PRE-CARE QUESTIONNAIRE

A Checklist for Adults

This checklist is designed to help an adult access whether she might be having problems with her auditory system. A Parent's Checklist is also available.

Check off any item that applies to you. If you check off many items, read about Auditory Integration Therapy and consider scheduling an Auditory Assessment.

I...

• have a history of hearing loss.
• have difficulty following verbal directions and/or often request that verbal instructions be repeated.
• rely on lip-reading, gesture, context -- or just plain guessing -- to understand what is being said. say "Huh?" and "What?" at least five or more times per day.
• experience problems with sound discrimination.
• give unusual descriptions of auditory stimulation or sensation.
• need frequent "quiet time" to regain mental energy and composure.
• am often negative or depressed without identifiable cause.
• experience growing fatigue as the day progresses.
• have difficulty taking notes during speech or lecture.
• notice that sounds upset or agitate me but not others.
• frequently notice sounds that others do not hear.
• am considered to be dyslexic.
• have problems relating an entire story.
• have problems with directions, such as left and right.
• need constant activity or visual stimuli.
• suffer from tinnitis (ringing or other sound in the ear).
• experience overriding stress over things inconsequential to others.
• have feelings of fragmentation and loss of orientation throughout the day.
• engage in excessive internal arguing: "What to do about . . .," "Why am I the way I am?", "Why did I do that?", etc.
• have a history of ear infection(s).
• have difficulty following conversations.
• frequently misunderstand what is said.
• am easily distracted by background noise
• have "startle" responses to sudden sound or movement.
• engage in constant humming or audible self-talk.
• can be irritable or picky "by nature".
• have difficulty organizing the day.
• have difficulty keeping track of a sequence of actions.
• experience painful discomfort with sounds that others find untroublesome.
• frequently notice sounds before others do.
• can learn a foreign language through reading and writing, but have difficulty learning a foreign language by listening to conversation.
• am unable to sing on key.
• have problems with balance, equilibrium or coordination.
• have a strong preference for sitting in a corner or next to a wall.
• try theories, groups, seminars and workshops one after another in an effort to find physical and mental health.
• have problems with sleep.
• have frequent compulsive thoughts and feelings.
• avoid social contact or interaction.