info@lorrainedriscoll.com
613-330-9254
4920 County Rd 12, PO Box 66, Lunenburg, ON K0C 1R0

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Child Assessment

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Child Assessment

Free Child Assessment

This quick and painless assessment can help you determine if your child suffers from possible learning difficulties. Simply fill out the 4-part form below and get your results immediately. If the results concern you or you have any questions, please do not hesitate to contact me for a consultation.

Part 1: Lower Brain Development

Please select all that apply.

Did not crawl or only for a short time, early walker

Frequently falls out of chairs/seats or clumsy

Uncoordinated, poor balance (difficulty learning to ride a bike)

Fidgets or prefers to be moving; rocks, wiggles, bounces

Easily angered or upset, impulsive

High or low pain tolerance, complains tags, or clothing is uncomfortable

Picky eater/ complains about food textures

Frequently zones out when someone is speaking to him or her

Does not remember a series of oral instructions

Poor posture, slumps when sitting down

Does homework laying on belly, back or with head laying on the desk/table

Taps foot, hand, hums, or other ‘distracting behaviours’

Says “what?” or “huh?” a lot, difficulty following oral instructions or misinterprets instructions

Becomes motion sick easily

Disorganized

Does not understand concept of personal space

Poor handwriting, writes to dark or too faint, awkward pencil grip

Chews on clothing, hair, pencils, etc.

Plays too rough, breaks items unintentionally

Poor spacing between letters and/or words

Delayed speech or speech difficulties

Difficulty retelling events or sequencing a story

Can’t catch a ball, dislikes sports

Part 2: Reading Difficulty

Please select all that apply

Uses finger to follow when reading or covers one eye when reading

Moves head when reading instead of just eyes, tilts head when reading

Complains letters/ words move, blur or reverse

More errors in reading and writing towards end of work, oral reading starts smooth but then becomes more laboured

Rests head on arms when reading or writing, turns body or paper at an extreme angle to read or write

Face is really close to the paper when reading or writing

Poor reading comprehension, difficulty retelling events or sequencing a story, yawns when reading

Makes mistakes when copying words from the board or another text

Did not crawl or only for a short time

Poor posture, slumps when sitting down

Does work laying on belly, back or with head laying on the desk/table

Poor spacing between letters and/or words

Phonics sounds don’t stick, guesses at words

Sounds out same word over and over, inconsistency from one day to next even when reading at same level

Delayed speech or speech difficulties, mixes words up –says ‘aminal’ instead of ‘animal’

Confuses left and right or had difficulty learning it, has mixed dominance – sometimes left, other times uses right

Part 3: Nutritional Deficiencies

Please select all that apply

Red scaly skin on face

Red or white acne like mumps on thigh, buttocks, and arms

Dry or rough skin

Nosebleeds

Easy bruising

Acne

Frequent colds

Infections

Never Sick

Dark circles around eyes

Poor night vision

Ruptured blood vessel in eyes

Nearsightedness

Pale lower lid

Burning eyes, eye fatigue, visual disturbance

Cracked lips

Indentations or cracks on tongue

Crowded teeth

Canker sores

Poor tooth enamel

Loss of smell and taste

Muscle cramping

Twitching

Muscle tenderness

Excess muscle fatigue

Colds hands and feet

Constant sore throat

Dyslexia/dyspraxia/ADHD Diagnosis

Insomnia

Poor memory

Irritability/anxiety

Speech problems

Fatigue or depression

Slow growth

Strong reactions to taste

Part 4: Gut Imbalance

Please select all that apply

C-section

History of antibiotics in mother or child

Frequently sick

Constipation as a baby (or now)

Diarrhea as a baby (or now)

Bottle fed

Stool is abnormally foul

Unformed stools

Complains of belly aches or cramping

Skin problems like eczema

Allergies, asthma

Picky eater

Eats mostly white carbs and dairy

Frequent belching

Gassy

Mother used hormonal contraception

Bloating

Sugar cravings

History of steroid use

Athlete’s Foot

Aggression/Hyperactivity

Cankers

Constant silliness–laughing fits

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The information on this website is for informational purposes only and is not in any way intended to substitute medical care or advice from your doctor. Lorraine Driscoll is acting in accordance with the regulations of her designation as a Registered Holistic Nutritionist. She does not seek or claim to diagnose or cure.

Contact Info

Phone: 613-330-9254
Email: info@lorrainedriscoll.com

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