KB-Insights

Early history of ear infections/ glue ear/ or hearing problems prior to age three?: Yes No

Persisting middle ear infections/ glue ear/ hearing problems/grommets or ENT operations beyond age three?: Yes No

Family history of speech, reading or spelling difficulties (including reluctant readers)?: Yes No

Family or school circumstances which may have affected the child’s development?: Yes No

CONCENTRATION, ATTENTION, LISTENING AND UNDERSTANDING

Daydreams in class?: Yes No

Disruptive in class (possibly because they can’t follow teacher for prolonged period)?: Yes No

Difficulty following through instructions – needs to check with teacher/ classmate to be sure?: Yes No

Difficulty coping with background noise or works better 1 to 1 than in class?: Yes No

Does not always respond when name is called or when being addressed as part of a group?: Yes No

Appears not to listen to what is being said?: Yes No

Evidence of standing back to see what others are doing before following a verbal instruction?: Yes No

Difficulty listening or following instructions while doing something?: Yes No

Difficulty listening and taking notes simultaneously?: Yes No

Homework takes much longer to complete than it should?: Yes No

Difficulty settling down to independent work?: Yes No

Tends to take things too literally for their age?: Yes No

Difficulty making/ sustaining friendships (slow processing may cause difficulties keeping up with fast-paced banter of peer group): Yes No

Oversensitivity to/ dislike of loud or particular sounds?: Yes No

SPEECH

Speech poorly articulated or slow, hesitant or confused?: Yes No

Intonation flat or monotonous?: Yes No

Word finding problems – struggles to find the word they want to say?: Yes No

Confusion/ difficulty saying multi-syllabic words?: Yes No

Difficulty initiating/ maintaining conversation or asking questions?: Yes No

READING, SPELLING AND NUMERACY:

Difficulty with decoding/ encoding?: Yes No

Appears not to hear the sounds/ sound sequence in words?: Yes No

Difficulty with layout of work?: Yes No

Difficulty with maths?: Yes No

Has your child had any specialist assessments E.G. Educational Psychologist, Speech and Language, Physio or Occupational Therapist, Specialist Teacher? Who and when? Yes No

Please add any further information or comments about your child’s hearing, listening and attention?