School Form - Kent -

School Report

School Report (ADHD/Autism Assessment) Kent

Newsletter

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First Name

Last Name

Date of birth

Completed by

Role

School

Year group

Date completed

Please complete as fully as possible, giving examples where you can.

In general what are the young person’s strengths and needs?

Strengths

Needs

What are the young person’s primary difficulties and how long have they been present? Please include relevant information from previous schools

What interventions have been tried by school to support them with their difficulties? Have these attempts been successful?

Academic functioning and ability to complete school work

Estimated intelligence

Results of recent SATS/CAT tests: please specify results and dates

Please comment on the young person’s academic functioning (including how this differs across subjects and how they compare to their peers)

Please comment on the young person’s art and P.E. skills (and compare with the more academic subjects and how they compare to their peers)

Does the young person have any particular aptitudes or difficulties (include any barriers to learning)?

Does the young person receive additional help in class or receive additional support such as speech and language therapy or small group working (please describe)? Are they on school action/school action plus or do they have an education statement?

Is the young person creative? (e.g. do they write creative stories?)

Attention and Activity levels

Blurts answers/ doesn’t wait for question to be asked

Never

Sometimes

Often

Is overbearing and loud while playing with peers

Never

Sometimes

Often

Takes actions without thinking of the consequences

Never

Sometimes

Often

Acts then instantly says they didn’t mean to

Never

Sometimes

Often

Difficulty staying on task in the class or in play

Never

Sometimes

Often

Disturbs others when playing or working

Never

Sometimes

Often

Has ‘careless mistakes’ or inaccuracies in work

Never

Sometimes

Often

Gets out of their seat when not expected

Never

Sometimes

Often

Climbs and jumps when being still is expected

Never

Sometimes

Often

Fidgets and squirms

Never

Sometimes

Often

Is always ‘on the go’

Never

Sometimes

Often

Difficulty listening to teaching part of lesson/ assembly

Never

Sometimes

Often

Avoids or dislikes activities which require mental effort

Never

Sometimes

Often

Doesn’t finish tasks

Never

Sometimes

Often

Finds it difficult to start tasks (even ones they could easily do)

Never

Sometimes

Often

Is forgetful during tasks

Never

Sometimes

Often

Often loses items

Never

Sometimes

Often

Cannot get organised with equipment needed

Never

Sometimes

Often

What are the young person’s organisational skills like? Please describe

What is the young person’s concentration like? Do they need help to settle and stay on task? Please describe

Is the young person distractible? Please describe

How much attention does the young person demand in the classroom?

Is the young person able to finish tasks in class? Do they regularly submit homework?

Do they find it difficult to speak in front of the class (e.g. answer questions or present their work)?

Does the young person make careless mistakes? If yes, please describe

Social Communication/Functioning

Is the young person popular/accepted by peers? Is it easy for them to make and keep friends or do they fall out with their peers?

If they fall out with their peers, can they usually reflect and understand what went wrong including their part in it?

How does the young person differ in 1:1 versus group situations?

Is the young person able to have a two-way, reciprocal conversation? If they experience difficulties with this, please describe

How does the young person make his/her needs known? Please describe

Does the young person interrupt others or blurt out answers? Please describe

Is the young person able to wait their turn in class work/play? Please describe

Does the young person talk excessively? Please describe

What is the young person like with the following?

Initiating contact with peers

Initiating contact with adults

Cooperating with peers

Cooperating with adults

Sharing with peers

Sharing with adults

Following instructions with peers

Following instructions with adults

Managing differences of opinion with peers

Managing differences of opinion with adults

Behaviour

Are there any specific attitude or management difficulties? What are they? Are they directed to particular individuals? Are there particular triggers?

What does the young person do at break time/lunchtime/other unstructured times? How does their behaviour differ in class relative to free time?

Does the young person act without thinking about the consequences? How do they react afterwards (e.g. are they generally sorry or do they not recognise what they did wrong)?

Do they fidget or leave their seat more often than expected? Please describe

How is the young person in assembly – can they sit quietly?

If there is a change to the timetable/teacher/plan how does the young person react?

Does the young person have any special interests that are unusual or excessive (please describe)?

Does the young person have any unusual, rigid or repetitive behaviours (including particular ways of doing things that they resist changing)? If yes, please describe

Is there anything in the environment/other people that seems to make the young person’s behaviour better/worse?

Sensory

Please describe any unusual response the young person has to the following:

Noise

Smell

Touch

Any others

Sensory processing

Response to noise:

Distracted by noises easily

Yes

Distressed by noise/ covers ears

Yes

Enjoys loud music or certain sounds

Yes

Response to touch:

Reacts emotionally or aggressively to touch

Yes

Difficulty standing in line

Yes

Seems to enjoy physical touch such as often being near peers, or pushing, or rough playing often

Yes

Response to movement:

Often fidgets/ bounces/ jumps/ flaps hands and seems to get joy from this

Yes

Often bumps into things, leans against surfaces, slouches and may not realise they are doing it

Yes

Cautious with movements – dislikes swings/ slides

Yes

Difficulty climbing stairs

Yes

Response to taste/smell:

Eats a small range foods that are similar in taste and texture e.g. bland and crunchy

Yes

Avoids certain tastes/ textures/ smells of food

Yes

Prefers foods with bold flavours and textures; has more of an adult pallet

Yes

Response to light:

Enjoys watching things move, can become fixated on lights

Yes

Avoids bright lights OR can become very distressed in bright light

Yes

Other behaviours:

Runs up and down repetitively

Yes

Walks on tiptoes

Yes

Makes or blurts out loud noises or hums

Yes

Interested in the texture of materials and toys

Yes

Body-focussed repetitive rubbing/ picking skin/ pulling hair

Yes

Mental and Emotional Wellbeing

Please tick against any concerns you have about the child's emotional well-being:

Anxiety

Fears or phobias

Obsessive Compulsive Behaviours

Hyperactivity

Hallucinations

School attendance issues

Mood Swings

Eating Disorder

Anger or aggression

Low Mood

Suicidal Ideation

Domestic Violence

Bereavement

Self-Harm

Drug or Alcohol use or addiction

Impulsivity

Short Attention span

Criminal activity/ antisocial behaviours and or Involvement with Youth Offending Team

None of the above

Has the child ever had treatment (including hospitalisation) by, or is currently seeing, a psychiatrist, psychologist, therapist, or counsellor?

Yes

If yes, please give the following details: Nature of the concerns; start and end date of support; where seen and clinician’s name; type of support, for example: counselling, play therapy, cognitive behaviour therapy, group work, family work, parent support and advice.

Previous Assessments

Please indicate if the child has be known had any of the following assessments? Please attach copies of any reports and information on support provided

Paediatric developmental assessment

Educational psychological assessment

Clinical psychological assessment

Speech and language assessment

CAMHS assessment

Occupational Therapy assessment

Children’s Centre

Special Needs Health visitor

Health visitor

Early Years SEN team or Communication and Autism Team (advisory teachers)

SEN Specialist Advice and Support Service

School support including SENCO, TAC (Team Around the Child), parent support, counselling, circle of friends, social support, behaviour support, Pupil Support Base

Social Services including CIN (Child in Need) and CP (Child Protection)

CAMHS Step 2 and Specialist CAMHS

None of the above

How is the young person’s attendance? Have they ever been excluded from school? If yes, please provide information

Are there any concerns about this young person’s self-esteem, confidence or emotional well-being? Please describe

Are there any safeguarding concerns about this young person? If yes, please describe how these have been responded to

Please use this space to describe anything else of note about this young person