Occupational Therapy Academic Questionnaire
Occupational Therapy Academic Questionnaire
Occupational Therapy Academic Questionnaire by Dr. Arunkumar.RM
Name of child: Age: Gender:
Class: Teacher:
Do out have concerns about: Vision? Hearing? Health problems?
(Rating scale: 1=poor, 2=fair, 3=average, 4=good, 5=excellent)
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| Score | comments | ||
1 | Spelling skills | 1 2 3 4 5 |
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2 | Handwriting skills | 1 2 3 4 5 |
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| Form of neatness |
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| Speed – keeping up with class |
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| Completing work |
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| Copying from blackboard |
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| Spacing between words |
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| Immature formation of letters |
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3 | Number/arithmetic skills | 1 2 3 4 5 |
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| Basic operations – addition |
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| – subtraction |
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| – multiplication |
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| – division |
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| Skills in use of abstract concepts |
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| Overall arithmetic/number skills |
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4 | Visual–perceptual skills | 1 2 3 4 5 |
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| Visual perceptual skills overall |
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5 | Language and communication | 1 2 3 4 5 |
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| Oral expression |
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| Written expression |
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| Clarity of speech/articulation |
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| Fluency – repetition/hesitation |
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| Vocabulary |
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| Language comprehension |
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| Follows directions given to class |
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| Follows directions given to individual Overall communication |
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6 | Physical skills
| 1 2 3 4 5 |
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| Gross motor (e.g. Skip or hop) |
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| Skill in sports/ball games |
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| Fine motor |
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| Skills/manipulation (e.g. Scissors and shoelaces) |
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| Preferred/established handedness l/r/both |
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7 | Development |
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7.1 | Emotional and personal | 1 2 3 4 5 |
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| Self-esteem/confidence |
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| Concentration/attention |
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| Motivation in classroom work |
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| Completes homework |
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| Aggression |
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7.2 | Social | 1 2 3 4 5 |
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| Gets on well with peers |
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| Gets on well with adults |
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| Withdrawn or isolated |
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| Gets teased or bullied |
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| Teases others or is spiteful |
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| Plays with younger children |
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| Classroom behavior problems |
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| Willingness to join in team games |
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General comments and recommendations
Class teacher: Support teacher:
Signature: Date:
Comments