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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