HISTORIA CLINICA DEL DESARROLLO Y DEL APRENDIZAJE

NOMBRE: _____________________________________________FECHA: ________

EDAD: ________________________ SEXO: ___________CURSO: ______________

Historia Familiar

Padre (edad, ocupacin, antecedentes)

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Madre (edad, ocupacin, antecedentes)

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Hermanos (edad, sexo, caractersticas relevantes, indicar si hubo abortos o nacidos

Muertos)
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Antecedentes familiares neurolgicos o psiquitricos (por interconsulta o tratamiento)

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Padre, madre, hermanos u otros familiares directos han sufrido trastornos emocionales,
conductuales o dificultades en los procesos de aprendizaje escolar.
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Cules?
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Historia prenatal

Hubo dificultades en la concepcin?

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El embarazo transcurri bajo vigilancia mdica?

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DURANTE EL EMBARAZO, LA MADRE TUVO:

Anemia_____ Hipertensin _____Toxemia_____Trastornos renales _____

Trastornos cardacos _____Hemorragias _____ Sarampin_____
Vmitos_____ Accidentes _____ Problemas emocionales _____
Amenaza de aborto _________________________________________
Otras enfermedades, descripcin:
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Medicacin tomada durante el embarazo por indicacin mdica.

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Sin indicacin mdica.

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Ingesta de alcohol, drogas, otros.

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Historia del desarrollo

Cundo el nio pudo darse la vuelta por s mismo?

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Cundo pudo permanecer sentado al ponerse as?

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Cundo se sent sin ayuda?

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Cundo gate?
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Cundo se levant y se sostuvo de pie?

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Cundo empez a andar slo?

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Qu problemas ha tenido para la marcha?

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Cundo comi slo? (con los dedos, cubiertos, vasos)

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Cundo aprendi a vestirse slo, abrochar botones, hacer lazos?
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Cundo aprendi a usar el bao, orinar y defecar, da y noche?

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Qu dificultades encontr en este aprendizaje?

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Cundo empez a hablar? (palabras, frases)

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Su lenguaje era claro y correcto? Cmo evolucion?

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Es diestro o zurdo?
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Otros aportes que se consideren relevantes.

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Historia perinatal
Horas transcurridas desde las primeras contracciones hasta el parto.
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Lugar del parto (domicilio, clnica, hospital)

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El parto fue natural o inducido?

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Estuvo anestesiada la madre durante el parto?

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Es gemelo, naci l primero?

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Naci con el cordn alrededor del cuello?

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Tuvo problemas de respiracin?

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Llor enseguida?
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Tena color normal?
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Fue usado oxgeno?

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Si se practic, cules fueron los resultados del test de Apgar?

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Cunto pes al nacer?

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Tuvo problemas la madre durante o inmediatamente despus del parto, cules?

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Tuvo problemas el nio, cules?

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Cundo el nio dej la maternidad?

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Cundo el nio es llevado al hogar, su actividad era normal?
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Ha tenido problemas en la alimentacin?
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Ha tenido algn trastorno intestinal agudo? (diarrea, colitis, otros)

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Ha padecido: Peste Cristal________ Rubola _________

Parotiditis________Varicela_________ Difteria __________ Alergias________
Craneales_______Otros traumatismos_________ Meningitis_______ Encefalitis
_______ Otras enfermedades ___________________________
Hospitalizaciones____________ Inter. Quirrgicas _____________
Intoxicaciones________________

Ha tenido problemas del sueo? Los tiene ahora?

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Su sensibilidad y percepcin auditiva parece normales?

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Ha tenido problema en los ojos?

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Ha sufrido convulsiones, con o sin fiebre?

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Ha tenido ausencia u otros episodios de posible petit mal, epilepsia?
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Frente a medicamentos ha reaccionado en forma especial, indique:

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Acusa problemas neurolgicos como:

dolor de cabeza_____ vmitos______ equilibrio______visin doble_______
entumecimiento_______ otros______

Otros datos importantes:

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Historia psicosocial

Qu dificultades han tenido antes y tienen ahora en la educacin el nio?

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Qu dificultades ha tenido y tiene el nio en sus relaciones y juegos con otros nios?
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Qu problemas se le notan en su conducta alimenticia?

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Demuestra su temperamento con rabietas, berrinches?

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Qu le gusta ms hacer?
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Qu cosas lo enfurecen?
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Es hbil en actividades que precisan poco control psicomotor?

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Es hbil en actividades que requieren de un alto control psicomotor?
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Tuvo dificultades para aprender a andar en bicicleta?

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Lanza o recoge pelotas, objetos?

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Le cuesta mantener la atencin?

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Parece demasiado impulsivo?

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Le falta autocontrol?
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Es muy agresivo, muerde, patea, golpea, rompe?

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Lo considera demasiado inquieto, difcil de controlar, o hiperactivo?

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Se excita fcilmente al jugar?

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Reacciona de forma desproporcionada frente a los problemas?

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Frente a actividades compartidas, sabe esperar su turno, se pone muy ansioso?

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Aparentemente tolera las frustraciones?

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Aportes significativos
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Historia Educacional

Ha asistido a sala cuna? ______ Present dificultad?

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Ha asistido a Jardn Infantil, tuvo problemas de adaptacin u otros?

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Cmo se integr a la escolaridad bsica?

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Ha cambiado de escuelas, por qu razn?

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Qu cree que usted que opinan los profesores del proceso escolar del nio?
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Tuvo dificultades para incorporar los procesos de lectura y escritura?

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Tuvo dificultades para incorporar las matemticas?

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Cmo cree usted que se relaciona con sus compaeros y profesores de curso?
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Cmo han sido sus relaciones en los aos anteriores ( compaeros, profesores, otros)
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Tuvo la necesidad de realizar interconsulta con un psiclogo, psicopedagogo, u otro
especialista por dificultad en el proceso escolar o social?
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Actualmente est en algn tratamiento con algn especialista?

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Cmo ha sido y es su rendimiento acadmico?

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Considera que el nio va a gusto a la escuela, sino, por qu?

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Aporte relevante en relacin al contexto escolar.
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Actividades recreativas

El nio juega en la casa, qu tipos de entretencin desarrolla?

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Practica algn deporte?

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Preferentemente juega con nios de su edad, ms grandes o ms pequeos?

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Es capaz de entretenerse slo, con juguetes, lecturas, otros?

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Comparte actividades recreativas con los hermanos, primos, padres?

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En relacin a la familia

Composicin.
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Alteraciones en el tiempo (nacimiento/s de hermano/s, separacin, muerte, otras)

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Relaciones interfamiliares actuales.

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Expectativas de los padres ( deseos, anhelos, temores, fantasas, acerca del futuro del
nio, y la familia)
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Psicopedagoga