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The INPP questionnaire should be filled in if you think your child maybe showing some of the signs of neuromotor immaturity. Research published in the British Journal of Occupational Therapy, October 1998, has shown that a score of 7 or more ‘yes’ answers on the questionnaire below indicates that further investigation for underlying neuromotor immaturity is advised for children over 7 years of age. If this is the case I will get in touch with you to advise you of the next steps. (Please note there is no obligation for you to proceed once the form is submitted.)

 

Screening Questionnaire
Name
Name
First
Last
Is there any history of learning difficulties in either parent or their families?
When you were pregnant, did you have any medical problems? e.g. High blood pressure, excessive vomiting, threatened miscarriage, severe viral infection, severe emotional stress?
Was the birth process unusual or difficult in any way? eg c-section, forceps, etc
Was your child born early for term (more than 2 weeks) or late for term (more than 10 days)?
Was your child’s birth weight below 5lbs?
In the first 13 weeks of your child’s life, did he/she have difficulty in sucking, feeding problems, keeping food down or colic?
Was your child very demanding in the first 6 months?
Did you child miss out on the motor stage of crawling on his/her tummy or creeping on hands and knees?
Was your child early (before 10 months) or late (later than 16 months) at learning to walk?
Did your child have difficulty learning to dress him/herself?
Does your child suffer from allergies?
Was there adverse reaction to any of the childhood vaccinations?
Did you child suck his/her thumb through to 5 years or more?
Did your child wet the bed, albeit occasionally, above the age of 5 years?
Does your child suffer from travel sickness?
Did he/she have difficulty learning to tell the time from a traditional clock face as opposed to a digital clock?
Did he/she have difficulty learning to ride a two-wheeled bicycle?
Did your child suffer numerous ear, nose, throat or chest infections?
In the first 18 months of life, did your child experience any illness involving high temperatures and/or convulsions?
Does your child have difficulty catching a ball, or doing forward rolls in PE?
Does your child have difficulty sitting still, even for a short period of time?
If there is a sudden, unexpected noise or movement, does your child over-react?
Does your child have reading difficulties?
Does your child have writing difficulties?
Does your child have copying difficulties?
Has your child had a diagnosis?