Dyspraxia Screener for 5-Year-Old Children

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.


Does the child have difficulty with fine motor skills?

Please select a rating based on the child's ability to perform tasks such as writing, drawing, and using utensils.

Does the child have trouble with gross motor skills?

Please rate the child's proficiency in activities involving coordination and physical movements.

Does the child struggle with balance and coordination?

Describe in detail any issues the child may have with balance and coordination.

Is the child able to follow multi-step instructions?

Assess the child's ability to understand and carry out tasks that involve multiple steps.

Does the child exhibit sensory processing difficulties?

Consider whether the child has sensitivities or aversions to sensory input.

Is the child able to maintain focus and attention?

Evaluate the child's ability to sustain attention on tasks and activities.

Does the child have trouble with planning and organization?

Assess the child's skill in organizing tasks and managing time effectively.

Is the child able to communicate effectively?

Consider the child's ability to express thoughts and ideas clearly.

Does the child exhibit signs of dyspraxia in social interactions?

Observe if the child struggles with social skills and interactions with peers.

Additional Comments

Please provide any further details or observations related to the child's behavior and development.