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Q.1
My child cries, covers her ears, or runs away when I turn on the vacuum cleaner.
*
Yes – frequently
Sometimes
No – never
Q.2
My child gets upset if anyone talks while we’re watching TV, even at a very low volume or during a commercial.
*
Yes – frequently
Sometimes
No – never
Q.3
My child can’t focus on his homework if he can hear someone talking or playing in another room.
*
Yes – frequently
Sometimes
No – never
Q.4
If I tell my child, “Go to your room and get your coat,” she’ll go to her room and come back without her coat.
*
Yes – frequently
Sometimes
No – never
Q.5
My child seems disinterested in music.
*
Yes – frequently
Sometimes
No – never
Q.6
My child gets stressed out when talking on the telephone — or even thinking about it.
*
Yes – frequently
Sometimes
No – never
Q.7
My child can’t focus on writing and listening at the same time, and has difficulty taking notes.
*
Yes – frequently
Sometimes
No – never
Q.8
My child has been tested for hearing problems, and everything came out fine.
*
Yes – frequently
Sometimes
No – never
Q.9
My child often says, “What?” even if no one is talking.
*
Yes – frequently
Sometimes
No – never
Q.10
My child mishears me when I’m speaking; he thinks I said “bread” instead of “red,” for example.
*
Yes – frequently
Sometimes
No – never
Q.11
My child often says sounds in the wrong order, long after his peers have stopped doing this.
*
Yes – frequently
Sometimes
No – never
Q.12
My child seems distracted or has trouble focusing during class.
*
Yes – frequently
Sometimes
No – never
Q.13
My child does poorly on oral tests but not written ones. My child has difficulty listening to auditory information (teacher teaching) when no visual information is available.
*
Yes – frequently
Sometimes
No – never
Q.14
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