M-Wise Assessment

 

Initial Questions

Chief Complaint

Additional Mental Health Concerns

Previous Mental Health Concerns 

Domains or Sections

1. Mood Dysregulation (MODY) 
2. ADHD (ADHD)
3. ODD/Conduct Disorder (ODCD)
4. Anxiety (ANX) 
5. Obsessive Compulsive Disorder (OCD)
6. Depression (DEP)
7. Trauma Related Disorders (TRAD) 
8. Eating Disorders (ED) 
9. Psychosis (PSY)
10. Tics/Tourette’s Disorder (TIC)
11. Hair Pulling (HP)
12. Autism Spectrum Disorder (ASD) 
13. Learning Disability (LD) 
14. Gender Dysphoria (GD)
15. Substance Use (SUD)
16. Attachment Disorders (ATT) 
17. Speech & Language Disorders (SLD)

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Q1: Pinpointing Your Key Issue   

What's the top reason that brings you here today? Please select the issue that is most critical. 

Just so you know, if you select "something else" or "I'm not certain," it might extend the duration of your MCAT evaluation.

• Anxiety (ANX)
• Depression (DEP)
• Anger episodes/Temper tantrums (MODY)
• Concerns of Bipolar Disorder (MODY)
• Disruptive Behavior (Child is loud, hyperactive but not necessarily angry) (ADHD)
• Poor focus  (ADHD)
• Learning Issues (LD)
• Concerns of ADHD (ADHD)
• Oppositional behavior (ODCD)
• Legal issues ((ODCD)
• Concerns for Autism Spectrum Disorder (ASD)
• Concerns of Obsessive Compulsive Disorder (OCD)
• Self harming behaviors (DEP)
• Suicide attempts (DEP)
• History of trauma (PTS) 
• History of abuse (PTS) 
• History of neglect (PTS) 
• Concerns of attachment issues (ATT) 
• Gender identity issues (GD)
• Concern of eating disorder (ED) 
• Hearing and seeing things when no one is around (PSY) 
• Tics (TIC)
• Hair pulling (HP)
• Substance use (SUD)
• School refusal (ANX)
• Something else.
• Not sure 

Q2: Exploring Additional Mental Health Concerns

With the primary mental health concern identified, we now aim to uncover any further mental health challenges your child may be encountering.

Besides the main concern, are there any other mental health challenges your child is currently facing? Please indicate ALL other relevant issues.

• Anxiety (ANX)
• Depression (DEP)
• Anger episodes/Temper tantrums (MODY)
• Concerns of Bipolar Disorder (MODY)
• Disruptive Behavior (Child is loud, hyperactive but not necessarily angry) (ADHD)
• Poor focus  (ADHD)
• Learning Issues (LD)
• Concerns of ADHD (ADHD)
• Oppositional behavior (ODCD)
• Legal issues ((ODCD)
• Concerns for Autism Spectrum Disorder (ASD)
• Concerns of Obsessive Compulsive Disorder (OCD)
• Self harming behaviors (DEP)
• Suicide attempts (DEP)
• History of trauma (PTS) 
• History of abuse (PTS) 
• History of neglect (PTS) 
• Concerns of attachment issues (ATT) 
• Gender identity issues (GD)
• Concern of eating disorder (ED) 
• Psychosis (hearing and seeing things when no one is around) (PSY) 
• Tics (TIC)
• Hair pulling (HP)
• Substance use (SUD)
• School refusal (ANX)
• Speech and Language issues (SLD)
• No other current challenges (This option is not allowed if other options are chosen. if this option is chosen, other options are not allowed)

Q3:  Previous Mental Health Challenges

Building on the previous questions which addressed your child's present mental health concerns, we are now exploring their past mental health history.

Were there any mental health issues in your child's past that are no longer present but were significant at that time? Please tick ALL relevant options:

• Anxiety (ANX)
• Depression (DEP)
• Anger episodes/Temper tantrums (MODY)
• Concerns of Bipolar Disorder (MODY)
• Disruptive Behavior (Child is loud, hyperactive but not necessarily angry) (ADHD)
• Poor focus  (ADHD)
• Learning Issues (LD)
• Concerns of ADHD (ADHD)
• Oppositional behavior (ODCD)
• Legal issues (ODCD)
• Concerns for Autism Spectrum Disorder (ASD)
• Concerns of Obsessive Compulsive Disorder (OCD)
• Self harming behaviors (DEP)
• Suicide attempts (DEP)
• History of trauma (PTS) 
• History of abuse (PTS) 
• History of neglect (PTS) 
• Concerns of attachment issues (ATT) 
• Gender identity issues (GD)
• Concern of eating disorder (ED) 
• Psychosis (hearing and seeing things when no one is around) (PSY) 
• Tics (TIC)
• Hair pulling (HP)
• Substance use (SUD)
• School refusal (ANX)
• Speech and Language issues (SLD)
• No other past challenges (This option is not allowed if other options are chosen. if this option is chosen, other options are not allowed)

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Domain 1: Mood Dysregulation 

Q 1.2): Pinpointing the Onset of Emotional Episodes

Pinpointing the onset of your child's emotional episodes provides insight into potential underlying issues.

When did you first notice these emotional episodes in your child?

1. Infancy (0-2 years) (review ASD domain) 
2. Early Childhood or preschool years (3-5 years) (review ODD, ADHD, ANX, ASD domains)
3. Middle Childhood or school-age (6-8 years) (review ODD, ADHD, ANX domains)
4. Late Childhood or tween years (9-11 years) (review DEP, ANX, ADHD domain) 
5. Adolescence (12-18 years) (review DEP, ANX domain) 
6. Not Sure

Q 1.3): Characterizing Your Child's Emotional Outbursts

Which of these sounds most like your child when they're having one of their moments? 

While your child might resonate with more than one description, please select the one that seems most predominant or most frequent:

1. Always on edge and snaps easily (review domain DEP)
2. Gets mega mad, sometimes to the point of shouting or even hitting, and this can last quite a bit, like 30 minutes or more
3. Suddenly throws a mini tantrum but it’s over in a flash (review domain ADHD)
4. Not Sure

Q 1.4) Navigating Emotional Breakdowns: Recognizing Behaviors

Recognizing patterns in your child's behavior during stressful episodes can guide us to the most effective support strategies. By identifying these signs, we take the first step towards managing and understanding their experiences.

How does your child typically react during these moments? Please select ALL that apply:

1. Appears overwhelmed, leading to what looks like an emotional unraveling (review DEP, ANX domain)
2. Talks down about themselves, expressing hopelessness or self-doubt. (review DEP domain)
3. Engages in actions that could cause self-harm.For example, hitting themselves (review DEP domain)
4. Raises their voice in frustration, including yelling or screaming.
5. Turns to physical outbursts on objects around them, like punching a door or throwing pillows.
6. Directs physical aggression toward people, perhaps lashing out at siblings or other family members.
7. Exhibits a behavior not mentioned above
8. Not Sure (Option 8 not allowed if other options are chosen. if Option 8 is chosen, other options are not allowed)

Q - 1.5): Gauging the In-Between Moments: Your Child's Typical Mood 

Outside of those intense episodes, what best describes their usual demeanor? Pick the one that sounds most like them: 

1. Pretty usual, just like any kid. (review domain ADHD, ODD)
2. Kinda grumpy a lot (review domain DEP)
3. Feels down on themselves, seems to see the glass half empty (review domain DEP)
4. Not Sure

Q 1.6): Mapping Out the Outbursts 

Does your child typically experience these episodes of anger at home or around extended family members?

1. Yes
2. No
3. Not sure

Q 1.7): Decoding the Triggers at Home and with Extended Family

To your best understanding, what usually sets off your child's big anger moments at home and with extended family? Tick ALL the triggers that you've noticed:

1.  They don’t get their way or what they asked for (review domain ODD)
2.  When you remind them of chores, tasks, or homework (need to review domain ADHD)
3. If they’re corrected or told off (review domain ADHD)
4. They get upset because homework is hard (review domain ADHD, LD) 
5. When there's too much going on around them (noise, light, etc.) (review domain ASD, ADHD)
6. A change in their daily routine (review domain ASD)
7. Switching between activities (as they like doing things step-by-step and not just because they do not like moving from fun to boring stuff) (review domain ASD)
8. Conflict with siblings 
9. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
10. Situations that make them nervous or anxious (review domain ANX)
11. Being in social situations, like with a group (review domain ANX)
12. Not sure, or it seems like nothing in particular sets it off (This option is not allowed if other options are chosen. if this option is chosen, other options are not allowed)

Q 1.8) Probing further into Triggers at Home and with Extended Family

This question is a follow-up to the last question where you identified all the possible triggers of anger episodes at home. In this question, we are focusing on identifying the most frequent trigger. This helps us understand the root cause of these episodes.

Of all the triggers you've identified in the previous question, which one do you believe is the most frequent cause of your child's intense anger moments at home and with extended family?

