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5-15R Teacher Questionnaire EnglishJohnny Kerr2024-09-18T11:41:29+01:00

5-15R Teacher Questionnaire English

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5-15R

Questionnaire for evaluation of development and behaviour
To the teacher: This questionnaire, for children and adolescents age 5 to 17, contains statements concerning the skills and behaviours of your child/student in various domains of development. Children are individuals. This means that their skills and behaviours vary from one child/student to another, and according to age.

The statements in the questionnaire are followed by boxes marked Does not apply – Applies sometimes/to some extent – Applies. Choose the statement that you think best corresponds to your student's functioning in everyday situations, compared to children of their own age. Have in mind the student's present functioning, i.e. within the last 6 months. To get the most correct picture of your student's functioning, it is important that you complete the whole questionnaire.

You will be asked if the student's functioning in various domains leads to problems in daily living. Please consider whether or not these problems affect the student and others at home, in school and among friends. These questions are followed by four options: No – A little – A great deal – Very much.

To the professional applying this questionnaire: The questionnaire aims at elucidating the teacher's views on their student's strengths and weaknesses in several developmental domains. It is not supposed to serve as the sole basis for diagnostic decisions. The use of this questionnaire requires knowledge about normal and atypical child development as well as basic knowledge in psychometrics.

A parent edition of the questionnaire is also available.

Statement of consent to process given information electronically

  • The purpose of the 5-15R questionnaire and evaluation system is to evaluate the child’s functioning in different areas of everyday life
  • The responses will be compared to a large group of responses for children of the same age and gender
  • The evaluation can identify areas where the child’s functioning will be subject of interest of further evaluation or intervention
  • The results from this evaluation are never used alone as basis for conclusions about the child or his/her environment
  • The collected information will be entered and stored in a database without any identification of the child or the informant
  • I declare that I have received consent from a parent or guardian to the collection, storage, and processing of data for the purpose described above
Consent*
Please enter a number greater than or equal to 0.
Child's date of birth*
Your relationship to the child*
Date of submission*

Motor skills - gross motor skills

The student's use of his/her body in various activities
1. Difficulty acquiring new motor skills, such as learning how to ride a bike, skate, swim
2. Difficulty throwing and catching a ball
3. Difficulty running fast
4. Has difficulties or does not like to participate in game sports such as soccer/football, land hockey, basketball
5. Balance problems; for instance, has difficulty standing on one leg
6. Often stumbles and falls
7. Clumsy or awkward movements

Motor skills - fine motor skills

The student's use of his/her hands
8. Does not like to draw, has difficulties drawing figures that represent something
9. Difficulty handling, assembling and manipulating small objects
10. Difficulty pouring water into a glass without spilling
11. Often spills food onto clothes or table when eating
12. Difficulty using knife and fork
13. Difficulty buttoning or tying shoelaces
14. Difficulty using a pen (e.g. presses too hard, hand is shaking)
15. Has not developed clear hand preference, i.e. is neither clearly right-handed nor left-handed
16. Writing is slow and laborious/hard to read the result
17. Immature pencil-grip, holds the pen in an unusual manner
Do problems with motor function interfere with your student’s daily function?

Attention and concentration

The student's ability to pay attention and to concentrate on various tasks and activities
18. Often fails to pay close attention to details or makes careless mistakes
19. Often has difficulty sustaining attention in tasks or play activities
20. Often does not seem to listen when spoken to directly
21. Problems following instructions and fails to finish schoolwork, chores, or duties
22. Often has difficulty organising tasks and activities
23. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as homework)
24. Often loses things necessary for tasks or activities (e.g. toys, school equipment, pencils, books, or tools)
25. Is often easily distracted by extraneous stimuli (e.g. irrelevant sounds like other people talking, cars driving by)
26. Is often forgetful in daily activities at school

Overactivity and impulsivity

The student's tendency to be too active or impulsive
27. In constant motion (fidgets with fingers, plucks at things etc.)
28. Difficulty remaining seated (squirms in seat, gets up and moves about)
29. Often runs about or climbs excessively in situations in which is inappropriate, (more than their peers)
30. Difficulty playing calmly and quietly
31. Is often ”on the go” or often acts as if ”driven by a motor”
32. Often talks excessively
33. Often blurts out answers before the question has been completed
34. Difficulty awaiting turns (in games, during meals etc.)
35. Often interrupts or intrudes on others (e.g. butts into conversations or games)
Do problems with attention, concentration, overactivity or impulsivity interfere with your student's daily function?

Passivity/inactivity

The student's inactivity or tendency to be too passive
36. Difficulty getting started on tasks/activities
37. Difficulty completing a task/activity, does not get things done like the rest of the group
38. Often ”in own world” or daydreaming
39. Seems slow, inert, or lacking energy
Does passivity or inactivity interfere with your student's daily function?

Planning/organising

The student's ability to plan or organise activities
40. Difficulty understanding consequences of own actions (e.g. climbs in dangerous places, careless in traffic)
41. Difficulty planning and preparing for tasks (e.g. collecting equipment needed for an outing or for school)
42. Difficulty completing sequential tasks (e.g. young children: getting dressed in the morning without constant reminders; older children: completing homework without constant reminders)
Do problems with planning/organising interfere with your student's daily function?

