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You and Your Child: 10-12

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MICRO QUESTIONNAIRE: YOU AND YOUR CHILD 10-12

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    SECTION A. MOTOR: TEN TO TWELVE YEARS OF AGE

    Section description

    • The following questions relate to your child’s motor skills. The skills are in sequential order; for example, the item that describes “running” is listed earlier on in the list than “hopping on one foot”.
    • In this section, there is specific information about your child’s motor skills, that is, your child’s ability to use his/her hands, move around and be as independent as his/her age permits.

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    A1. Motor: Fine: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    A2. Motor: Gross: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION B. SOCIAL AND EMOTIONAL: TEN TO TWELVE YEARS OF AGE

    Section description

    • The following statements relate to your child’s social and emotional skills.

    Section Instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item

    B1: Social Development: Ten to Twelve Years of Age

    Social Skills - description

    • In this section, there is specific information about your child’s social skills, that is, the way your child relates to others and interacts with them in socially acceptable ways.
    • Please note that items in this section contain statements that apply to children with ages ranging between 10 AND 12 years old.

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION C. COGNITIVE: TEN TO TWELVE YEARS OF AGE

    Section description

    • The following questions relate to your child’s intellectual/cognitive skills.
    • This section contains information about how your child deals with the world around him/her, how well he/she is able to solve problems and how well he/she is able to recognize and express basic information.

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION D. LITERACY: TEN TO TWELVE YEARS OF AGE

    D1: Literacy: Reading: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    D2. Literacy: Writing: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    D3. Literacy: Math: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION E. LANGUAGE

    Section description

    • The following statements refer to your child’s language and communication skills.
    • This section is sub-divided into 4 mini-sections: receptive language, expressive language, articulation and pragmatics
    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item.

    E1: Language: Receptive: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    E2. Language: Expressive: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    E3. Language: Pragmatic: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    E4. Language: Articulation: Ten to Twelve Years of Age

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION F. ADAPTIVE: TEN TO TWELVE YEARS OF AGE

    Section description

    • The following section contains information about your child’s self help skills or how he/she takes care of him/herself.
    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION G. SENSORY PROCESSING/SENSORY SENSITIVITY: TEN TO TWELVE YEARS

    Section description

    • The following section contains information about your child’s sensory processing skills

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much/somewhat/slightly, not) concerned that my (10-12 year-old) child does not

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    SECTION H. QUESTIONS FOR PROFESSIONALS

    In this section we have compiled a list of questions that could help voice any concerns you may have about your child’s development, to the appropriate professionals (for example, pediatricians and nurses):

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    SECTION I. AM I FOSTERING MY CHILD'S LITERACY DEVELOPMENT

    This section contains information that could help you foster your child’s development.

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    SECTION J: The Wonder that is your Child

  • Please write your email address in the box bellow and your responses will be sent to you.

Last updated on January 25, 2013 @10:23 pm

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