RegisterOther-Functional

Current Functioning level

* Indicates required field

Describe the speech / conversation level of your child *

Less than typical 3 yr old Level of typical 3-6 yrs old Level of typical 6-9 yrs old Better than typical 9 yr old Normal speech on par with peers

If Other please specify: *

Describe the behavior maturity of your child *

Less than 3 yrs 3 - 6 yrs 6 - 9 yrs 9 - 15 yrs Better than a typical 15 yr old No behavior deficits

Other behaviors , issues *

Attention deficiency and Focus issues Memory disorders Anxiety Stimming behaviors Social deficits Repetitive behaviors Obsessive Compulsive Disorders

Other general traits *

Impulse control deficits Fine motor deficits Emotion control Constant self talk scripted talk Emotional extremes, anger, suicidal etc.

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