1.  They don’t get their way or what they asked for (review domain ODD)
2.  When you remind them of chores, tasks, or homework (need to review domain ADHD)
3. If they’re corrected or told off (review domain ADHD)
4. They get upset because homework is hard (review domain ADHD, LD) 
5. When there's too much going on around them (noise, light, etc.) (review domain ASD, ADHD)
6. A change in their daily routine (review domain ASD)
7. Switching between activities (as they like doing things step-by-step and not just because they do not like moving from fun to boring stuff) (review domain ASD)
8. Conflict with siblings 
9. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
10. Situations that make them nervous or anxious (review domain ANX)
11. Being in social situations, like with a group (review domain ANX)
12. Not sure 

Q 1.9) Exploring Parent-Child Interaction Dynamics

Grasping these interaction patterns is key to guiding you in managing your child's emotional reactions.

Which situation out of the two mentioned below often leads to stronger emotional moments? Choose the most frequent one: 

1. Not receiving something they asked for (review domain ODD)
2. Being reprimanded after refusing a parental request 
3. Both lead to equally strong emotional reactions
4. None of the above leads to any emotional reactions
5. Not sure 

Q 1.10) Delving Deeper into Parent-Child Interaction Patterns

Focusing on these interaction patterns helps us decode the emotional struggles affecting your child's mental health.

When they decline a parental directive, how do they usually behave? Select the behavior that most accurately reflects your child's usual reaction:

1. Directly confronts you, making eye contact, and firmly says "no." (review domain ODD)
2. Seems to tune out, giving an impression of not hearing the request. (review domain ADHD)
3. Commits to doing it "in a moment" but doesn't take action. (review domain ADHD)
4. Assures it's completed, when in truth, it remains undone. (review domain ADHD)
5. Respond in a way not mentioned here 

Q 1.11) Mapping Out the Outbursts

Do these episodes of anger happen in school?

1. Yes
2. No
3. Not sure

Q 1.12): Decoding the Triggers in school

To your best understanding, what usually sets off your child's big anger moments in school?  Please check ALL the options that apply: 

1.  They don’t get their way or what they asked for (review domain ODD)
2. Conflict with peers (review domain ODD, ADHD) 
3.  When teachers remind them to focus on schoolwork (need to review domain ADHD)
4. If they’re corrected or told off (review domain ADHD)
5. They get upset because school stuff is hard (review domain ADHD, LD) 
6. When there's too much going on around them (noise, light, etc.) (review domain ADHD, ASD)
7. A change in their daily routine (review domain ASD) (as they like doing things step-by-step and not just because they do not like moving from fun to boring stuff) (review domain ASD)
8. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
9. Situations that make them nervous or anxious (review domain ANX)
10. Being in social situations, like with a group (review domain ANX)
11. Not sure, or it seems like nothing in particular sets it off (This option is not allowed if other options are chosen. if this option is chosen, other options are not allowed)

Q 1.13) Probing further into Triggers at School

This question is a follow-up to the last question where you identified all the possible triggers of anger episodes in school. In this question, we are focusing on identifying the most frequent trigger. This helps us understand the root cause of these episodes.

Of all the triggers you've identified in the previous question, which one do you believe is the most frequent cause of your child's intense anger moments in school?

1.  They don’t get their way or what they asked for (review domain ODD)
2. Conflict with peers (review domain ODD, ADHD) 
3.  When teachers remind them to focus on schoolwork (need to review domain ADHD)
4. If they’re corrected or told off (review domain ADHD)
5. They get upset because school stuff is hard (review domain ADHD, LD) 
6. When there's too much going on around them (noise, light, etc.) (review domain ADHD, ASD)
7. A change in their daily routine (review domain ASD) (as they like doing things step-by-step and not just because they do not like moving from fun to boring stuff) (review domain ASD)
8. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
9. Situations that make them nervous or anxious (review domain ANX)
10. Being in social situations, like with a group (review domain ANX)
11. Not sure

Q 1.14): Mapping Out the Outbursts

Do these episodes of anger happen at public places or social events?

1. Yes
2. No
3. Not sure

Q 1.15): Decoding the Triggers at Public Places & Social Events

To your best understanding, what usually sets off your child's big anger moments at public places & social events? Please mark ALL relevant options:

1.  They don’t get their way or what they asked for (review domain ODD)
2. If they’re corrected or told off (review domain ADHD)
3. When there's too much going on around them (noise, light, etc.) (review domain ASD, ADHD)
4. Being in social situations, like with a group (review domain ANX, ASD)
5. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
6. Situations that make them nervous or anxious (review domain ANX)
7. Not sure, or it seems like nothing in particular sets it off (Option 7 not allowed if other options are chosen. Other options are not allowed if option 7 is chosen)

Q 1.16) Probing further into Triggers at Public Places or Social Events

This question is a follow-up to the last question where you identified all the possible triggers of anger episodes in social settings. In this question, we are focusing on identifying the most frequent trigger. This helps us understand the root cause of these episodes.

Of all the triggers you've identified in the previous question, which one do you believe is the most frequent cause of your child's intense anger moments at public places & social events? 

1.  They don’t get their way or what they asked for (review domain ODD)
2. If they’re corrected or told off (review domain ADHD)
3. When there's too much going on around them (noise, light, etc.) (review domain ASD, ADHD)
4. Being in social situations, like with a group (review domain ANX, ASD)
5. When they’re asked to do something they’re scared they’ll mess up.(review domain ANX)
6. Situations that make them nervous or anxious (review domain ANX)
7. Not sure.

Q - 1.17):  Pinpointing Anger Hotspot

Is there ONE place where these anger outbursts happen way more than others? 

Tick the main one!

1. At school and/or daycare (review domain ANX, ADHD, LD)
2. At home and/or with extended family (review domain ODD, ADHD)
3. Public places or social events (review domain ANX, ASD)
4. Some other place not mentioned here.
5. Nope, nowhere specific. (This option not allowed, if other options chosen; If this option chosen, other options not allowed) 

Q - 1.21): Understanding Daily Patterns of Emotional Regulation

Detecting these patterns helps uncover potential triggers, shedding light on root causes.

Is there a specific time of day when these big anger moments usually happen for your child? Tap ALL that fit!

1. More intense at bedtime (review domain ADHD, ODD, ANX)
2. Right in the morning, before school (review domain ADHD, ODD, ANX)
3. Sometime in the afternoon. (review domain ADHD, ODD) 
4. Nope, no pattern I can see. (This option not allowed, if other options chosen; If this option chosen, other options not allowed)

Q - 1.22): Tracing Weekly & Monthly Patterns of Emotional Regulation

Recognizing these patterns aids in identifying triggers and understanding underlying factors.

Do you notice any weekly or monthly rhythm to your child's big anger moments? Choose ALL the options that ring a bell:

1. A sort of rollercoaster: super happy or really irritable moods, then back to normal, then maybe even a bit down. The twist? It doesn't seem to be caused by stuff happening around them.
2. Specifically on Sunday nights. (review domain ANX)
3. Only for girls: Gets worse around her period (review domain DEP)
4. I can't spot any pattern. (This option not allowed, if other options chosen; If this option chosen, other options not allowed)

Q - 1.23) Assessing Potential Signs of Bipolar Disorder

Taking a closer look based on your previous answer, when your child has those super happy or really intense moments, have you noticed any of the changes listed below.  

Remember, we're searching for things that stand out from their usual behavior. Tap all that seems familiar. 

1. Like they've turned on a turbo mode: super energetic and everywhere at once!
2. Suddenly very focused on certain tasks or goals.
3. Acting as if they're on top of the world.
4. Thoughts seem to bounce around rapidly, almost like their mind is racing.
5. Talking speed: fast and unstoppable like it's pressurized and hard to steer (Note: It's different and much more from just being excited and chatty). 
6. Sleep? Who needs it? Feeling pumped with less sleep and still fresh the next day.
7. Taking risks that are out of character, like behaviors that are overly daring or unusual for them (like becoming super flirtatious, or trying out illicit substances).
8. None of the above (This option not allowed, if other options chosen; If this option chosen, other options not allowed)

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DOMAIN 2: ADHD

Q 2.2) Classroom Focus and Attention

Recognizing inattention in the classroom setting can be a crucial step in identifying potential ADHD. 

Now, picture your child in their school's classroom. Do they often seem lost in their own world or find it hard to stay tuned in?

1. Yes
2. No
3. Not sure
4. Not applicable 

Q 2.3) Delving into Possible ADHD Symptom Origins

Let's explore further within the classroom environment to pinpoint the reasons behind inattention.

In which class or subject does your child most frequently lose focus?

1. Just one particular subject (review LD) 
2. A few subjects here and there (review LD) 
3. The majority of their classes
4. Every single subject
5. Not sure

Q2.4) Delving into Possible ADHD Symptom Origins

Let's dive into your child's mind for a moment. When they're in the classroom, where do their thoughts tend to drift? 

Please tick ALL the boxes that fit:

1. Daydreaming about unrelated things (like, "Hmm, what's for dinner?")
2. Classroom & school-related worries: "Will the teacher ask me a question? What if I get the answer wrong?" "Are my classmates talking about me?" (review domain ANX) 
3. Concerns related to home and family (review domain ANX)
4. Reflecting on past memories, especially those that were stressful or unsettling (review domain PTSD)
5. Unsure (Allowed only if answers not chosen from 1-4. If this is chosen other options are not allowed) 

Q 2.5)  Attention Patterns Beyond the Classroom

Understanding focus challenges beyond academic settings can provide a holistic view of your child's attention span.

Outside of school, in which situations does your child often become distracted or lose concentration? Tick ALL that match:

1. While tackling homework.
2. Handling chores (e.g., room cleanup, dishwashing).
3. During day-to-day routines (like brushing or showering)
4. Engaging in sports.
5. Participating in extracurriculars.
6. Chatting with others.
7. Not sure or none of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 2.6) Spotting ADHD Symptoms in Daily Moments

When observing your child's attention & focus, which of these moments feel familiar? Tick ALL that resonate:

1. Daily tasks such as homework and chores tend to slip their memory
2. They breeze past details, making those little slip-ups in tasks. 
3. They frequently become sidetracked by distractions
4. During conversations, they seem lost in their own world.
5. They start tasks enthusiastically but struggle to complete them.
6. None of these ring a bell (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 2.7) Assessing Your Child's Organizational Skills

Understanding these habits can provide insights into potential ADHD symptoms.

Which of these organizational challenges does your child often face? Select ALL appropriate responses:

1. Struggles to tackle tasks in order.
2. Has a hard time keeping their room and things tidy.
3. Time management seems to be a consistent challenge
4. Missing deadlines is more of a norm than an exception.
5. Often finds themselves on a mini treasure hunt for basics – be it school supplies, books, keys, glasses, or that ever-elusive phone!
6. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q2.8)  Exploring ADHD's Impact on Learning and Emotions

ADHD can affect learning, behavior, feelings, and friendships. Understanding ADHD's influence can help tailor interventions to support your child's specific needs.

Tick ALL the statements that sound like your child:

1. Struggles to keep up with lessons, affecting grades (review domain LD)
2. Often misses turning in assignments, impacting scores. 
3. Puts in extra effort to achieve average grades. (review domain LD)
4. Feels constantly overwhelmed with assignments and deadlines. (review domain ANX)
5. Feels stressed or dislikes school-related tasks. 
6. Doubts their abilities due to academic challenges. (review domain DEP)
7. Gets angry if asked to correct their work. (review domain MODY)
8. Feels resistant, upset or angry about homework. (review domain LD, DEP, MODY)
9. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 2.9) Age of Onset: Inattention and Poor Organization

When did you begin to notice your child exhibiting signs of inattention and poor organization?

1. Infancy (0-2 years) 
2. Early Childhood or preschool years (3-5 years) 
3. Middle Childhood or school-age (6-8 years) 
4. Late Childhood or tween years (9-11 years) 
5. Adolescence (12-18 years) 
6. Not Sure

Q 2.11) Assessing Hyperactivity Through Daily Habits

Reflecting on your child's daily energy and routines, which statements resonate with your child? Please select ALL that stand out: 

1. When they're engaged in activities or playing, their volume often goes up a notch, sometimes causing disruptions.
2. Restlessness is their sidekick, and sitting still seems like a challenge. 
3. They have a rhythm of their own, often fidgeting, tapping hands or feet, or constantly shifting in their seat. 
4. Their words flow freely, sometimes more abundantly than situations might call for.
5. Friendships can be tricky, sometimes their energetic vibe can feel intense to peers or come across as stepping into personal bubbles
6. None of these hit the mark. (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 2.12) Age of Onset: Hyperactivity 

When did you begin to notice your child exhibiting signs of hyperactivity?

1. Infancy (0-2 years) 
2. Early Childhood or preschool years (3-5 years) 
3. Middle Childhood or school-age (6-8 years) 
4. Late Childhood or tween years (9-11 years) 
5. Adolescence (12-18 years)
6. Not sure or Not applicable 

Q 2.14) Assessing Impulsivity as an ADHD Indicator

Impulsivity is a key dimension of ADHD. Recognizing it helps in understanding the condition better.

Which of the following behaviors mirrors your child? Tick ALL that apply:

1. Waiting in lines? They'd rather not!
2. Jumping into conversations or games without waiting? That's them.
3. Taking things without asking? Happens often.
4. Answering before the question is complete? Typical of them.
5. Emotions driving sudden reactions? Yes, that too.
6. None of the above. (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 2.15) Age of Onset: Impulsivity

When did you begin to notice your child exhibiting signs of impulsivity?

1. Infancy (0-2 years) 
2. Early Childhood or preschool years (3-5 years) 
3. Middle Childhood or school-age (6-8 years) 
4. Late Childhood or tween years (9-11 years) 
5. Adolescence (12-18 years) 
6. Not sure or Not applicable 

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DOMAIN 3: Oppositional Defiant/Conduct Disorder 

Q 3.2) Delving into Signs of Defiant Behavior

Which behaviors best describe your child's interactions with authority figures or peers? Choose ALL that apply.

1. Engages in arguments with adults. 
2. Disregards set rules
3. Resists following directions
4. Intentionally annoys others
5. Shifts blame for their actions onto others.
6. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 3.3) Pinpointing Hotspots for Defiant Behavior

Is there ONE place where this kind of behavior happens way more than others? 

Tick the main one!

1. Home
2. Extended family like grandparents
3. School and/or daycare (review domain ADHD)
4. Some other place
5. More or less equally across all environments (review domain ADHD, MODY)
6. Not sure

Q 3.4) Assessing for Vindictive Tendencies

Vindictiveness can be indicative of Oppositional Defiant Disorder, guiding our diagnosis. 

Has your child ever displayed an overwhelming desire for revenge?

1. Yes
2. No 
3. Not quite sure 

Q 3.5) Age of Onset: Oppositional & Defiant Behavior

At what point did you first observe signs of defiance in your child?

1. Infancy (0-2 years) (Review domain ASD)
2. Early Childhood or preschool years (3-5 years) (Review domain ADHD) 
3. Middle Childhood or school-age (6-8 years) (Review domain ADHD) 
4. Late Childhood or tween years (9-11 years) 
5. Adolescence (12-18 years) (Review domain DMDD) 
6. Not Sure

Q 3.7) Probing Conduct Disorder Traits

Building on our discussion about ODD, we're now exploring behaviors associated with Conduct Disorder. 

Has your child ever exhibited any of the following actions? Please select ALL that apply:

1. Left home in a manner that made you think they had run away.
2. Taken valuable items without the owner's immediate knowledge. 
3. Damaged someone else's belongings intentionally
4. Entered someone's house, building, or car without permission.
5. Intentionally set fires.
6. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 4: Anxiety

Q 4.2)  School-Related Anxieties  

Navigating school life brings its unique set of challenges. Let's pinpoint what's on your child's mind. 

What aspects of school life do your child worry about? Choose ALL that apply: 

1. Grades or academic performance  (review domain ADHD, LD) 
2. Tests and quizzes (review domain ADHD, LD) 
3. Disappointing teachers (review domain ADHD, LD) 
4. Getting in trouble (review domain ADHD) 
5. Performing in front of others, like class presentations or extracurricular activities
6. Interaction with peers 
7. Something else
8. None or I am not sure (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.3)  Honing in on Top Concerns in School

From the issues identified in the last question, which single aspect of school life weighs most heavily on your child's mind? Choose the main stressor:

1. Grades or academic performance  (review domain ADHD, IDLD) 
2. Tests and quizzes (review domain ADHD, IDLD) 
3. Disappointing teachers (review domain ADHD, IDLD) 
4. Getting in trouble (review domain ADHD) 
5. Performing in front of others, like class presentations or extracurricular activities
6. Interaction with peers 
7. Something else
8. Not quite sure

Q 4.4)  Identifying Key Challenges in Peer Interactions

Based on your previous response, it seems that interacting with peers is a challenging area for your child in school. Let's explore this further.

Could you identify the primary factor that might be contributing to your child's difficulty in engaging with other kids? Select ALL that seem relevant:

1. Feeling anxious during interactions
2. Feeling different or having little in common with peers (review domain ASD)
3. Difficulty in starting or keeping up conversations (review domain ASD)
4. Lack of interest in forming friendships (review domain ASD)
5. High energy levels leading to conflicts or overwhelming peers (review domain ADHD)
6. Irritability that may repel peers (review domain DEP)
7. Displays of anger towards other children (review domain DMDD)
8. Experiencing bullying
9. Something else
10. Not quite sure

Q 4.5) Home Life Worries

Home is where the heart is, and it's essential to know what's weighing on your child's heart. 

What aspects of home life does your child seem most concerned about? Select ALL relevant options: 

1. Disappointing parents
2. Relationships with family
3. Family's financial situation
4. Health of family members
5. Safety of family members
6. Getting in trouble (review domain ADHD) 
7. Something else
8. None or I am not sure  (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.6) Self-related worries explored

Recognizing worries about self provides a glimpse into your child's internal thought process and fears. 

