Auditory Processing Disorder Questionnaire - Adult form

  • ONLINE ARCHES APD Screening Questionnaire

    Adapted from Buffalo Model Questionnaire-Revised Simplified Adult Form
  • Today's date:
     / /

  • Please indicate if you are currently receiving or have received any of the services and number of years:

  • Auditory training?
  • Speech Therapy?
  • Special help with reading?

  • NEXT SECTION: Please mark 'YES' if the statement applies to you or "NO" if it not a problem.

  • DECODING

  • DEC: 1. I have a problem saying speech sounds
  • DEC: 2. I have a problem understanding language
  • DEC: 3. I have a problem understanding spoken instructions
  • DEC: 4. I have a problem reading aloud
  • DEC: 5. I have a problem with phonics (speech sounds)
  • DEC: 6. I have a problem with spelling
  • DEC: 7. I respond slowly/delayed to spoken language
  • DEC: 8. I may have a problem learning a foreign language
  • DEC: 9. I speak slowly

  • NOISE

  • NOI: 1. I am hypersensitive to noise
  • NOI: 2. I am distracted by noise
  • NOI: 3. I struggle to understand speech in noise
  • NOI: 4. I am noisy/makes more noises in comparison to their peers

  • MEMORY

  • MEM: 1.I respond too quickly, at times
  • MEM: 2. I interrupt frequently others talking
  • MEM: 3. I have a problem with reading comprehension
  • MEM: 4. I speak quickly
  • MEM: 5. I forget things they have been told
  • MEM: 6. I have a problem remembering spoken instructions

  • VARIANCE

  • VAR: 1. I have a problem paying attention
  • VAR: 2. I have a problem using language
  • VAR: 3. I may have ADHD/ADD
  • VAR: 4. I have anxiety (e.g., new situations)

  • INTEGRATION

  • INT: 1. I have extremely poor handwriting
  • INT: 2. I have a problem integrating auditory and visual info
  • INT: 3. I have significant reading/spelling difficulties
  • INT: 4. I may have significant visual perception difficulties
  • INT: 5. I sometimes has very long response delays
  • INT: 6. I have Dyslexia

  • ORGANISATION

  • ORG: 1. I have a problem keeping things in organised
  • ORG: 2. I have a problem sequencing verbal items/information
  • ORG: 3. I am messy/tends to lose things

  • APD/OTHER HISTORY

  • APD: 1. I have a history of ear infections / ear fluid as a child
  • APD: 2. I have a problem understanding what is said
  • APD: 3. I have a learning disability
  • APD: 4. I have a problem following spoken instructions
  • APD: 5. I have an intellectual disability
  • APD: 6. I have had a head injury
  • APD: 7. I have Autism or a related problem

  • GENERAL CHARACTERISTICS

  • GEN: 1. I am hypersensitive to touch
  • GEN: 2. I have a problem maintaining eye contact with a speaker
  • GEN: 3. I have a problem with long-term memory
  • GEN: 4. may have a psychological problem
  • GEN: 5. I may have a behaviour problem
  • GEN: 6. I may have a problem coordinating body movements
  • GEN: 7. I may have allergies
  • GEN: 8. I have a problem learning math concepts
  • GEN: 9. I have a hearing problem
  • Would you like to be contacted about these results?

  • Thank you for your interest in APD services at Arches Audiology. 

    For more information, please visit www.archesaudiology.com.au.

    We welcome all enquiries: contact@archesaudiology.com.au or 0423 374 684.

     

  • Image field 104
  • Should be Empty: