THE BEFORE SCHOOL FUNCTIONING QUESTIONAIRE
Early Morning Routine, Before School: From 6am to 9am
Doctor Requesting Form
Did your child have difficulty with:
None
Mild
Moderate
Severe
1. Listening (to parents, other caregivers, siblings)
2. Following Directions (coming to breakfast, getting dressed, picking up necessary things)
3. Overall Organization (morning routines, getting things together, time awareness)
4. Dressing (putting on shirts, blouse, pants, shoes, coats)
5. Attention (focusing on morning routines or activities)
6. Being Quiet (loud, cannot occupy self unless with TV/electronics)
7. Distraction (easily off task, distracted by objects, noise, others)
8. Procrastination (waiting until the last moment to complete morning tasks)
9. Forgetfulness (memory for specific items: gym clothes, instrument, equipment)
10. Misplacing/losing items (book bag, lunch box, school assignments/projects)
11. Hyperactivity (excessive motor activity, running around in the morning)
12. Talkativeness (talking excessively)
13. Interrupt/Blurt Out (interrupting/intruding, blurting out before question is completed)
14. Silliness (goofiness, silliness, joking around)
15. Awaiting Turn (at breakfast, in line for bus or ride, bathroom time)
16. Breakfast (not sitting down to eat, distracted while eating)
17. Hygiene (washing, combing hair, brushing teeth)
18. Independence (ability to perform tasks by him/herself)
19. Time Awareness (not using time correctly, taking too long)
20. Getting to School (missing the bus, disruptive car/bus ride, walking to school, tardy)
1. Time to wake up and get out of bed:
Time to complete routines (from out of bed to exit home):
Your Name:
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