comments


        twelfth: Emotional / Social Responses

         

        *Seems to have difficulty liking self (for example, low self-esteem).

        *Has trouble "growing up" (for example, reacts immaturely to situations).

        *Is sensitive to criticisms.

        *Has definite fears (for example, fears are predictable).

        *Seems anxious.

        *Displays excessive emotional outbursts when unsuccessful at a task.

        *Expresses feeling like a failure.

        *Is stubborn or uncooperative.

        *Has temper tantrums.

        *Poor frustration tolerance.

        *Cries easily.

        *Overly serious.

        *Has difficulty making friends (for example, does not interact or participate in group play).

        *Has nightmares.

        *Has fears that interfere with daily routine.

        *Doesn't have a sense of humor.

        *Doesn't express emotions.

        Additional comments


        Thirteenth: Behavioral Outcomes of Sensory Processing

         

        *Talks self through tasks.

        *Writing is illegible.

        *Has trouble staying between the lines when coloring or when writing.

        *Uses inefficient ways of doing things (for example, wastes time, moves slowly, does things a harder way than is needed).

        *Has difficulty tolerating changes in plans and expectations.

        *Has difficulty tolerating changes in routines.

        Additional comments


        Fourteenth: Items Indicating Thresholds for Response

         

        *Jumps from one activity to another so that it interferes with play.

        *Deliberately smells objects.

        *Does not seem to smell strong odors.

        Additional comments


        Adolescent and adults sensory profile

        To Be Completed by the Caregiver

        هل توجد جوانب في حياتك غير راضٍ عنها؟


        يرجى التوضيح:


        Instructions for Parent:


        Please read each statement and select the response that best describes مدى تكرار السلوك:

        • Almost Always→ 90% or more of the time
        • Frequently→ about 75%
        • Half the Time→ about 50%
        • Occasionally→ about 525%
        • Almost Never→10% or less

        First: Taste / Smell Processing

         

        *I leave or move to another section when I smell a strong odor in a store (for example, bath products, candles, perfumes).

        *I add spice to my food.

        *I don't smell things that other people say they smell.

        *I enjoy being close to people who wear perfume or cologne.

        *I only eat familiar foods.

        *Many foods taste bland to me (in other words, food tastes plain or does not have a lot of flavor).

        *I don't like strong tasting mints or candies (for example, hot/cinnamon or sour candy).

        *I go over to smell fresh flowers when I see them.

        Additional comments


        Second: Movement Processing

         

        *I'm afraid of heights.

        *I enjoy how it feels to move about (for example, dancing, running).

        *I avoid elevators and/or escalators because I dislike the movement.

        *I trip or bump into things.

        *I dislike the movement of riding in a car.

        *I choose to engage in physical activities.

        *I am unsure of footing when walking on stairs (for example, I trip, lose balance, and/or need to hold the rail).

        *I become dizzy easily (for example, after bending over, getting up too fast).

        Additional comments


        Third: Visual Processing

         

        *I like to go to places that have bright lights and that are colorful.

        *I keep the shades down during the day when I am at home.

        *I like to wear colorful clothing.

        *I become frustrated when trying to find something in a crowded drawer or messy room.

        *I miss the street, building, or room signs when trying to go somewhere new.

        *I am bothered by unsteady or fast-moving visual images in movies or TV.

        *I don't notice when people come into the room.

        *I choose to shop in smaller stores because I'm overwhelmed in large stores.

        *I become bothered when I see lots of movement around me (for example, at a busy mall, parade, carnival).

        *I limit distractions when I am working (for example, I close the door, or turn off the TV).

        Additional comments


        Fourth: Touch Processing

         

        *I dislike having my back rubbed.

        *I like how it feels to get my hair cut.

        *I avoid or wear gloves during activities that will make my hands messy.

        *I touch others when I'm talking (for example, I put my hand on their shoulder or shake their hands).

        *I am bothered by the feeling in my mouth when I wake up in the morning.

        * I like to go barefoot.

        *I'm uncomfortable wearing certain fabrics (for example, wool, silk, corduroy, tags in clothing).

        *I don't like particular food textures (for example, peaches with skin, applesauce, cottage cheese, chunky peanut butter).

