The Questionnaire that you will receive will
be asking for details in several areas. After working with special
education students for over 20 years, I have learned that the problem
we are looking at is often not the root of the real issue.
Think of this questionnaire as an educational "case history" that is
much like forms you prepare for your first visit to a medical
specialist. You will be asked questions about your child’s educational
history, a brief description of any significant medical history,
relevant family history, and descriptions of situations where specific
problems typically occur. You will not be asked questions that
intrude into areas of your personal privacy nor your child’s privacy,
but the more information you are able to provide, the easier it becomes
to pinpoint possible causes for your difficulty. The more accurately we
can diagnose causes, the more precisely we can recommend solutions. ALL information you provide remains totally confidential and we will return your information packet to you along with the Consultation Report.
Educational History Section
 You can light the way! |
You will need to describe the kind of educational
placement your child was working in since kindergarten. You will be
asked for information about your child’s responses to early academic
teaching and to describe any signs of difficulty that appeared.
There will be questions about the kinds of reading
and/or math materials your child has used; such information helps in
discovering whether or not your child’s problems are related to faulty
instructional programs. You may not be able to answer all the
questions, but it is important that you be as complete as possible. |
 Good schooling
brings joy! |
Medical History Section
 We need the
doctor's help! |
You will be asked basic questions about early
illnesses, pregnancy complications and hospitalizations or surgeries.
These are standard questions. Recent research has also provided
information about certain sets of factors such as exposure to
environmental toxins that can seriously affect a child’s educational
performance. There will be questions seeking information about these
less well-known problem areas. You will also be asked whether your
child is currently taking any medications and you will be asked to list
them. Again, it is important for you to provide answers as completely
as possible.
|
Family History Section
|
These questions are not meant to be intrusive, but
because the research indicates that some children’s problems can be
tied to family genetics, it is important to be as accurate as possible.
You will also be asked to explain the nature of your family situation
as it relates to being a one-parent or two-parent home, and any
significant emotional traumas that may have kept the child’s attention
from focusing on academic work for a significant time. This information
is often far more significant than many parents realize in
understanding the child’s educational performance. |
Strong families
are a blessing! |
Evaluation Section
 Assessments are important! |
You will be asked to provide COPIES of any
formal evaluations or diagnostic tests that have been done for your
child. This includes medical evaluations for Attention Deficit or other
problems, Intelligence Tests and/or Educational Assessments, such as
the Stanford 9, the California Achievement Tests, or similar
standardized tests. If possible, you should include copies of teacher
comments on report cards and other information that might provide a
clearer picture of your child’s educational difficulties. |
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