AADCd Symptom Questionnaire

This questionnaire is designed to help you and your doctor identify whether your child should be tested for AADCd. This is not exhaustive or conclusive.

Click here to download a PDF version that you can print off and take with you to your next appointment.

Questionnaire:

1) Does your child have poor muscle tone (hypotonia) - is he / she floppy?

Yes          No

2) Is your child's development delayed?

You can use this table to help identify delays in your child’s development.

Developmental Milestone:        Has Your Child Reached This Milestone?       If yes, when?

Hold up/control head                Yes                    No                                                ---------------------------------------------------

Roll over                                        Yes                    No                                                ---------------------------------------------------

Babble                                           Yes                    No                                                ---------------------------------------------------

Speak                                             Yes                    No                                               ---------------------------------------------------

Sit up with some support           Yes                    No                                               ---------------------------------------------------

Crawl                                              Yes                    No                                               ---------------------------------------------------

Stand up without help                 Yes                    No                                              ----------------------------------------------------

Walk                                                Yes                    No                                              ----------------------------------------------------

3) Does your child make any involuntary movements, such as sudden jerking, flailing, or twisting?

Yes          No 

If yes, does your child repeat these movements? Explain:

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4) Does your child have involuntary eye movements, such as sudden episodes of irregular  upward eye movement, sometimes accompanied by increased blinking?

Yes          No 

Describe other symptoms not related to diagnosed seizures that occur at these times.

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5) Does your child seem “frozen” or does he or she “zone out” or “space out” while this  happens? Does your child respond if you touch or call to them during those times?

Yes          No

If yes, please explain:

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6) Does your child sweat even when it is not warm?

Yes          No 

7) Is your child very sensitive to warmth or cold?

Yes          No 

8) Does your child often drool excessively?

Yes          No  

9) Does your child sleep more or less than normal, or seem to often be awake at night?

Yes          No 

If yes, explain:

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   10) Do your child’s symptoms get worse when he or she is tired, and better immediately after sleeping or resting?

Yes          No 

If yes, explain:

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11) Is your child often inconsolable, or unable to be comforted?

Yes          No 

If yes, explain:

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12) Does your child have frequent diarrhea, or is he or she often constipated?

Yes          No 

If yes, explain:

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List any additional symptoms you’d like to discuss with your child’s doctor.

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e: enquiries@aadcresearch.org

Tel: 01883 674467

 

The AADC Research Trust

Soper Hall, 2 Harestone Valley Road,

Caterham, Surrey, CR3 6HY

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© AADC Research Trust