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S. Et-reeducations, Etablissement scolaire fréquenté par votre enfant actuellement : ______________________________________ Classe actuelle : ____________________ La scolarité de votre enfant vous paraît-elle adaptée à ses besoins ? Non Oui

S. Non,

, Votre enfant bénéficie actuellement (plusieurs réponses possibles

, D'un soutien psychologique D'un soutien scolaire D'une rééducation orthophonique D'une rééducation en kinésithérapie D'une rééducation en ergothérapie D'une rééducation en psychomotricité Autre

, Votre enfant a-t-il bénéficié dans le passé de soutiens ou de rééducations ? Oui Non

S. Oui, DIFFICULTES D'APPRENTISSAGE ET SCOLAIRES Votre enfant présente-t-il des difficultés d'apprentissage ? Oui Non

, Si Oui, depuis quel âge ?

, Quel type de difficultés ? (plusieurs réponses possibles) Lenteur Troubles de l'attention Troubles de la mémoire Troubles du langage Difficultés en français Difficultés en mathématiques Difficultés en graphisme / écriture Problèmes de comportement en classe Merci de préciser

, Ne peut s'arrêter lors d'une activité répétitive 29, Cruel

«. Comportement, ou immature [demande qu'on l'aide pour quelque chose qu'il (elle) peut faire seule(e), est « collant(e)

, Problèmes de fixation de l'attention ou distractibilité 32 Maux de tête 33. Changements d'humeur rapides et marqués 34

, Ne s'entend pas avec ses frères ou soeurs

, Se décourage facilement lorsqu'un effort est nécessaire

, Enfant foncièrement malheureux 40 Problèmes d'alimentation (mauvais appétit, se lève après chaque bouchée) 41. Maux d'estomac 42 Problèmes de sommeil (ne peut s'endormir, se réveille trop tôt, se réveille pendant la nuit), Dérange les autres enfants 39

, Autres plaintes physiques et douleurs 44 Vomissement, nausées 45 Se sent « lésé(e) » à la maison 46

, Se laisse écraser, manipuler par les autres 48. Problèmes d'évacuation intestinale (selles molles, va à la selle irrégulièrement, constipation)