Please provide us with information about your child
Childs Interests and Strengths
What/who are your child's favorite toys and characters? (ie. cars, puzzles, Thomas the Tank Engine, SpongeBob.)
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What are some of your child’s favorite activities? (e.g., running, climbing, swinging, water play, lining up objects, watching videos, etc.)
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Every child has strengths. What abilities do you notice in your child? (Examples include: excellent climber, exceptional physical strength, good memory, ability to recite dialogue, sense of humor, etc.)
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Safety Issues
Does your child show an interest in objects that could be harmful? (e.g., fire /matches, glass objects that could break, power tools, etc.) If so, what objects?
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Does your child show interest in activities that could be harmful? (e.g., climbing tall trees or other structures, running away, etc.) If so, what activities?
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Child's Communication of Likes and Dislikes
How do you know when your child likes or wants something?
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How does s/he let you know about his/her likes?
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How do you know when your child dislikes or does not want something?
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How does s/he let you know about his/her dislikes?
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Earlier, we asked about activities and objects that your child likes. Are there activities, objects, or sensations that your child especially dislikes? (e.g., fearful of swinging, hates wearing shoes, will not walk through the grass in his bare feet, alarmed or bothered when someone touches hair, bothered by tags in clothing, afraid of nail cutting, avoids bath time, won’t hold hands, etc.)
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Does your child have any extreme fears, phobias, or other very strong negative reactions to situations that might be encountered in therapy? (e.g., fear of certain noises, separation anxiety, major upset over minor physical injuries like bumps and scrapes, etc.?)
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Are there any situations (such as transitions, situations that involve the child’s phobias, etc.) that you generally avoid because of the child’s upset? What are those situations?
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What comfort techniques have you found to be effective at calming your child when s/he gets very upset or distressed?
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Other Issues
If your child needs to use the bathroom, how does s/he tell you? If your child is being toilet trained, which cues should we watch for?
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Does your child use idiosyncratic words and language forms? For example, one child might refer to all furry animals as “dogs,” and another use a name like “Nana” to label all women. Are there any unique words or language forms that therapists should know about in order to better understand your child?
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Does your child fear certain foods, or have anxiety around certain foods?
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Are there other things about your child that we should know or keep in mind?
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