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Listening Questionnaire for teens and adults

Do people often tell you: “Don’t be so lazy” or “You have so much wasted potential…..”

Maybe you or your child has a hidden difficulty that can be diagnosed and treated using the Tomatis method! Impaired listening may be a central component of your functioning and manifests itself in different ways, such as attention deficit disorder, anxiety, developmental trauma, difficulty seeing another person’s point of view, learning disabilities, or speech and communication disorders. This questionnaire will help you assess whether you or your child has symptoms that may be helped using the Tomatis method.

Tomatis Questionnaire

Please mark the option that best suits your listening functions:

Difficulty focusing for long periods of time
Short Attention Span
Easily distracted (especially by noise)
Misinterpretation of questions/requests
Hypersensitivity to certain sounds
Difficulty distinguishing between different voices
Confusion between similar-sounding words
Needing clarification and repetition.
Follows only one or two instructions in a sequence of instructions
Difficulty understanding conversation
Difficulty with short-term memory
Difficulty with long-term memory
Needing to reread sentences several times to assimilate the content.
A feeling that people are talking too fast
A flat and monotonous voice
Difficulty retrieving words
Reading Difficulties
Many Spelling Errors
Difficulty Summarizing a Story

Please mark the option that best describes your motor skills:

Difficulty Maintaining Posture
Excessive longing for movement or touch
Reduced awareness of personal space and physical boundaries
Clumsy – including a tendency to bump into things or fall
Left-right confusion
Confusion of direction and location
Poor sports skills
Poor sense of rhythm
Sloppy and illegible handwriting
Difficulty with organization

Please mark the option that best describes your social behavior and adaptation:

Low frustration threshold
Difficulty connecting or maintaining friendships
Low self-image or self-confidence
Tendency to avoid social events
Excessive fatigue at the end of a school/work day
Low motivation, little desire to take an active part in studies/work
Stress and worries
Difficulty setting goals and priorities
Difficulty starting and finishing projects
Difficulty with concepts of time and meeting a schedule
Reluctance to accept responsibility
Failure to finish assignments
Tactless
Tendency to immature/childish behavior
Difficulty dealing with stressful situations
Name

If you identify a number of difficulties that cause you concern, contact us.