Questionnaire:

Shows aggressivity

Destructive behavior

Hyperaktivity

Too quiet/in his world

Bites and scratches himself/others

Bites himself or others

Does not accept to clean teeth

Does not accept to wash hairs

Eats what he can get

Puts everything he can get in the mouth?

Bad eater

Smells everywhere

Bad coordination

Unsure on stairs

Looks directly in the light

hyper- or hyposensitive to light

Nervous in supermarkets, swimmingpools, etc.

Looks for noisy environement

Suffers from a hypersensitive hearing

Uncontrolled behavior

Motricity difficulties

Difficulties in finger-motricity

Your personal observations

Please not the medicaments you take:

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