Listening Checklist © The Listening Centre

Was the Developmental History problematic in any way?
--- a stressful pregnancy	Yes No
--- difficult birth	Yes No
--- adoption	Yes No
--- early separation from the mother	Yes No
--- delay in motor development	Yes No
--- recurring ear infections	Yes No
Is there a problem with "Receptive Listening?" (This is the listening that is directed outward. It keeps us attuned to the world around us, to what’s going on at home, at work or in the classroom...)
--- short attention span	Yes No
--- distractibility	Yes No
--- oversensitivity to sounds	Yes No
--- misinterpretation of questions	Yes No
--- confusion of similar sounding words	Yes No
--- frequent need of repetition	Yes No
--- inability to follow sequential instructions	Yes No
Are there difficulties (related to the vestibular system, 'the ear of the body') with Motor Skills?
--- poor posture	Yes No
--- fidgety behaviour	Yes No
--- clumsy, uncoordinated movement	Yes No
--- poor sense of rhythm	Yes No
--- messy handwriting	Yes No
--- hard time with organization, structure	Yes No
Is there a problem with Level of Energy? (The ear acts as a dynamo, providing us with the energy we need to survive and lead fulfilling lives...)
--- difficulty getting up	Yes No
--- tiredness at the end of the day	Yes No
--- habit of procrastinating	Yes No
--- hyperactivity	Yes No
--- tendency toward depression	Yes No
--- feeling overburdened with everyday tasks	Yes No
Is there a problem with "Expressive Listening"? (This is listening that is directed within. We use it to control our voice when we speak and sing...)
--- flat and monotonous voice	Yes No
--- hesitant speech. weak vocabulary	Yes No
--- poor sentence structure	Yes No
--- overuse of stereotyped expressions	Yes No
--- inability to sing in tune	Yes No
--- confusion or reversal of letters	Yes No
--- poor reading comprehension	Yes No
--- poor reading aloud	Yes No
--- poor spelling	Yes No
Are there difficulties with Behavioural and Social Adjustment?
--- low tolerance or frustration	Yes No
--- poor self-confidence	Yes No
--- poor self-image	Yes No
--- shyness	Yes No
--- difficulty making friends	Yes No
Total number of 'yes' answers:
Please give any additional information that you think may be relevant:
Today's date:
Date of birth:
Would you like us to email you back to discuss your answers?	Yes No
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