What self-centric concerns has your child conveyed or demonstrated? Mark ALL that are applicable: 

1. Their own health
2. Their own safety
3. Worries about the future
4. Something else
5. None or I am not sure  (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.7) Worries related to Social life

Unraveling social concerns helps us grasp how your child interacts and perceives their social world.

Which social aspects seem to concern your child the most? Check ALL that resonate:

1. Quality of friendships
2. Being liked by others
3. Feeling left out or excluded
4. Interactions on social media
5. Group dynamics and fitting in
6. Something else
7. None or I am not sure  (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.8) Probing Separation Anxiety

Understand how your child feels when separated from familiar surroundings or people can offer pivotal insights into their emotional framework.

Does your child become excessively distressed or uneasy when away from home or separated from you?

1. Yes
2. No

Q 4.9) Diving Deep into School Vibes

Having explored the wide array of anxiety-inducing factors, let's refocus on the role of school. This insight will guide our understanding and shape tailored interventions.

Which statement best reflects the impact of school on their anxiety?

1. School is a major source, accounting for over 75% of their anxiety 
2. School is a significant contributor, representing 50-75% of their anxiety
3. School plays a moderate role, contributing to 25-50% of their anxiety.
4. School has a minor impact, making up less than 25% of their anxiety.
5. School is a place of tranquility, not a source of anxiety for them.

Q 4.10) Identifying Specific Phobias

Recognizing phobias can shape our approach to alleviating anxiety.

Does your child have any of the following intense fears or phobias? Select ALL that fit: 

1. Being alone
2. Extreme weather
3. Darkness
4. Needles
5. Insects
6. Driving
7. Flying
8. Heights
9. Thinking about germs
10. Something else
11.  No - My child does not exhibit any intense fears or phobias. (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.13) Assessing Social Comfort Zones

We aim to gauge your child's ease in various social settings. 

In which scenarios does your child typically feel uneasy? Please choose ALL relevant options.

1. Being around groups of people
2. Meeting unfamiliar people
3. In unfamiliar environments or settings
4. While trying new activities or tasks
5. When performing in front of others
6. Being watched while eating or drinking
7. Being in other situations not listed here 
8. Not sure 
   
   

Q 4.15) Probing Avoidance Patterns from Anxiety & Phobias

We aim to understand the extent to which anxiety impacts their daily life, guiding us in personalized treatment suggestions. 

Does your child avoid any places, people or situations due to anxiety?

1. Yes
2. No

Q 4.16) Physical Symptoms Linked to Anxiety

Anxiety can manifest in physical symptoms; identifying these can guide us in prescribing targeted interventions.

In the past month, has your child shown any physical signs that might be linked to feeling anxious? 

1. Yes
2. No

Q 4.17) Listing Physical Symptoms of Anxiety

Please specify ALL physical signs you've observed in your child that seem to be related to anxiety: 

1. Shortness of breath
2. Feeling like they are choking 
3. Heart racing 
4. Stomach ache 
5. Upset stomach 
6. Nausea 
7. Feeling dizziness 
8. Chest pain 
9. Shaking or trembling
10. Sweating more than usual 
11. Feeling like they might faint
12. Tingling sensation 
13. Getting chills
14. Experiencing hot flashes
15. Other symptoms not listed here 

Q 4.18) Patterns of Anxiety Manifestation

Understanding patterns helps pinpoint potential underlying causes of anxiety.

Are there specific times or situations when your child appears notably more anxious? Please mark ALL the relevant moments:

1. Every morning before school (review domain ADHD) 
2. Each night at bedtime (review domain ADHD) 
3. Typically on Sunday evenings (review domain ADHD) 
4. When facing other scenarios not mentioned above 
5. None or I am not sure (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.19) Analyzing Personality Traits Linked to Anxiety

Delving into personality traits can shed light on predispositions to anxiety.

Which of the following descriptors best align with your child's personality? Choose ALL that resonate with your child’s personality:

1. Aims for perfection in everything
2. Prefers to know details well in advance to prepare
3. Holds themselves to very high standards and gets upset if they aren't met
4. Tries to avoid conflicts or confrontations
5. Feels stressed when multiple tasks pile up or deadlines approach
6. Gets embarrassed easily
7. None  (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 4.20) Age of Onset: Anxiety

Thinking over our conversation about anxiety, at what stage did you first recognize anxious behaviors in your child?

1. Infancy (0-2 years) 
2. Early childhood or preschool years (3-5 years) 
3. Middle childhood or school-age (6-8 years) 
4. Late childhood or tween years (9-11 years) 
5. Adolescence (12-18 years)
6. Not Sure
   
   

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DOMAIN 5: Obsessive Compulsive Disorder (OCD) 

Q 5.2) Exploring 'Contamination' Obsessions

In the past month, have you noticed or has your child shared any of these specific concerns? Just tap on ALL that ring true:

1. Concerns of dirt, germs and certain illnesses
2. Disgust with bodily waste or secretions
3. Excessive concern with environmental contaminants (like radiation, toxic waste etc.)
4. Excessive concern with household items (eg, cleaners) 
5. Excessive concern about animals/insects
6. Distress over sticky substances or residues
7. Fear of falling sick due to a contaminant
8. Worry about accidentally making others sick by spreading contaminant
9. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.3) Understanding Aggressive-Thought Obsessions

In the past month, which of these concerns has your child expressed or seemed to experience? Choose ALL that resonate:

1. Fear might harm self
2. Fear might harm others
3. Fear harm will come to self
4. Fear harm will come to others
5. Violent or horrific images
6. Fear of blurting out obscenities or insults
7. Fear of doing something embarrassing
8. Fear will act on unwanted impulses
9. Fear will steal things
10. Fear will harm others because not careful enough (eg, hit/run motor vehicle accident)
11. Fear will be responsible for something else terrible happening (eg, fire, burglary, flood) 
12. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.4) Examining Religious Obsessions

Over the past month, which of these faith-related thoughts has your child expressed or seemed to wrestle with?  Mark ALL that feel relevant:

1. Excessive concern or fear of offending religious objects
2. Excessive concern with right and wrong morally 
3. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.5) Unpacking Somatic Obsessions

Over the past month, which of these body sensation-related thoughts has your child been particularly aware of or mentioned? Select ALL that stand out:

1. Excessive concern with illness or disease 
2. Excessive concern with body part or aspect of appearance 
3. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.6) Gently touching on a sensitive topic: obsessions linked to sexuality

Over the past month, has your child expressed or seemed to struggle with any of these sexuality-related thoughts? Kindly select ALL that apply:

1. Forbidden sexual thoughts or/and images
2. Fear of engaging in inappropriate sexual behavior towards others 
3. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.7) Exploring Other Obsessive Thoughts in Your Child

Over the past month, have any of these obsessions popped up in your child's mind? 

Please check ALL that sound familiar:

1. The need to know and remember 
2. Fear of saying certain things
3. Fear of not saying the right thing
4. Intrusive (non-violent) images
5. Intrusive sounds, words, music or numbers
6. Fear of losing things
7. Lucky/unlucky numbers, colors, words 
8. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.8) Impact of Obsessive Thoughts on Daily Activities

To accurately diagnose and support your child, we need to understand how their obsessive thoughts affect their daily life.

Are your child's obsessive thoughts disrupting their school, social life, or other important activities?

1. Yes
2. No
3. Not sure 

Q 5.10) Assessing Distress from Obsessive Thoughts

Understanding if your child's obsessive thoughts are a source of distress or anxiety is crucial for accurate diagnosis and effective treatment plan.

Are your child's obsessive thoughts causing them distress or anxiety?

1. Yes
2. No
3. Not sure

 

 

Q 5.14) Unpacking Cleaning and Washing Compulsions

In the last month, which of these behaviors have you observed in your child? 

Please tick ALL of the following actions you've observed:

1. Excessive or ritualized hand washing 
2. Excessive or ritualized showering, bathing, tooth brushing, grooming, toilet routine
3. Excessive cleaning of items
4. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.15) Exploring 'Checking' Compulsions

In the past month, have you observed your child repeatedly checking things? 

Please identify ALL the behaviors from the following list that are familiar or recognizable to you:

1. Checking locks, toys, school books/items, etc.
2. Checking that did not/will not harm others
3. Checking that did not/will not harm self
4. Checking that nothing terrible did/will happen
5. Checking that did not make mistake
6. Checking tied to somatic obsessions
7. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.16) Spotting "Repeating" Rituals

Over the past month, did you notice your child engaging in any repeated rituals or habits? 

Please select ALL the behaviors from the following list that resonate with their actions:

1. Rereading, erasing, or rewriting
2. Need to repeat activities (eg, in/out of doorway, up/down from chair)
3. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.17) Tuning into Counting Compulsions

Please check off ALL the behaviors listed below that ring a bell:

1. Counting objects
2. Counting numbers
3. Counting words
4. Counting something else 
5. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.18) Examining Ordering and Arranging Compulsions

Over the last month, did you notice your child frequently organizing or rearranging items? 