        *I move away when others get too close to me.

        *I don't seem to notice when my face or hands are dirty.

        *I get scrapes or bruises but don't remember how I got them.

        *I avoid standing in lines or standing close to other people because I don't like to get too close to others.

        *I don't seem to notice when someone touches my arm or back.

        Additional comments


        Fifth: Activity Level

         

        *I work on two or more tasks at the same time.

        *It takes me more time than other people to wake up in the morning.

        *I do things on the spur of the moment (in other words, I do things without making a plan ahead of time).

        *I find time to get away from my busy life and spend time by myself.

        *I seem slower than others when trying to follow an activity or task.

        *I don't get jokes as quickly as others.

        *I stay away from crowds.

        *I find activities to perform in front of others (for example, music, sports, acting, public speaking, and answering questions in class).

        *I find it hard to concentrate for the whole time when sitting in a long class or a meeting.

        *I avoid situations where unexpected things might happen (for example, going to unfamiliar places or being around people I don't know).

        Additional comments


        Sixth: Auditory Processing

         

        *I hum, whistle, sing, or make other noises.

        *I startle easily at unexpected or loud noises (for example, vacuum cleaner, dog barking, telephone ringing).

        *I have trouble following what people are saying when they talk fast or about unfamiliar topics.

        *I leave the room when others are watching TV, or I ask them to turn it down.

        *I am distracted if there is a lot of noise around.

        *I don't notice when my name is called.

        *I use strategies to drown out sound (for example, close the door, cover my ears, wear ear plugs).

        *I stay away from noisy settings.

        *I like to attend events with a lot of music.

        *I have to ask people to repeat things.

        *I find it difficult to work with background noise (for example, fan, radio).

        Additional comments

    • ARFID Assessment

      • Avoidant/Restrictive Food Intake Disorder Questionnaire (Parent-Report Version)

        This assessment is designed to evaluate a child’s eating patterns and identify potential signs of Avoidant/Restrictive Food Intake Disorder (ARFID).

        The questionnaire measures several key areas, including:


        • Level of food selectivity (picky eating)
        • Sensory responses to food characteristics (taste, texture, smell, and appearance)
        • Anxiety or avoidance related to trying new foods
        • Interest in food and eating
        • The impact of eating behaviors on the child’s health and social functioning

        Age Range:

        Suitable for children aged 2 years and above, based on parent-report observations in daily environments.

        After the Assessment:

        You will receive:

        • A detailed analysis of the results
        • Identification of the child’s core areas of difficulty
        • A structured, clear, and simplified home therapy plan

        • Approved recommendations

        Therapeutic Approach:

        The home plan is based on the SOS (Sequential Oral Sensory)approach, a widely recognized evidence-based method used to support children with feeding difficulties through gradual and stress-free food exposure.


        Instructions for Parent:


        Please read each statement and rate how accurately it describes your child over the past 3 months.:


        Feeding Behavior

         

        *1.My child is often described by others as a picky eater.

        *2. I notice that my child is selective and limited in their food choices.

        *3. My child eats a narrower range of foods compared to peers.

        *4. My child shows anxiety or hesitation when trying new foods.


        Food Sensory Sensitivity

         

        *1. My child refuses certain foods because of how they look.

        *2. My child refuses certain foods because of their texture.

        *3. My child refuses certain foods because of their smell.

        *4. My child refuses certain foods because of their taste, even if others enjoy them.


        Food Interest and Physical Response

         

        *1. My child shows little interest in food or eating.

        *2. My child avoids certain foods due to fear of discomfort or stomach upset.

        *3. Some foods cause my child to gag or vomit when trying them.


        Family Observations and Development

         

        *1. As parents, we have been concerned about our child’s eating habits.

        *2. The number of foods my child accepts has decreased over time.

        *3. My child may prefer not to eat rather than eat unfamiliar or uncomfortable foods.


        Psychological and Social Aspects

         

        *1. My child feels embarrassed about eating in front of others.

        *2. My child only accepts very specific foods and refuses similar alternatives.

        *3. Seeing others eat does not encourage my child to try new foods.


