Comprehensive Questionnaire (to gather detailed information) for a child with ADHD or autism


Conducting a detailed case history is essential in homeopathy to understand the child's individual symptoms, behaviors, and overall health. Here's a comprehensive questionnaire to gather detailed information for a child with ADHD or autism:

General Information

  1. Name:
  2. Age:
  3. Gender:
  4. Parent/Guardian Contact Information:
  5. Date of Birth:
  6. Height and Weight:

Medical History

  1. Birth History:

    • Full-term or premature?
    • Any complications during birth?
    • Birth weight and length.

  2. Developmental Milestones:

    • At what age did the child start crawling, walking, and talking?
    • Any delays in motor or speech development?

  3. Medical Conditions:

    • Any diagnosed medical conditions (e.g., allergies, asthma, epilepsy)?
    • History of infections, surgeries, or hospitalizations?

  4. Medications:

    • Current medications or supplements?
    • Any previous treatments for ADHD or autism?

  5. Family Medical History:

    • Any family history of ADHD, autism, or other neurological/psychiatric conditions?
    • Other significant medical conditions in the family?

Behavioral and Emotional Profile

  1. Attention and Focus:

    • How does the child perform in school or during tasks that require focus?
    • Any specific difficulties with attention or concentration?

  2. Activity Levels:

    • Describe the child's level of physical activity.
    • Any hyperactivity or inability to stay still?

  3. Impulsivity:

    • Does the child act without thinking or interrupt others frequently?
    • Any instances of risky or impulsive behavior?

  4. Social Interactions:

    • How does the child interact with peers, teachers, and family members?
    • Any difficulties with making or keeping friends?

  5. Communication:

    • Describe the child's verbal and non-verbal communication skills.
    • Any echolalia (repetitive speech) or difficulty in understanding social cues?

  6. Emotional Regulation:

    • How does the child handle emotions like frustration, anger, or sadness?
    • Any frequent mood swings or emotional outbursts?

Sensory and Physical Profile

  1. Sensory Sensitivities:

    • Any sensitivities to sounds, lights, textures, or smells?
    • Describe any sensory-seeking or sensory-avoiding behaviors.

  2. Motor Skills:

    • Any difficulties with fine or gross motor skills?
    • Examples of clumsiness or uncoordinated movements.

  3. Repetitive Behaviors:

    • Any repetitive movements such as hand-flapping, rocking, or spinning?
    • Describe any routines or rituals the child follows.

  4. Sleep Patterns:

    • Describe the child's sleep habits and any difficulties with sleep.
    • Any problems with falling or staying asleep?

Lifestyle and Environment

  1. Diet and Nutrition:

    • Typical daily diet and any food preferences or aversions.
    • Any dietary restrictions or allergies?

  2. Daily Routine:

    • Describe a typical day in the child's life.
    • Any structured activities, hobbies, or therapies?

  3. School Performance:

    • How is the child performing academically?
    • Any specific subjects or areas of difficulty?

  4. Home Environment:

    • Describe the family structure and home environment.
    • Any significant changes or stressors at home?

Observations

  1. Parent/Guardian Observations:

    • What are the primary concerns and observations about the child's behavior and health?
    • Any specific incidents or patterns that stand out?

  2. Teacher/School Observations:

    • Feedback from teachers or school staff regarding the child's behavior and performance.
    • Any interventions or support provided at school?

Additional Information

  1. Previous Evaluations:

    • Any previous evaluations or diagnoses by healthcare professionals?
    • Results of any psychological or developmental assessments.

  2. Therapies and Interventions:

    • Current or past therapies (e.g., occupational therapy, speech therapy, behavioral therapy)?
    • Any observed benefits or challenges with these interventions?

  3. Goals and Expectations:

    • What are the parents' or guardians' goals for the child's treatment?
    • Any specific outcomes they hope to achieve with homeopathic treatment?

This detailed questionnaire will help gather comprehensive information about the child, enabling a thorough analysis and personalized homeopathic treatment plan. 

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