Teacher - Child Diagnostic Questionnaire

Interview Questionnaire for Kindergarten/Childcare Workers & Teachers

Please note the information provided in this questionnaire may be released to the parent upon request and included in any subsequent report. Please do not include any information that you do not wish to be shared with the family.

PLEASE SCREENSHOT EACH PAGE AS YOU GO INCASE OF SUBMISSION ERROR TO AVOID LOSING COMPLETED INFORMATION

We will be meeting with a student of yours in the near future, and we would appreciate your time in filling in this detailed questionnaire in order to obtain information about the child’s behaviours and skills within your setting. This information is of great value. Thankyou

You might consider; do they anticipate the needs of others, how do they initiate social contact (e.g. barging into play or conversations), do they show awareness of boundaries/personal space, are they ever distant, aloof, in a world of their own?
You may consider; initiation of conversation, waiting for others to finish speaking, responds and seeks clarification, being aware of the needs of their communication partner, turn-taking in conversation, one sided interactions, talking “at” people, difficulty with monitoring and repairing conversation, talks about own interests exclusively/redirects the conversation back to their own interests, literal interpretation, do they ask questions of others to seek information about their interests?
You might consider; do they seek consolation/comfort? Can they self-regulate?
You might consider; can they maintain eye contact, do they use it to regulate conversation, any intense staring.
You might consider; do they use descriptive gestures (e.g., using hands to describe or place emphasis when speaking), use of body postures (crossed arms, hands on hips), social gestures (high 5’s, waving), gestures to communicate needs (pointing, nodding/shaking their head).
You might consider; are they blank/monotone in their affect, exaggerated emotions, out of context emotions, emotions unrelated to the situation, facial grimacing.
You might consider; do they have a consistent group of friends/best friend, how do you think other children would describe this child, do they show an interest in other children and in making friends, have they been able to maintain relationships/friendships, do they greet and farewell others, do they initiate conversation and play with peers, do they have an apparent absence of interest in people? Do they only play by their own rules, do they have difficulties with losing, are they directive/bossy or submissive during play, do they play interactively, parallel or isolated/solo play, do they play a variety of games/activities?
You might consider; flapping their hands, walking on their toes, rocking, swaying, pacing, finger movements, body stiffening, tics, head banging, unusual gait, making unusual vocal noises.
You might consider; speaking in accents, echoing others or being repetitive with phrases, referring to themselves in the third person, making up language/gibberish, mixing up their pronouns, repetitive questioning, usual phrases, being pedantic or inflexible with their use of language.
You might consider; lining, grouping or ordering objects/toys/food/school items/their possessions. Flicking, spinning, being repetitive with objects (open and shut doors, flicking light switches on and off)
You might consider; daily classroom routine changes, furniture or room changes, room transitions, specialist teacher classes, relief teachers. Do they notice and/or comment on change?
You might consider; seating positions, bag positions, routine when entering the classroom, verbal rituals (saying something in a particular way or at a particular time).
You might consider; topics of special interest e.g., Thomas the Tank Engine, dinosaurs, space, computer games. Have they acquired factual knowledge, monologues regarding specific interests, relate drawings/activities back to this interest?
You might consider; collections, small objects, particular items from the classroom or brought from home.

Do they demonstrate any sensory based behaviours such as;

e.g., taps everything, fiddles with objects, difficulties playing with glue, sand, paint on hands, food textures
e.g., sniff food, objects or people
e.g., chewing clothes, mouthing objects, licking objects or people
e.g., examining things from different angles/close to eyes, staring at lights, fascinated by mirrors
e.g., not wearing jumpers when it is cold.
(high, average, low)

Thankyou for you time.