Perception of space and directions

The student's perception of space and directions in the physical world
43. Difficulty finding his/her way around (even in well known places)
44. Seems disturbed by height differences (even slight) such as in connection with climbing stairs etc.
45. Difficulty judging distance or size
46. Difficulty comprehending orientation and spatial directions (e.g. young children turning clothes back to front, older children confusing letters such as b, p, d, or digits such as 6, 9)
47. Bumps into other people, especially in narrow places

Concepts of time

The student's ability to understand concepts of time
48. Poor concepts of time, (e.g. does not have an intuitive feeling for how long “five minutes” or “one hour” take or is uncertain about how long ago something happened)
49. Has only a vague idea about what time it is, whether it is morning or afternoon, whether it is time or not to go to school
50. Repeatedly asks about when something is going to happen, (e.g. how much time is left before an outing or before it is time to go to/leave school)
51. Can read the clock mechanically but does not understand the actual time concept

Perception of own body

The student's perception of his/her own body and sensory impressions
52. Does not have a sense of how clothes fit, does not straighten socks or trousers that have slid down
53. Surprisingly poor perception of cold, pain etc.
54. Poor body awareness, uncertain of size of own body in relation to the environment, (e.g. bumps into or tumbles over things without intention to do so)
55. Oversensitive to touch (is irritated by tight clothing, perceives soft touch as rough etc.)
56. Difficulty imitating other people’s movements

Perception of visual forms and figures

The student's ability to perceive forms and figures
57. Tends to misinterpret pictures; (e.g. may perceive a picture of a fried egg as that of a flower)
58. Difficulty noticing small differences in shapes, figures, words and patterns that look alike
59. Difficulty drawing pictures such as that of a car, a house etc. (compared with their peers)
60. Difficulty with jigsaw puzzles
Do problems with perception of space and directions, time, own body, or forms and figures interfere with your student’s daily function?

Memory

The student's ability to remember facts or what he/she has experienced
61. Difficulty remembering information about personal data, such as date of birth, home address etc.
62. Difficulty remembering the names of other people (e.g. name of teacher, school peers)
63. Difficulty remembering the names of weekdays, months and seasons
64. Difficulty remembering non-personal facts learned at school (e.g. historic events, chemical formulas etc.)
65. Difficulty remembering what has occurred recently, as who has phoned or, what he/she ate a few hours ago etc.
66. Difficulty remembering events that occurred some time ago, such as what happened on a trip, what Christmas presents he/she got etc.
67. Difficulty remembering where he/she put things
68. Difficulty remembering appointments with peers or what homework he/she has got
69. Difficulty learning rhymes, songs, multiplication tables etc. by heart
70. Difficulty remembering long or multiple-step instructions
71. Difficulty acquiring new skills, such as rules of new play or games
Do problems with memory interfere with your student’s daily function?

Comprehension of spoken language

The student's ability to understand language and speech
72. Difficulty understanding explanations and instructions
73. Difficulty following stories read aloud
74. Difficulty perceiving what other people say (often says “what?”, ”what do you mean?”)
75. Difficulty with abstract concepts such as “the day after tomorrow”, ”in the right order”
76. Tends to misinterpret what is said

Expressive language

The student's ability of language expression and to pronounce words
77. Uncertain of speech sounds and tends to misarticulate words
78. Difficulty learning the names of colours, people, letters etc.
79. Difficulty finding words or explaining to other people, says: “the, the, the ...”
80. Tends to remember words incorrectly, says ”armbow” instead of ”elbow” etc.
81. Difficulty explaining what he/she wants
82. Difficulty speaking fluently without any breaks
83. Difficulty expressing himself/herself in whole sentences, in grammatically correct sentences, or inflecting words
84. Pronounces specific sounds incorrectly (has a lisp, difficulty pronouncing the sound of ”r”, nasal voice etc.)
85. Difficulty pronouncing complex words such as ”electric”, ”screwdriver” etc.
86. Has a hoarse voice
87. Stutters
88. Speaks so rapidly that it is difficult to comprehend what he/she is saying
89. Has a muddled speech

Verbal communication

The student’s ability to use language and ability to communicate with others
90. Difficulty telling about experiences or situations so that the listener understands (e.g. what happened during the day or during the summer vacation)
91. Difficulty keeping ”on track” when telling other people something
92. Difficulty taking part in a conversation, (e.g. problems shifting from listening to talking)
Do problems with understanding of language, use of language, or verbal communication interfere with your student's daily function?