Please mark ALL the behaviors listed below that you've noticed: 

1. Lining items up in a certain way
2. Arranging items in a specific pattern
3. Shuffle items to achieve symmetry
4. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.19) Shedding Light on Some Other Compulsions

Over the last month, have you observed your child displaying any of the following actions? 

Simply tick ALL that resonate with what you've seen:

1. Feeling a need to tell, ask or confess
2. Feeling a need to touch, tap, or rub
3. Hoarding or collecting items lacking monetary or sentimental value
4. Following specific eating rituals
5. Making lists more than usual
6. Taking measures (not just checking) to prevent harm to self or others
7. Taking measures (not just checking) to prevent any terrible consequences
8. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 5.20)  Impact of Compulsive Behaviors on Daily Activities

To provide the most effective diagnosis and assistance for your child, it's important to gauge the impact of their compulsive behaviors on everyday life.

Do your child's compulsive behaviors interfere with their school performance, social interactions, or other crucial daily activities?

1. Yes
2. No
3. Not sure 

 

Q 5.22) Gauging Distress from Compulsive Behaviors

Determining whether your child's compulsive behaviors are a source of distress or anxiety is vital for an accurate diagnosis and an effective treatment plan.

Do your child's compulsive behaviors result in distress or anxiety?

1. Yes
2. No
3. Not sure

 

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DOMAIN 6: Depression (DEP)

Q 6.2)  Negative Thought Patterns in Depression

Our thoughts often shape our emotions, and persistent negative thinking can be linked to feelings of sadness or depression. 

Let's dive deeper into your child's mindset. Which of the following thought patterns have you noticed in your child lately? Select ALL that resonate with your child:

1. Often seems to lack hope. 
2. Expresses self-doubt or speaks negatively about themselves. 
3. Tends to have a pessimistic perspective
4. Believes or voices feelings of unworthiness
5. Frequently displays signs of guilt or regret.
6. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 6.3) Behavioral Indicators of Depression

Depressive emotions can sometimes manifest as noticeable changes in behavior. 

In the recent weeks, have you observed any of the following shifts in your child's behavior? Please tick ALL that resonate: 

1. Has lost interest in once-loved activities
2. Increasingly seeks solitude or shies away from social gatherings
3. Often appears fatigued or lacks energy
4. isn't eating as usual
5. Experiences disturbed sleep patterns
6. Demonstrates heightened irritability 
7. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 6.4)  Probing Severe Depressive Indicators

Understanding the depth of emotional challenges is crucial for tailored care. Some symptoms might suggest a heightened concern in terms of depression severity. 

With that context, in the past month, have you noted any of these behaviors or sentiments in your child? Indicate ALL choices that apply:

1. Regularly mentioning or alluding to death
2. Sharing thoughts of self-injury, without specifying a method
3. Expressing intentions of self-harm with a distinct plan in mind
4. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 6.6) Zooming In on School Stressors

 School challenges come in many shades. Gaining clarity on these can pave the way to better understanding and support.

Which area of school life feels most challenging for your child right now? Pick ALL options that are relevant:

1. School work (Review domain ADHD) 
2. Interaction with teachers (Review domain ANX)
3. Interaction with peers (Review domain ADHD, ANX) 
4. Something else
5. Not sure (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 6.7) Diving Deeper into life stressors

The context behind each challenge is essential for comprehensive care.

Could you provide a bit more insight into the specific situations or events that have been stressful for your child?

________ (FREE TEXT PARAGRAPH) ______________

 

Q 6.10) Exploring Self-Harm History

Past behaviors, even if they've changed, offer valuable insights into emotional well-being and potential triggers.

BEYOND THE LAST MONTH, has your child shown signs of self-harm, such as cutting or scratching?

1. Yes
2. No

Q 6.12) Past Suicidal Actions Explored 

Understanding past suicide attempts sheds light on your child's emotional journey, enabling us to craft a tailored treatment plan.

BEFORE THIS PAST MONTH, did your child ever attempt suicide?

1. Yes
2. No

Q 6.13) Age of Onset: Depression

Considering our discussion on depression, when did you first identify potential signs of depression in your child?

1. Infancy (0-2 years) 
2. Early Childhood or preschool years (3-5 years) 
3. Middle Childhood or school-age (6-8 years) 
4. Late Childhood or tween years (9-11 years) 
5. Adolescence (12-18 years)
6. Not Sure

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DOMAIN 7: Trauma Related Disorders (TRAD) 

Q 7.2) Assessing Nighttime Distress

Recurring nightmares in children can often be a manifestation of unresolved stress or traumatic experiences.

Has your child been troubled by recurring nightmares about a distressing event or past trauma? 

1. Yes
2. No
3. Not quite sure 

Q 7.4) Recurring Distressing Recollections

Children may sometimes replay troubling events in their minds, which can be a sign of underlying stress or trauma.

Has your child been frequently reliving distressing memories from a past upsetting event or experience?

1. Yes
2. No
3. Not quite sure 

Q 7.6) Assessing for Flashbacks

Flashbacks are intense, vivid moments where an individual feels as though they are reliving a past traumatic event in the present moment.

In the recent past, or at any time, has your child experienced 'flashbacks' related to a traumatic event or abuse?

1. Yes
2. No
3. Not sure 

Q 7.8) Examining Episodes of Dissociation

Dissociative episodes can make someone feel as if they're observing themselves from afar or sense that their environment isn't quite real.

Has your child had moments where they felt detached or distant from their own thoughts or surroundings?

1. Yes
2. No
3. Not sure 

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DOMAIN 8: Eating Disorder (ED)

Q 8.2) Assessing Dietary Patterns: Insight into Your Child's Nutritional Intake

We're gathering information on your child's daily eating schedule to gain insights into their nutritional habits.

In the past month, how many meals a day has your child typically been eating? 

1. Regularly eats 3 or more meals 
2. Usually has 2 meals 
3. Mostly just 1 meal 
4. Skips meals, only snacking once or twice 
5. Doesn’t eat anything all all 

Q 8.3) Monitoring Weight Fluctuations

Over the past month, have you observed any changes in your child's weight? How would you categorize this change?

1. Remained about the same 
2. Loss or gain of under 2 pounds
3. Loss between 2-4 pounds 
4. Lost more than 4 pounds 
5. Gained more than 2 pounds

Q 8.4) Physical Indicators of Eating Disorder Complications

Certain physical symptoms may be indicative of complications associated with eating disorders. It is crucial for us to recognize these signs early to manage and address any potential health concerns effectively

In the last month, has your child experienced any of the following? Kindly mark each symptom that applies:

1. Absence of menstrual cycles 
2. Fatigue or a decline in energy during activities 
3. Increased sensitivity to cold temperatures 
4. Digestive discomfort, including constipation, abdominal pain, or bloating 
5. Heart palpitations or an unusual awareness of their heartbeat 
6. Episodes of lightheadedness or faintness 
7. Early satiety or feeling quickly full while eating 
8. Noticeable hair thinning or increased hair loss 
9. Excessive skin dryness 
10. Swelling in the extremities, particularly the feet
11. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

 

Q 8.7) Investigating Compensatory Behaviors

Which of the following measures has your child adopted to balance out calorie intake? Select ALL that resonate to your child’s behavior: 

1. Inducing vomiting
2. Skipping meals for a long time (fasting)
3. Exercising more than usual
4. Using laxatives to control weight
5. Using water pills (diuretics) to control weight
6. Taking weight loss drugs
7. Another method not mentioned here
8. Not sure (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 9: PSYCHOSIS

Q 9.2) Identifying Triggers for Auditory Events

Pinpointing the moments and situations that intensify these auditory experiences aids in reaching an accurate diagnosis and developing an effective treatment plan.

Below, please select ALL circumstances that you've noticed may aggravate your child's unique hearing experiences:

1. At night (review domain ANX, DEP)
2. When they are alone (review domain ANX, DEP)
3. When thinking about past tough times (review domain DEP, PTS)
4. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.3) Pinpointing Environmental Triggers for Auditory Episodes

Gaining insight into the settings that amplify your child's auditory experiences is key to providing an accurate diagnosis and developing an impactful care strategy.

Please indicate ALL the settings listed below that seem to amplify these auditory experiences:

1. Around unfamiliar people (review domain ANX)
2. In new or unfamiliar places (review domain ANX)
3. In school  (review domain ANX, IDLD)
4. At home
5. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.4) Emotional Triggers of Auditory Experiences

Understanding the emotional contexts in which your child might experience these auditory events assists in accurate diagnosis and informs our care plan. 

Could you identify the emotional states during which your child's auditory experiences are more likely to occur? Please indicate ALL relevant emotions:

1. During times of sadness (review domain DEP)
2. When feeling anxious (review domain ANX)
3. Amidst stress (review domain DEP, ANX)
4. While feeling angry (review domain DEP, DMDD)
5. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.5) Identifying the Voices: Familiarity and Perception

Do the voices your child hears sound like someone they know or have heard about in real life?

