Child Questionnaire
X and Y Screening Questionnaire (XYSQ)
If you have answered YES to three or more questions, please consider speaking to your primary care provider about having a chromosomal analysis to determine if your child has an X or Y Chromosomal Variation.
1. My baby was quiet and demanded little attention Yes | No
2. By 9 months, my baby was not saying “ma-ma”, “da-da” or “ba-ba” in a turn taking game with me Yes | No
3. My child was on the late side for walking (after 16 months) Yes | No
4. My child struggled with “latching on” to the breast Yes | No
5. My child cried for several weeks when beginning Day Care, Preschool or Kindergarten Yes | No
6. My child is shy with other children but talks very well with me and familiar adults Yes | No
7. My child seems clumsy in comparison to his age group Yes | No
8. My child has flat feet Yes | No
9. My child has a shortened attention span for his/her age Yes | No
10. My child “worries” about events, people or what might happen Yes | No
11. My child seems very good at puzzles or computers Yes | No
12. My child has angry outbursts over minor events Yes | No
13. My child seems “a step behind” when compared to his peers in speech and language skills Yes | No
14. My child struggles with reading Yes | No
15. My child shows fear or increased discomfort with loud noises, vacuum cleaners or in crowded places Yes | No
16. My child seems to have soft muscles sometimes called low muscle tonus Yes | No
17. My child is taller than his/her peers Yes | No
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The Forgotten Children
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What You Can Do Now
If you have had a prenatal diagnosis or feel you may have a child with developmental delays or developmental dysfunction the following options are designed to help you towards the next step in treatment or early diagnosis.
