Assessment Questions

Name: Age:

Brain Stem
1. Irregular/outside normal limits heart, temperature regulation, and respiratory rate. Weight does not match food intake. Normal child heart rate is 75-110 with some variance for age. Wearing shorts in snow is a Koncern. A child who eats over 3,000 calories per day and is below average weight is also a Koncern.
2. Autoimmune diagnosis such as allergies, eczema, or bowel issues. Symptoms include seasonal allergies, food allergies, bumps on skin, frequent diahrea or constipation. Child may have purple rings under the eyes or a persistent post nasal cough or runny nose. Constant clearing of the throat is another symptom. Bowel issues refers more to fecal consistency and frequency than toileting behaviors.
3. Eyes do not move in a smooth pursuit; child has difficulty with reading; child can’t look up without neck involvement; child runs around room upon entry; child has difficulty copying from the front classroom screen, difficulty reading, lack of eye contact, can’t find objects in a drawer or messy room, and is easily distracted during fine motor tasks. A simple "follow my finger" test to assess if the child can look up, down, left, and right without using neck muscles will indicate visual muscle health.
4.Difficulty with food. Does the child only eat a limited amount of food or do they have perceived poor manners (mouth stuffing, drooling, spitting food)?
Diencephalon/Cerebellum
5. Difficulty with Sleep Sleep: difficulty getting a full night's sleep, night waking, fear of the dark, difficulty going to sleep, being constantly tired
6. Poor Fine Motor Skills Difficulty with cutting, coloring, putting a key in a lock, using utensils, playing an instrument, using hand muscles.
7. Poor Groos Motor Coordination Falls often, poor balance, difficulty crossing midline, toe walking, w-sitting, difficulty with sports techniques, holds breath in activity
8. Often withdrawn or lethargic? Poor participation in groups, absence seizures, blank stares, headaches, withdrawal, or lack of response to pain or other stimulus
9. Overly active or constantly moving. 9. Overactivity, loud talking, excessive movement, difficulty settling down, crashing and bumping into things, climbing high and swinging fast
10. Environmental sensory input negatively influences mood. 10. Client demonstrates tactile or auditory sensory defensiveness, limited food or clothing choices, constantly seeking or avoiding input, difficulty soothing.
Limbic
11. Difficulty with emotions and matching regulatory state to environment. 11. Difficulty moving between up- and down-regulation, constantly seeking or avoiding input, difficulty soothing, lack of awareness of others' emotions, difficulty identifying own emotions, emotions don’t match mood.
12. Has difficulty relating to others. 12. Client is unable to recognize non-verbal cues, is lacking empathy, doesn’t seek a caring adult when hurt, or has difficulty with intimacy, forming age-appropriate relationships, and sexuality. Decreased eye contact.
13. Has difficulty with feelings and body sensations 13. Has difficulty distinguishing between anger, fear, and hunger frequent bowel or bladder accidents.
Cortex
14. Demonstrates difficulty with communication (verbal and non-verbal) and concepts of time/waiting. 14. Poor sense of time, inability to wait, tendency to fall apart when told “no”, difficulty with language, inability to express needs verbally, doesn’t answer to name, inability to follow verbal directions, stuttering, difficulty understanding conversations, or difficulty finding words.
Frontal Cortex
15. Acts on impulse rather than thought Quick to take action. Often feels remorseful after the impulsive event.
16. Poor moral reasoning, lying, or frequent delinquent behavior 16. Poor moral reasoning, lying, or frequent delinquent behavior