        Eating Patterns and Repetitive Behaviors

         

        *1. My child goes through phases of eating one food repeatedly, then rejecting it.


        Impact on Daily Life

         

        *1. My child’s eating difficulties affect their social interactions.

        *My child’s eating difficulties affect their overall health.


      • Comprehensive Child Anxiety Assessment (Parent Version)

        This assessment is designed to evaluate a child’s anxiety patternsand identify potential difficulties related to different anxiety disorders. It helps provide a clear understanding of how the child thinks, feels, and responds to everyday situations.

        The questionnaire measures several key areas, including:

        • General anxiety and excessive worry

        • Social anxiety and fear of judgment or interaction
        • Separation anxiety and dependency on caregivers

        • Physical symptoms of anxiety (e.g., rapid heartbeat, stomachaches, tension)

        • School-related and performance anxiety

        • Obsessive thoughts and repetitive behaviors

        • Specific fears (e.g., darkness, insects, crowded places)

        • Behavioral expression of anxiety (avoidance, withdrawal, irritability, crying)

        Age Range:


        Suitable for children aged 4 years and above, based on parent-report observations in daily environments.

        After the Assessment:


        You will receive:
        • A detailed analysis of the results

        • Identification of the child’s primary type of anxiety

        • Understanding of how anxiety presents (cognitive, physical, behavioral)

        • A clear and simplified home support plan

        • Evidence-based recommendations tailored to the child

        Therapeutic Approach:


        This assessment is developed based on internationally recognized tools such as:

        RCADS and SCARED, along with therapeutic programs like Face Your Fears.

        The intervention approach is based on evidence-based practices, including:

        • Cognitive Behavioral Therapy (CBT)

        • Gradual exposure techniques (Exposure Therapy)

        • Emotional regulation and coping skills development

        The goal is to support the child in understanding and managing anxiety in a gradual, safe, and pressure-free way..


        Instructions for Parent:


        Please read each statement and select the response that best describes how often your child shows the behavior:

        • Almost Always→ 90% or more of the time
        • Frequently→ about 75%
        • Half the Time→ about 50%
        • Occasionally→ about 25%
        • Almost Never→10% or less

        If the behavior has not been observed, please select "Does not apply."
        Additional comments can be provided at the end of each section


        1. Generalized Anxiety (Worry & Overthinking)

         

        *My child overthinks about the future or “what might happen”

        *My child worries about not doing things perfectly

        *My child is afraid of making mistakes or failing

        *My child asks repeated questions for reassurance

        *My child worries about what others think of them

        *My child struggles to let go of past events

        *My child worries about many things without a clear reason

        Additional comments


        2. Social Anxiety

         

        *My child feels nervous around unfamiliar people

        *My child is afraid of being judged or embarrassed

        *My child avoids social situations or group settings

        *My child feels anxious when being observed (e.g., reading aloud, performing)

        *Avoids social gatherings or crowded places

        *My child worries about how they appear to others

        Additional comments


        3. Separation Anxiety

         

        *My child is afraid of being away from parent

        *My child refuses to sleep alone

        *My child fears something bad might happen to family members

        *My child avoids going places without parents

        *My child becomes anxious when separated from caregivers

        Additional comments


        4. Physical Symptoms of Anxiety (Somatic / Panic)

         

        *My child complains of stomachaches or headaches without a medical cause

        *My child experiences a rapid heartbeat

        *My child sweats or trembles

        *My child reports difficulty breathing

        *My child feels dizzy or faint

        *My child feels nauseous or like vomiting

        Additional comments


        5. School & Performance Anxiety

         

        *My child avoids going to school

        *My child feels anxious before tests or exams

        *My child struggles to start homework due to anxiety

        *My child becomes anxious when being evaluated

        *My child’s concentration is affected by anxiety

        Additional comments


        6. Obsessive Thoughts & Repetitive Behaviors

         

        *My child repeatedly checks things (e.g., doors, homework)

        *My child experiences intrusive or unwanted thoughts

        *My child feels the need to do things in a specific way to feel safe

        *My child repeats actions or behaviors unnecessarily

        Additional comments


        7. Specific Fears (Phobias)

          (Select or add based on the child)