1. Yes  (review domain ANX, PTS)
2. No
3. Not quite sure

Q 9.6) Recognizing Voices: Personal Connections 

If the voices sound familiar, can you identify who they resemble? For example, do they sound like family members, friends, or perhaps characters from stories or media that your child has been exposed to? Please elaborate:

_____________ LONG TEXT PARAGRAPH ___________

Q 9.7) Echoes of the Past: Auditory Recollections

Do these experiences of hearing things remind your child of something that happened in the past?

1. Yes (review domain ANX, DEP, PTS)
2. No
3. Not quite sure

Q 9.8) Tracing Echoes: Identifying Past Memories

Could you share with us any specific memories or past experiences that seem to echo in the sounds or voices your child hears? Please elaborate:

_____________ LONG TEXT PARAGRAPH ___________

Q 9.9) Command Hallucinations: Assessing Directive Voices

Do these experiences of hearing things include voices that tell your child to do something or command them in any way?

1. Yes
2. No

Q 9.10) Safety Assessment

Have the voices your child hears ever suggested they hurt themselves or someone else?

1. Yes 
2. No

Q 9.11) Safety Assessment

Has your child mentioned any specific plans to act on these voices' instructions?

1. Yes
2. No

Q 9.12) Identifying Calming Factors

Recognizing what helps to silence these voices can be beneficial in managing your child's experiences.

Are there specific activities, situations, or emotional states that seem to alleviate or silence the voices for your child? 

1. Yes
2. No
3. Not quite sure 

Q 9.13) Explaining Calming Factors

Can you provide more details about the activities, circumstances or emotions that reduce the intensity of the voices your child hears? Please elaborate: 

_____________FREE TEXT PARAGRAPH _____________

 

Q 9.16)  Identifying Triggers for these visual events

Pinpointing the moments and situations that intensify these visual experiences aids in reaching an accurate diagnosis and developing an effective treatment plan.

Below, please select ALL the circumstances you've noticed that may aggravate your child's unique visual experiences:

1. At night (review domain ANX, DEP)
2. When they are alone (review domain ANX, DEP)
3. When reflecting on past upsetting events (review domain DEP, PTS)
4. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.17) Pinpointing Environmental Triggers for Auditory Episodes

Gaining insight into the settings that amplify your child's visual experiences is key to providing an accurate diagnosis and developing an impactful care strategy.

Please indicate ALL the settings listed below that seem to amplify these visual experiences:

1. Around unfamiliar people (review domain ANX)
2. In new or unfamiliar places (review domain ANX)
3. In school  (review domain ANX, LD)
4. At home
5. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.18) Emotional Triggers of Visual Experiences

Understanding the emotional contexts in which your child experiences these visual events assists in accurate diagnosis and informs our care plan. 

Could you identify the emotional states during which your child's visual experiences are more likely to occur? Please indicate ALL relevant emotions:

1. During times of sadness (review domain DEP)
2. When feeling anxious (review domain ANX)
3. Amidst stress (review domain DEP, ANX)
4. While feeling angry (review domain DMDD)
5. Not sure or None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 9.19) Identifying the Visuals: Familiarity and Perception

Do these visuals that  your child experiences resemble someone they know or have heard about in real life?

1. Yes  (review domain ANX, PTS)
2. No
3. Not quite sure

Q 9.20) Recognizing Visuals: Personal Connections

Can you provide more details about these visuals and whom they might resemble? Elaborate here:  

_____________FREE TEXT PARAGRAPH _____________

Q 9.21) Connecting Visual Experiences with Memories

Do the things your child sees connect to a memory or past event they've shared with you?

1. Yes (review domain ANX, DEP, PTS)
2. No
3. Not quite sure

Q 9.22) Exploring the Past Connections of Visions

Can you share more about what your child has mentioned regarding these visions and their connection to past events? Please elaborate: 

_____________FREE TEXT PARAGRAPH _____________

Q 9.23) Interpreting Visions: Instructions and Dictates

Does your child feel that these visions are giving them specific instructions or commands?

1. Yes 
2. No

Q 9.24) Safety Assessment 

Has your child ever mentioned that these visions suggest or urge them to harm themselves or someone else?

1. Yes
2. No

Q 9.25) Safety Assessment

Has your child shared any specific plans or steps they might take based on the instructions from these visions?

1. Yes
2. No

Q 9.26) Identifying Calming Factors

Recognizing what helps to reduce these visions can be beneficial in managing your child's experiences.

Are there specific activities, situations, or emotional states that seem to reduce these visions or make them disappear?

1. Yes
2. No
3. Not quite sure 

Q 9.27) Explaining Calming Factors

Can you detail any particular activities, environments, or emotional states that appear to soothe your child and lessen the occurrence of the visions they experience?

_____________FREE TEXT PARAGRAPH_____________

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DOMAIN 10: Tic Diorder 

10.2) Identifying Motor Tics

Think of motor tics as those quirky, unplanned twitches that sneak up like a surprise sneeze – swift and out of the blue. 

Spotted any of these sneaky twitches in your child recently? Tick ALL that look familiar:

1. Excessive eye blinking
2. Facial grimacing
3. Shoulder shrugging
4. Head jerking
5. Another movement not mentioned here
6. None (allowed only if other options not chosen, if this option chosen then other options are not allowed)

10.3) Exploring Phonic Tics

Phonic tics are like hiccups in speech — unexpected noises or sounds that just pop out, without your child intending them.

Has your kid made any of these sounds out of the blue recently? Check ALL that ring a bell:

1. Throat clearing
2. Squeaking
3. Hollering
4. Grunting 
5. Sniffing
6. Barking  
7. Moaning 
8. Some other sound not mentioned here
9. None (allowed only if other options not chosen, if this option chosen then other options are not allowed)

10.5) Past Motor Tic Assessment

Can you identify any additional motor tics your child has exhibited in the past that we haven't covered?

1. Excessive eye blinking
2. Facial grimacing
3. Shoulder shrugging
4. Head jerking
5. Another movement not mentioned here
6. None (allowed only if other options not chosen, if this option chosen then other options are not allowed)

10.6) Documenting Past Phonic Tics

Could you identify any additional vocal or sound tics that your child has exhibited, which have not been listed earlier?

1. Throat clearing
2. Squeaking
3. Hollering
4. Grunting 
5. Sniffing
6. Barking  
7. Moaning 
8. Some other sound not mentioned here
9. None (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 11: Hair Pulling 

 

Q 11.3) Efforts to Overcome Hair Pulling

Understanding attempts to control hair pulling can inform us about the child's awareness and the behavior's compulsivity. 

Has your child made any efforts to reduce or stop hair pulling in the past month?

1. Yes
2. No
3. Do not know

Q 11.4) Evaluating Success in Managing Hair Pulling

Gauging the outcomes of efforts to curb hair pulling can shed light on the behavior's manageability. 

Has your child been successful in their attempts to decrease or cease hair pulling?

1. Yes
2. Somewhat successful 
3. No 
4. Do not know

Q 11.5) Assessing Stress Related to Hair Pulling Control

Understanding if hair pulling is a source of stress can help address emotional well-being. 

Does the challenge of stopping or managing hair pulling cause your child stress? 

1. Yes
2. No
3. Not certain

Q 11.6) Identifying Triggers for Hair Pulling

Pinpointing specific triggers can guide us in creating effective strategies for your child. 

What factors do you think may contribute to or trigger your child’s hair-pulling behavior? Please select ALL that apply: 

1. Increased focus on the sensation or act of hair pulling 
2. Experiencing anxiety or nervousness (Review domain ANX)
3. Experiencing sadness or feeling stressed (Review domain DEP)
4. Experiencing anger or frustration  (Review domain MODY)
5. After starting or changing medications
6. Some other factors not mentioned here 
7. None (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 12: Autism Spectrum Disorder (ASD)

Q 12.1) Evaluating Ease in Social Exchanges 

Casual banter and light-hearted exchanges are a staple of social interactions.

Does your child struggle with engaging in the easy, back-and-forth small talk that often happens in social settings?

1. Yes
2. No
3. Not quite sure

Q 12.2) Assessing Social Communication Skills

It's common for children to learn the ebb and flow of conversation through practice and experience. Sometimes, they might say something surprising or ask questions that don't quite fit the moment.

In social situations, does your child sometimes say things or ask questions that might seem a bit out of place or unexpected?

1. Yes
2. No
3. Not certain

Q 12.3) Decoding Conversational Nuances

 While navigating dialogue, some children may take words and phrases at face value, bypassing the subtle cues that give language its depth.

Does your child tend to take things said in conversation at face value, overlooking the implied or 'between the lines' meanings?

1. Yes
2. No
3. Not quite sure 

Q 12.4) Observing Sharing of Interests

Every child expresses enthusiasm in their own unique way, and not all may outwardly show what catches their interest.

Does your child actively seek to show you things that excite them, such as a new toy or a game they are enjoying?

1. Yes
2. No
3. Not quite sure 

Q 12.5) Assessing Spontaneous Sharing Behavior

The way children choose to share or keep possessions can vary widely; some may frequently offer to share, while others may do so less often.

Has your child shown a tendency to voluntarily share their possessions, such as toys or food, with you or others?

