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JIAS difficulties questionnaire
JIAS Difficulties Questionnaire
Step
1
of
2
50%
About this questionnaire
I agree to the participate
This questionnaire looks at the range of difficulties the individual is experiencing which may be altered by a JIAS programme.
Please find 18 statements of difficulties the individual may be experiencing. Rate each statement according to how much this affects your child where 1 is not at all and 10 is severely affected.
Parent name
(Required)
First
Last
Child / Young person's name
(Required)
First
Last
Does your child / young person daydream when they are meant to be listening?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty following instructions?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty coping with background noise?
1
2
3
4
5
6
7
8
9
10
Does your child / young person appear not to hear when their name is called?
1
2
3
4
5
6
7
8
9
10
Does your child / young person appear not to listen to what is being said?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty following instructions whilst doing something?
1
2
3
4
5
6
7
8
9
10
Does your child / young person take longer to complete tasks?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty settling down to independent work?
1
2
3
4
5
6
7
8
9
10
Does your child / young person takes things too literally/have difficulty with jokes?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have an oversensitivity to particular sounds?
1
2
3
4
5
6
7
8
9
10
Does your child / young person's speech appear slow, poorly articulated or hesitant?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have word finding problems (struggles to find desired word)?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty with conversations/asking questions?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty sounding out words when reading?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty hearing individual sounds in words?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have difficulty with mathematics?
1
2
3
4
5
6
7
8
9
10
Is your child / young person disruptive in class?
1
2
3
4
5
6
7
8
9
10
Does your child / young person have behavioural difficulties?
1
2
3
4
5
6
7
8
9
10