        *Fear of the dark

        *Fear of insects

        *Fear of animals

        *Fear of heights

        *Fear of loud noises

        *Fear of germs or illness

        *Fear of sleeping alone

        *Fear of crowded places

        Additional comments


        8. Behavioral Expression of Anxiety

         

        *Cries or becomes tearful

        *Yells or screams

        *Withdraws or becomes quiet

        *Refuses tasks or situations

        *Becomes restless or hyperactive

        *Displays aggressive behavior

        *Act silly / laughing

        *Shows physical signs (blushing, sweating)

        Additional comments

      • Parent Executive Skills Questionnaire (Ages 12+)

        This assessment is designed to evaluate a child’s or adolescent’s executive functioning skills and identify difficulties that may affect academic performance, daily responsibilities, self-regulation, behavior, and decision-making.

        The questionnaire measures several key areas, including:

        • Impulse control and thinking before acting

        • Working memory and remembering instructions

        • Emotional regulation

        • Task initiation and procrastination

        • Sustained attention and task completion
        • Planning and prioritization

        • Personal organization
        • Time management

        • Flexibility and adapting to change

        • Self-monitoring and learning from mistakes

        • Goal-directed persistence

        • Stress tolerance and coping under pressure

        Age Range:

        Suitable for children and adolescents aged 12 years and above, based on parent-report observations over the past 3 months.

        After the Assessment:

        You will receive:
        • A detailed analysis of the results

        • Identification of executive strengths and weaknesses

        • Explanation of academic or behavioral challenges

        • A clear and simplified home support plan

        • Professional therapeutic and educational recommendations

        Why It Matters:

        This assessment helps understand how the child manages daily life tasks such as starting work, organizing time, controlling emotions, staying focused, and persisting through challenges.
        It is highly valuable in cases involving distractibility, procrastination, forgetfulness, emotional reactivity, and poor responsibility skills..

        Therapeutic Approach:

        Results are interpreted using executive function frameworks and occupational therapy principles, then translated into practical strategies for home and school environments.


        Instructions for Parent:


        Please read each statement and rate how accurately it describes your child over the past 3 months.:

         


        Section 1: Response Inhibition

         

        *Thinks before speaking.

        *Pauses before reacting when upset.

        *Can wait for their turn without interrupting.


        Section 2: Working Memory

         

        * Remembers multi-step directions.

        *Remembers what was asked without frequent reminders.

        *Can hold information in mind while doing a task.


        Section 3: Emotional Control

         

        *Handles frustration with relative calm.

        *Small things do not greatly affect mood.

        *Can calm down after becoming upset.


        Section 4: Task Initiation

         

        *Starts homework or tasks without major delay.

        *Does not procrastinate much when responsibilities exist.

        *Can begin even when the task is not enjoyable.


        Section 5: Sustained Attention

         

        *Maintains focus during tasks.

        *Finishes tasks through to completion.

        *Returns to task easily after interruptions.


        Section 6: Planning / Prioritization

         

        *Knows what should be started first.

        *Breaks large tasks into smaller steps.

        *Can prioritize when many tasks exist.


        Section 7: Organization

         

        *Keeps belongings organized.

        *Knows where important items are.

        *Keeps bag / room / desk organized.


        Section 8: Time Management

         

        *Usually arrives on time.

        *Estimates time needed for tasks well.

        *Uses time appropriately during the day.


        Section 9: Flexibility

         

        *Accepts plan changes without major distress.

        *Adjusts to new situations.

        *Can change approach if the first one fails.


        Section 10: Metacognition

         

        *Notices mistakes and tries to correct them.

        *Learns from past experiences.

        *Thinks about performance and how to improve it.


        Section 11: Goal-Directed Persistence

         

        *Keeps going even when tasks are hard.

        *Gives up immediate pleasure for later goals.

        *Stays committed to goals until achieved.


        Section 12: Stress Tolerance

         

        *Works well under pressure.

        *Handles unexpected situations reasonably well.

        *Can continue functioning despite stress.


    *Please select your preferred language for the report

    *Please select your preferred report delivery method

    Notes

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