1. Yes
2. No
3. Not quite sure 

Q 12.6) Evaluating Emotional Sharing

Sharing emotions is a unique and varied experience for every child.

Does your child show or communicate feelings of happiness or excitement with you or others?

1. Yes
2. No
3. Not quite sure 

Q 12.7) Evaluating Empathetic Responses

Children often respond in various ways to others' discomfort or distress, although they may not always recognize or react to these situations.

Does your child attempt to offer comfort or assistance when they notice someone feeling unwell or distressed?

1. Yes
2. No
3. Not quite sure 

Q 12.8) Understanding Behavioral Adaptability

Kids typically vary their actions to align with different environments, though some may not always modify their behavior accordingly.

Have you observed your child changing their behavior to suit various social contexts, such as being reserved around strangers or in places like a church?

1. Yes
2. No
3. Not quite sure 

Q 12.9) Understanding difficulty in making and keeping friends

Children on the Autism Spectrum may face challenges in forming, maintaining, and understanding relationships. 

Does your child seem to have trouble making friends, not because they're nervous or worried about being judged, but because they either don't seem interested or don't quite grasp how to connect with others?

1. Yes
2. No
3. Not Sure

Q 12.10) Examining Social Nonverbal Communication: Eye Contact

Eye contact can speak volumes in a conversation, offering a silent, yet powerful connection between people.

Does your child engage in eye contact during conversations?

1. Yes
2. No
3. Not quite sure

Q 12.11) Understanding Non-Verbal Social Engagement

Sharing glances can create a silent dialogue that deepens bonds during shared activities.

Does your child often look to your face for reactions while you're engaged in an activity together?

1. Yes
2. No
3. Not quite sure

Q 12.12) Examining Social Nonverbal Communication: Social Smile

A smile can be a universal sign of friendliness and recognition in new encounters or social gatherings.

In social settings or when meeting new people, does your child use a smile to greet others?

1. Yes
2. No
3. Not quite sure

Q 12.13) Examining Social Nonverbal Communication: Social Smile

Smiling is a fundamental non-verbal cue in social interactions, often exchanged reciprocally between people.

If someone smiles at your child during social interactions, how does your child typically react?

1. Returns the smile
2. Rarely or never smiles back
3. I am uncertain of their usual response

Q 12.14) Examining Social Nonverbal Communication: Everyday Gestures

Everyday gestures are a key part of our non-verbal communication, like waving to say goodbye or putting a finger to our lips for silence.

Does your child commonly use such gestures in their interactions?

1. Yes, they use gestures regularly
2. No, they seldom use gestures
3. I am not sure

Q 12.15) Examining Social Nonverbal Communication: Range of Facial Expression

Just as every child has a unique laugh, the way they show joy, surprise, or concern can also vary. Some kids might not express their feelings in the expected ways, or might have a subtler range of facial expressions.

Does your child show a wide range of facial expressions, or do they express themselves differently?

1. Yes, they have a diverse range of expressions
2. No, their expressions are more subtle or less varied
3. I'm not sure or it's hard to tell

Q 12.16) Examining Social Nonverbal Communication: Appropriateness of Facial Expression

Every child expresses emotions in their own manner — for some, their facial expressions vividly narrate their inner feelings; for others, it's a social milestone that's developing at its own pace.

Do your child’s facial expressions typically mirror their emotions or the context of what they’re communicating?

1. Yes
2. No
3. Not quite sure

Q 12.17) Examining Social Nonverbal Communication: Body Language

It's natural for body language to vary from child to child, especially in new or social situations.

Have you noticed your child exhibiting body language that stands out as atypical or awkward when interacting with others?

1. Yes
2. No
3. Not quite sure

Q 12.18) Examining Social Nonverbal Communication: Interpreting Non-Verbal Cues

Recognizing and making sense of body language and facial expressions is a subtle yet complex skill that not all children master at the same pace.

Does your child find it difficult to grasp the body language and facial expressions of others?

1. Yes
2. No
3. Not quite sure

Q 12.19) Examining Social Nonverbal Communication: Understanding Personal Space

Kids with ASD may not instinctively grasp personal space, often standing closer than expected during interactions. This contrasts with children with ADHD, whose energetic nature might lead them into others' space unintentionally.

Does your child seem to understand the concept of personal space, such as not standing too close to others?

1. Yes
2. No
3. Not quite sure

Q 12.20) Recognizing Repetitive and Stereotyped Behaviors: Body Movements

Children with Autism Spectrum Disorders might exhibit repetitive behaviors that are quite distinct. Unlike the spontaneous, energetic movements seen in hyperactivity, these can be patterned and persistent, often taking the form of hand flapping or twisting actions near the face.

Have you noticed your child engaging in any repetitive behaviors or movements that seem to have a pattern or routine to them?

1. Yes
2. No
3. Not quite sure

Q 12.21) Examining Speech Patterns

Each child has their own style of expressing themselves, and sometimes they come up with their own quirky phrases or sayings.

Does your child frequently use phrases or expressions that are unconventional or unique?

1. Yes
2. No
3. Not quite sure

Q 12.22) Examining Speech Patterns: Repetitive Speech

It's not uncommon for children to echo their favorite catchphrases from time to time. However, children with ASD might have a tendency to repeat the same phrases or sentences much more frequently and in a repetitive fashion. 

Does your child frequently repeat the same phrases or sentences in the same manner?

1. Yes
2. No
3. Not quite sure

Q 12.23) Examining Speech Patterns: Echolalia

While all kids might mimic words or phrases occasionally, some children with ASD exhibit echolalia, which is the immediate or delayed repetition of what they’ve heard.

Does your child frequently echo words or phrases soon after hearing them, or repeat them at a later time?

1. Yes
2. No
3. Not quite sure

Q 12.24) Examining Speech Patterns: Vocal Characteristics

Each child has a unique way of speaking that adds to their individuality. Certain speech patterns may suggest a diagnosis of ASD. We'd like to understand the nuances of your child's vocal expressions. 

Can you identify any of the following characteristics in your child's speech? Check ALL that apply:

1. Uses a unique tone of voice, like sounding robotic or lecture-like
2. Doesn't realize when speaking too loudly
3. Speaks so slowly, quickly, or unevenly that it's challenging to understand.

Q 12.25) Examining Speech Patterns: Neologisms

Children often surprise us with their creativity in language. Sometimes, though, they may create their own words, which can be an aspect of their individual expression or an indicator of ASD.

Does your child often use words that seem made-up or invented by them?

1. Yes
2. No
3. Not quite sure

Q 12.26) Examining Speech Patterns: Unique Descriptive Language

Unique or unusual descriptions can sometimes be a sign of a child's inventive mind. However, within the context of ASD, such distinctive phrases may point to alternative ways of experiencing and interpreting the world.

Does your child often describe everyday objects or events in an unusual or indirect manner, like saying "hot rain" for steam?

1. Yes
2. No
3. Not quite sure

Q 12.27) Examining Speech Patterns: Pronoun Reversal

Swapping pronouns or using them in unconventional ways can be a notable feature in the language development of children with ASD.

Does your child frequently mix up pronouns, such as using "you" instead of "I" or saying "he" or "she" when referring to themselves?

1. Yes
2. No
3. Not quite sure

Q 12.28) Examining sensitivity to change: Surrounding Environment

Insistence on Sameness: For kids with ASD, even the tiniest tweaks in their everyday surroundings can be unsettling, regardless of direct impact.

Does your child become upset by minor changes in familiar surroundings, like moving ornaments in the living room?

1. Yes
2. No
3. Not quite sure

Q 12.29)  Examining sensitivity to change: Routines & Personal Environment

Insistence on Sameness: Kids with ASD have difficulty with minor changes in their own routines or personal environment.

Does your child get distressed by how their belongings are arranged or slight changes in their daily routine like switching from long to short sleeves?

1. Yes
2. No
3. Not quite sure

Q 12.30) Examining Desire for symmetry or completeness

Many children with ASD show a keen interest in order and symmetry, finding comfort in predictable patterns and arrangements. 

Does your child display any of the following behaviors that suggest a preference for symmetry or specific order? Select ALL that resonate with your child’s behavior:

1. Always lines up toys in a particular order
2. Likes to arrange objects symmetrically or in a special sequence
3. Seems really drawn to patterns that are symmetrical
4. None of the above ((allowed only if other options not chosen, if this option chosen then other options are not allowed)

Q 12.31) Evaluating Difficulty with transitions

Does your child find it tough to switch between tasks, often becoming really absorbed in completing one thing before moving on to the next? 

Remember, this question doesn't cover situations where most children might choose a fun activity over a less enjoyable one, such as picking playtime over chores. 

1. Yes
2. No
3. Not Sure

Q 12.32) Understanding Rituals in ASD

Has your child ever seemed compelled to do things in a specific order or way? Like they have a set 'routine' or 'ritual' they feel they must stick to?

1. Yes
2. No
3. Not Sure

Q 12.33) Exploring Unique Passions

Children on the autism spectrum often exhibit remarkably deep and focused interests that may seem too intense.

Does your child have any hobbies or interests that stand out due to their unusually intense focus? 

