Childhood Neurobehavioral Hemispheric Checklist

Check all symptoms or characteristics that apply; then add the total number of checks below each section.

Name *
Name
MOTOR CHARACTERISTICS OF A RIGHT-BRAIN DELAY *
MOTOR CHARACTERISTICS OF A LEFT-BRAIN DELAY *
SENSORY CHARACTERISTICS OF A RIGHT-BRAIN DELAY *
SENSORY CHARACTERISTICS OF A LEFT-BRAIN DELAY *
EMOTIONAL SYMPTOMS OF A RIGHT-BRAIN DEFICIENCY *
EMOTIONAL SYMPTOMS OF A LEFT-BRAIN DEFICIENCY *
BEHAVIORAL CHARACTERISTICS OF A RIGHT-BRAIN DELAY *
BEHAVIORAL CHARACTERISTICS OF A LEFT-BRAIN DELAY *
ACADEMIC CHARACTERISTICS OF A RIGHT-BRAIN DELAY *
ACADEMIC CHARACTERISTICS OF A LEFT-BRAIN DELAY *
COMMON IMMUNE CHARACTERISTICS OF A RIGHT BRAIN DELAY *
COMMON IMMUNE CHARACTERISTICS OF A LEFT BRAIN DELAY *
COMMON AUTONOMIC CHARACTERISTICS OF A RIGHT BRAIN DELAY *
COMMON AUTONOMIC CHARACTERISTICS OF A LEFT BRAIN DELAY *
Grand total for complete number of checks for Right-Brain Delay.
Grand total for complete number of checks for Left-Brain Delay.
Hemispheric Weakness is on the right, left, or whole? *
If there are check marks within 5 of each hemisphere, then check 'whole'.
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