Developmental History Form

A Developmental History is a comprehensive account of an individual’s growth and development from infancy to the present. It is used in clinical, educational, and psychological assessments to understand how a person’s early life experiences, milestones, and challenges may contribute to their current functioning.This history provides essential background information for diagnosing and supporting conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Condition (ASC), Dyslexia, and other mental health or neurodevelopmental conditions.

General Information (the person undergoing assessment)

Client First Name

Client Last Name

Client Phone *

Client Email *

Date of birth *

Client Gender

General Information (the person completing this form)

Full Name (person completing this form)

Email (person completing this form)

Number (person completing this form)

Family and Prenatal History

1. Is there any family history of neurodevelopmental or mental health conditions? 2. Were there any complications during pregnancy (infections, substance use, medication, illness)? 3. Please also provide birth details (gestation period, type of delivery, birth weight, complications)

Early Developmental Milestones

1)Gross motor skills (e.g., crawling, walking) 2)Fine motor skills (e.g., grasping, using utensils) 3)Speech and language development (first words, sentences, delays noted) 4)Sensory sensitivities (e.g., sound, texture, light) 5)Sleep patterns (difficulties falling/staying asleep, night terrors) 6)Feeding/eating concerns (e.g., preferences, restrictions, ARFID-like tendencies)

Social and Emotional Development

1) Attachment patterns (e.g., separation anxiety, preference for certain caregivers) 2) Social interactions (e.g., making friends, playing with others) 3) Emotional regulation (e.g., tantrums, meltdowns, emotional sensitivity) 4) Eye contact and nonverbal communication5) Interests and play preferences (e.g., repetitive play, imaginative play)

Educational History and Learning Profile - Nursery

1) School history (transitions, exclusions, support provided 2) Academic strengths and challenges (e.g., reading, writing, numeracy) 3)Attention and concentration (e.g., easily distracted, hyperfocus) 4)Processing speed and working memory Need for additional support (e.g., EHCP, IEP, 1:1 support)

Educational History and Learning Profile - Primary School

Educational History and Learning Profile - Secondary School

Educational History and Learning Profile - College/University (if under 18, please complete teacher/SEN details)

Name of Teacher (if person being assessed is under 18)

Please include first and last name if possible

SEN Email (if person being assessed is under 18 and is applicable)

Work History (if applicable)

1. Previous/Current Jobs, 2. Strengths and Challanges in the Workplace (time managment, organisation, team/individual tasks) 3. Attention and Concentration (distraction/hyperfocus/attention to detail) 4. Processing Speed and Working Memory (any need for additional support in the workplace?)

ADHD Specific History

1)Hyperactivity/impulsivity (e.g., fidgeting, interrupting, difficulty waiting) 2)Inattention (e.g., forgetfulness, disorganization, daydreaming)Executive functioning challenges (e.g., planning, task completion)Emotional dysregulation (e.g., mood swings, frustration tolerance)

ASC specific History

1) Sensory processing difficulties (e.g., auditory, tactile, vestibular) 2)Routines and rigidity (e.g., distress with changes, repetitive behaviors) 3)Special interests and restricted patterns of behavior 4)Social communication differences (e.g., literal thinking, difficulties with conversation)

Dyslexia and Specific Learning Differences (SpLD's)

1) Early signs of reading, writing, and spelling difficulties 2)Phonological awareness (e.g., sound-letter association, rhyming) 3)Memory and sequencing challenges (e.g., days of the week, instructions) 4)Speed of processing and verbal vs. nonverbal abilities 5)Use of assistive technology or accommodations

Other Mental Health and Neurodevelopmental Conditions

1) Anxiety and mood disorders (e.g., generalized anxiety, depression, OCD) 2) Behavioral concerns (e.g., aggression, defiance, school refusal) 3) Self-harm or suicidal thoughts/behaviors (if applicable) 4) History of trauma or adverse childhood experiences (ACEs) 5) Sensory and motor tics (e.g., Tourette’s Syndrome

Medical History and Other Considerations

1) Chronic health conditions (e.g., epilepsy, genetic syndromes) 2) Sleep disturbances and impact on daily functioning 3) Medication history and response to treatments 4) Occupational therapy, speech therapy, or physiotherapy interventions

Other

Reason for the Assessment Referral

Please describe the concerns or challenges that have led you to seek this assessment. What changes or difficulties have occurred in the last six months that prompted this referral? Include any observations related to behavior, learning, emotions, social interactions, or daily functioning.

Current Views and Understanding

This section allows the individual (or their caregiver, if applicable) to express their own perspective on their challenges, strengths, and experiences. Please describe how the individual currently understands their difficulties and how these issues affect their daily life, learning, work, relationships, and well-being.

Strengths

This section highlights the individual's positive qualities, abilities, and areas of success that can be used to support their development and well-being. Identifying strengths is essential for creating a balanced and strengths-based approach to assessment and intervention.

Extra Information

This section allows you to provide any additional information that may be relevant to the assessment but has not been covered in the previous sections. Consider including details that could support a clearer understanding of the individual's needs, strengths, and experiences.

Declaration

I confirm that the information provided in this form is true and accurate to the best of my knowledge. I understand that this information may be used for assessment, diagnosis, and support planning. If any details change or require updates, I will notify the relevant professional accordingly.

Please write confirm if all knowledge you have provided is true

Date of Declaration Confirmation

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