1. Yes
2. No
3. Not Sure

Q 12.34) Exploring Unique Fascinations

Children with ASD may exhibit an intense and singular concentration on certain interests that go beyond typical childhood preferences.

Does your child exhibit peculiar or uncommon interests? For instance, do they show a significant fascination with things like lights, street signs, toilets, or vacuum cleaners? 

1. Yes
2. No
3. Not Sure

Q 12.35) Understanding Object Attachment in Children with ASD

Children with Autism Spectrum Disorder (ASD) may form profound attachments to specific items, which can provide them comfort and a sense of security. This attachment can sometimes extend to less typical objects beyond the usual teddy bear or blanket.

Is there an object your child is deeply attached to and frequently carries around? This might be a teddy bear, a blanket, or even something more unique like a pipe or a stone. 

1. Yes
2. No
3. Not Sure

Q 12.36) Assessing Noise Sensitivity in Children with ASD

Does your child display heightened sensitivity to noise? In other words, do they react strongly or seem bothered by loud sounds more than other kids? 

1. Yes
2. No
3. Not Sure

Q 12.37) Evaluating Auditory Sensitivity and Distress

Does your child sometimes become noticeably upset or irritated by specific sounds, like someone coughing or a baby crying? 

1. Yes
2. No
3. Not Sure

Q 12.38) Understanding Sensory Food Preferences and Rituals

It's not uncommon for children with ASD to have distinctive eating habits, often reacting in specific ways to the sensory aspects of food or adhering to certain rituals during meals.

Does your child react strongly to certain aspects of food, like taste, smell, texture, or appearance, or engage in rituals related to these aspects? 

(And/Or) 

Do they also have significant food restrictions? 

1. Yes
2. No
3. Not Sure

Q 12.39) Exploring Sensory Fascinations and Concerns

Children on the autism spectrum often exhibit distinct preferences or fascinations due to their heightened sensory awareness. We're exploring the various ways your child may experience the world around them.

Select ALL the statements listed below that apply to your child:

1. Shows an unusual interest in the appearance, feel, sound, taste, or smell of objects or people. For instance, they might sniff toys, objects or people in a way that seems out of the ordinary.
2. Appears overly concerned with the feel or texture of items they come into contact with.
3. Displays a noticeable fascination with observing lights or watching objects as they spin.
4. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 13: Learning Disorder (LD)

Q 13.2) Identifying Learning Challenges

Understanding where your child struggles academically helps us to focus our support effectively.

Do you notice any particular subjects or areas where your child faces difficulties in learning, or is it a more general concern across all subjects?

1. Single subject
2. A few subjects
3. Multiple subjects (review domain ADHD) 
4. Every subject (review domain ADHD) 
5. Not sure

Q 13.3) Reading Skills Check-In

Reading Beyond Words: Reading fluently involves not just accuracy but also a smooth and swift pace that aids comprehension.

When reading aloud, does your child often misread words, pause, guess, or have trouble sounding out words?

1. Yes
2. No
3. Not quite sure 

Q 13.4) Reading Comprehension Check

Understanding the meaning behind the text is as crucial as reading the words themselves.

Is your child able to read words correctly but still faces challenges grasping the context, connections, or subtler points within the text?

1. Yes
2. No
3. Not quite sure 

Q 13.5) Spelling Skills Spotlight

Decoding Letters and Sounds: Accurate spelling requires understanding the relationship between sounds and their written form.

Does your child frequently add, omit, or rearrange letters, indicating a struggle with spelling words correctly?

1. Yes
2. No
3. Not quite sure 

Q 13.6) Written Expression Challenges

Grammar and Structure: Clear writing depends on proper grammar and organized thoughts.

Is your child struggling to articulate their thoughts in writing, often making grammatical errors or failing to structure paragraphs coherently?

1. Yes
2. No
3. Not quite sure 

Q 13.7) Mathematical Understanding Difficulties

Problem-Solving and Calculation: Applying math concepts is crucial for solving numerical problems.

Is your child struggling with math problem-solving or calculations?

1. Yes
2. No
3. Not quite sure 

Q 13.8) Educational Support Inquiry

Extra Help in School: Tailored interventions can aid your child's learning progress. 

Has your child been provided with any special accommodations or interventions at school?

1. Yes
2. No
3. Not sure 

Q 13.9) Detailing School Accommodations  

Understanding Tailored Support: Specific measures can significantly benefit your child's education. 

Could you specify the types of accommodations or interventions your child receives at school?

___________ FREE LONG TEXT PARAGRAPH _________

Q 13.10) Evaluating Educational Support

Assessing Impact: It's important to gauge the effectiveness of educational measures.

Have these accommodations made a positive impact on your child's learning?

1. Yes
2. No
3. Not quite sure 

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DOMAIN 14: Gender Dysphoria (GD)

Q 14.2) Identifying Biological Gender

We respectfully inquire about your child's gender assigned at birth to ensure that our support is considerate of their personal narrative.

What gender was assigned to your child at birth?

1. Male
2. Female

Q 14.3) Understanding Experienced Gender

Approaching with respect, we seek to affirm your child's gender identity, supporting their well-being and self-esteem.

Which gender does your child most identify with currently?

1. Male
2. Female
3. Non-binary (explanation widget: Non-binary refers to a gender identity that does not align exclusively with the conventional categories of male or female. Individuals who identify as non-binary may experience their gender as a blend of both, neither, or as a completely distinct gender identity) 
4. Genderfluid  (explanation widget: Gender fluidity describes a gender identity that is dynamic and may change or fluctuate over time, rather than being fixed) 
5. Agender (explanation widget: Agender refers to a person who does not identify with any gender, indicating an absence of gender identity.) 
6. Bigender (explanation widget: Bigender refers to a gender identity where an individual identifies with two distinct genders, either simultaneously or variably) 

• Not sure 

Q 14.4) Gender Identity and Well-being

Understanding if there is any distress or difficulty stemming from gender identity can guide us in providing appropriate support and care.

Is the distinction between your child's biological and experienced gender affecting their emotional health or their functioning in daily activities, such as school or home life?

1. Yes
2. No
3. Not quite sure 

Q 14.5) Impact Reflection

Understanding the specifics helps us support your child effectively.

Can you provide details on how your child's gender experience is affecting their day-to-day life and emotional state?

___________ FREE LONG TEXT (PARAGRAPH) _________

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DOMAIN 15: Substance Use Disorders (SUD)

Q 15.2) Current Substance Use Inquiry

Monitoring present substance use helps in evaluating the immediacy and nature of any needed support.

Is your child currently engaging in any substance use such as tobacco, marijuana, alcohol or other drugs?

1. Yes
2. No
3. Unsure

Q 15.3) Detailing Substance Use

Knowing the specific substances your child may be using helps us to provide targeted advice and support.

Which specific substances is your child currently using? Please select ALL that apply:

• Traditional cigarettes (tobacco)
• Vaping or e-cigarettes
• Marijuana (often called weed) 
• Alcohol
• Cocaine
• Methamphetamine
• Esctasy
• Mushrooms (psychedelic)
• LSD
• Heroine
• Other substances not mentioned here

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DOMAIN 16: Attachment Disorders (ATT)

Q 16.2) Assessing Child's Interaction with Adults  

Does your child often seem reserved, quiet, or unexpressive when interacting with adults?

1. Yes
2. No
3. Not sure 

Q 16.3) Seeking Comfort: Child-Caregiver Connection

When your child is feeling upset or distressed, do they typically seek comfort and support from their caregivers?

1. Yes
2. No
3. Not sure 

Q 16.4) Evaluating Receptivity to Caregiver Soothing

When your child is upset or distressed, do they usually respond positively to the comfort and reassurance provided by caregivers?

1. Yes
2. No
3. Not sure

Q 16.5) Evaluating Secure Attachment Through Stranger Interaction

A child's interaction with strangers can provide insights into their secure attachment with their caregivers.

Please select all the behaviors your child exhibits:

1. Engages with unfamiliar adults readily.
2. Does not seek out their caregiver in unfamiliar settings.
3. Shows willingness to go with people they do not know.
4. None of the above (allowed only if other options not chosen, if this option chosen then other options are not allowed)

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DOMAIN 17: Speech & Language Disorders (SLD)

Q 17.2) Evaluating Clarity of Speech

Does your child face difficulty speaking clearly or expressing themselves in a way that others can easily understand?

1. Yes
2. No
3. Not sure 

Q 17.3) Understanding Speech Flow

When kids are fluent, they talk smoothly without repeating sounds or words, or stopping awkwardly. 

Does your child often repeat sounds, hesitate, or switch words when speaking, indicating difficulty with speech flow?

1. Yes
2. No
3. Not sure 

Q 17.4) Navigating Speech Barriers in Communication

Do your child’s speech and language challenges affect their ability to talk to or understand others?

1. Yes
2. No 
3. Not sure 

Q 17.5) Language Hurdles in Academic Engagement

Do the difficulties in speech and language affect your child's academic performance?

1. Yes
2. No 
3. Not sure 

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