Acquisition of academic skills

Is the student 8 years of age or older?*

Reading, writing, arithmetic

93. Acquiring reading skills is more difficult than expected considering his/her ability to learn other things
94. Has difficulties to understand what he/she is reading
95. Difficulty reading aloud at normal speed (e.g. reads too slowly, too quickly, or fails to read fluently)
96. Does not like reading (e.g. avoids reading books)
97. Makes guesses while reading
98. Difficulty spelling
99. Has difficulties shaping letters and to write neatly
100. Difficulty formulating himself/herself in writing
101. Difficulty acquiring basic maths skills (addition, subtraction; i.e. plus, minus)
102. Difficulty with maths problems given in written form
103. Difficulty learning and applying various mathematical rules
104. Difficulty learning and using multiplication tables
105. Difficulty with mental arithmetic

Learning new things and applying knowledge in school

106. Difficulty understanding verbal instructions
107. Difficulty understanding or using abstract terms, (e.g. terms relating to size, volume, spatial directions)
108. Difficulty participating in discussions with other children
109. Difficulty learning facts or acquiring knowledge about the surrounding world
110. Exceptional knowledge or skills in some area
111. Is good at artistic or practical things (e.g. playing an instrument, drawing, painting, construction work)

Problem solving in school and approach to new learning situations

112. Difficulty planning and organising activities, (e.g. the order in which things should be done, how much time is needed to manage a specific task)
113. Difficulty shifting plan or strategy when this is required (e.g. when the initial approach failed)
114. Difficulty comprehending explanations and following instructions given by adults
115. Difficulty solving abstract tasks (i.e. is dependent on learning material that can be seen or touched)
116. Difficulty sticking with/completing tasks, often leaves them half finished
117. Unmotivated for school work or comparable learning situations
118. Learning is slow and laborious
119. Does things too quickly, hastily, or in a hurry
120. Can/will not take responsibility for own actions, needs a lot of supervision
121. Very much in need of support, wants to know whether he/she is performing well
Do academic problems or learning difficulties interfere with your student’s daily function?

Social skills

The student’s capacity to participate in social settings and interact with others
122. Does not understand other people’s social cues, (e.g. facial expressions, gestures, tone of voice, or body language)
123. Difficulty understanding the feelings of other people
124. Difficulty responding to the needs of other people
125. Difficulty verbally explaining emotions when feeling lonely, being bored etc.
126. Speaks with a monotonous or strange voice
127. Difficulty expressing emotions and reactions with facial gestures or body language
128. Seems ”old fashioned” in style or behaviour?
129. Difficulty behaving as expected by peers
130. Difficulty realising how to behave in different social situations, such as when visiting relatives together with parents, when visiting friends, seeing a doctor, going to the cinema, etc.
131. Is perceived by peers as different, odd, or eccentric
132. Unintentionally makes a fool of himself/herself so that parents feel embarrassed or peers start laughing
133. Often seems to lack common sense
134. Has a weak sense of humour
135. Blurts out socially inappropriate comments
136. Difficulty comprehending rules or prohibitions
137. Often quarrels with peers
138. Difficulty understanding and respecting other people’s rights, for example, that younger children need more help than older ones, and that parents should be left alone when they demand it, etc.
139. Difficulty in group or team activities or games, invents new rules for own benefit
140. Difficulty making friends
141. Does not often interact with peers
142. Difficulty to participate in group activities
143. Not accepted by other children to participate in their games
144. Does not care for physical contact such as hugs
145. Has one or a few interests that take up considerable time and that impinge on relations with family and friends
146. Repeats or gets stuck in seemingly meaningless behaviours or activities
147. Gets very upset by tiny changes in daily routines
148. Eye contact in face-to-face situations is abnormal or missing
Do problems with social skills interfere with your student's daily function?

Emotional problems

149. Poor self-confidence
150. Seems to be unhappy, sad, depressed
151. Often complains about feelings of loneliness
152. Has tried to inflict bodily damage to himself/herself or talks about that
153. Has a poor appetite
154. Often expresses a feeling of being worthless or inferior to other children
155. Often complains about bellyaches, headaches, breathing difficulties or other bodily symptoms
156. Appears tense and anxious or complains about being nervous
157. Becomes very anxious or unhappy when leaving home (e.g. when setting off to school)
158. More sleeping problems than most children of similar age
159. Often has nightmares
160. Walks in sleep or has nocturnal attacks when he/she cannot be ”reached” or comforted
161. Often loses temper
162. Often argues with adults
163. Often refuses to follow the instructions of adults
164. Often teases others by deliberately doing things that are perceived as provocative
165. Often blames others for own mistakes or bad actions
166. Is easily offended, or disturbed by others
167. Often gets into fights
168. Is cruel to animals
169. Lies and cheats
170. Steals things at home
171. Often destroys the belongings of other family members or other children
172. Are you aware if the student has recurrent episodes of a few days with extremely high activity level and flight of ideas
173. Are you aware if the student has recurrent periods of obvious irritability

Obsessive actions or thoughts

Actions or thoughts that the student appears unable to control
174. Compulsively repeats some activities or has habits that are very difficult to change
175. Has obsessive/fixed ideas
176. Has involuntary movements, tics, twitches or facial grimaces
177. Repeats meaningless movements, such as head shaking, body jerking and finger drumming
178. Emits unmotivated sounds such as throat clearing, sneezing, swallowing, barking, shouting etc.
179. Difficulty keeping quiet, (e.g. whistles, hums, mumbles)
180. Repeats words or parts of words in a meaningless way
181. Uses dirty words or language in an exaggerated way
Do emotional problems, obsessive actions or thoughts interfere with your student’s daily function?

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