Questionnaire for relatives and surrounding

Questionnaire for relatives and surrounding (coordinated by IRSA Brussels)

Questionnaire to describe the observations concerning the activities of the child in daily life, to favor the comprehension of the impact of disorders.

To complete the evaluation of the professionals, it is completely necessary to collect the observations of the child’s surrounding in the daily life situations. For this, we need to elaborate a detailed questionnaire, totally implemented in the assessment process, regarding the situation for the daily and school life situations. This collection of information will be an important part of the assessment process, which cannot be efficient without the daily life situations, especially lived by parents, or the direct surrounding of the child (teachers, etc.)

This questionnaire will be submitted to parents and the surrounding (teachers…) to validate this tool by those who will use it (focus group) and to enrich the questionnaire if necessary.

The questionnaire will comprise different parts:

  • Collection of information concerning the case history of the child (age, school, medical pathway, etc.)
  • Collection of observations about the child in the family (life habits, behaviour, personal characteristics, etc.)
  • Collection of observation about the child in his/her environment, at school and out of school (school skills, behaviour to work, behaviour in the groups of peers, etc.)
  • Previous inventory of tools existing in each country and adaptation to the target group


CVI_Questionaire – for 3-5 Years old

CVI_Questionaire – 6-12 Years old