Fatigue Survey
Parent – Cognitive
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P1C) During an average school day, how often does your child seem mentally exhausted?
0
% of the time.
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P2C) How do you know when your child is mentally exhausted? Choose all that apply.
Loses focus or gets distracted
Has trouble following instructions
Asks for things to be repeated
Zones out, gives up, or lets someone else do things for them
Has difficulty making decisions
Makes more mistakes
Other:
If you selected other, type your response here.
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P3C) What situations make your child feel mentally exhausted? Choose all that apply.
Listening or watching for a long time
Classes where they need to learn new words/concepts or do a lot of reading
Not being able to take a break when they need it
Being in a noisy or visually busy environment
Other
I don’t know
If you selected other, type your response here.
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P4C) What does your child do when they are mentally exhausted? Choose all that apply.
Movement breaks (Example: stretch, walk around, leave the room, go to washroom)
Brain breaks (Example: breathing exercises, meditation, listen to music, pull out their phone)
Asks for what they need (Example: ask for breaks, let someone know if they need help)
Tries to reduce background noise (Example: turn down volume or take off hearing aids or cochlear implants)
Stops paying attention (Example: go for a nap, close their eyes)
Other
If you selected other, type your response here.
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P5C) When does your child seem mentally exhausted? Choose all that apply.
At the beginning of the school day
During classes throughout the school day
During breaks throughout the school day
At the end of the school day
During after-school activities (Example: sports)
In the evening before bed
Other
They don’t ever seem to feel mentally exhausted
If you selected other, type your response here.
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P6C) At the end of the school day, how often does your child seem too mentally exhausted to do after-school activities (playing sports, participating in clubs)?
0
% of the time
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P7C) Do you think that your child has to use more mental effort than their peers to watch, listen, and understand in the classroom?
Yes
No
I don’t know
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P8C) Do you think that teachers think your child has to use more mental effort than their peers to watch, listen, and understand in the classroom?
Yes
No
I don’t know
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P10C) Does your child need breaks from listening and watching during the day?
Yes
No
I don’t know
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P11C) How often does your child take breaks from listening and watching during the day?
All the time
Often
Not Often
Never
I don’t know
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P12C) Which of the following strategies have you suggested to your child's individual support team to help with mental exhaustion? Choose all that apply.
Schedule breaks during the day
Provide designated quiet area
Allow optimal seating location (Example: close to the front of the class, close to speaker)
Allow resources for stress and anxiety (Example: fidget toys)
Reduce background noise
Use visuals (Example: visual schedule, closed captions on videos, images to support text)
Audio/video record lessons
Provide note takers or provide class notes in advance
Use assistive technology properly
Look for signs or symptoms of fatigue
Reduce speaker overlap
Other
I haven’t had the opportunity to suggest any strategies
If you selected other, type your response here.
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P13C) What kind of background noise in your home makes it difficult for your child to listen, watch and understand? Choose all that apply.
Heating or air conditioning system
Outdoor/hallway sounds
People moving around
TV or music playing
Chairs moving
People talking
Equipment or appliances (Examples; kettle, TV, microwave)
Other
I don’t know
If you selected other, type your response here.
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P14C) What kind of communication problems make it difficult for your child to listen, watch and understand? Choose all that apply.
Talking over each other (Example: group discussions, family gatherings)
Speaking fast, quietly, or mumbling
People with an accent that is difficult to understand
People covering their mouths or turning away while speaking
Other
I don’t know
If you selected other, type your response here.
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P15C) What kind of lighting problems make it difficult for your child to listen, watch and understand? Choose all that apply.
Glare from window or computer screen
Computer screen brightness
Room is too dark or bright
Flickering light
Reflection on surfaces
Other
I don’t know
If you selected other, type your response here.
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