How stressed out are you?

Your Stress Response
Area 1 of 7

Stress response reflects the hard-wiring of your body and brain to react to stress to protect you against threats, whether real or imagined. But, if your mind and body are constantly on edge because of excessive stress in your life, you may face serious health problems. This is because your body’s “fight-or-flight reaction” ‐ its natural alarm system ‐ is constantly on.

Examples: ability to reduce stress, to relax and lower tension, to decrease overwhelming feelings, to reduce nervous habits, and to improve poor sleep

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you deal with stress poorly? *

2. Do you have trouble relaxing? *

3. Do you feel overburdened with everyday responsibilities? *

4. How often do you feel tense and anxious? *

5. Do you have trouble falling or staying asleep? *

6. Do you have overwhelming physical or mental exhaustion at night? *

How healthy are your relationships?

Your Social & Emotional Intelligence
Area 2 of 7

Social and emotional intelligence impact your ability to relate to others, manage emotions, resolve conflicts, and understand and respond to social situations.

Examples: self-confidence, compassion, social interactions, interpersonal relationships, mood regulation, conflict resolution

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you have a low self-image? *

2. Are you shy, avoiding interactions with people? *

3. Do you have poor social skills? *

4. Do you have trouble having healthy relationships with others? *

5. Do you struggle with managing your mood and/or emotions? *

6. Are you uncomfortable in new situations and/or trying new things? *

Before you go any further, please share with me your name and email address, so that I can send you more specific information on your Brain Score.

First Name *

Email *

How well do you listen?

Your Auditory Processing

Area 3 of 7

Auditory processing is your ability to understand and make sense of what you hear. Difficulty processing auditory information can have a negative impact on learning, thinking, communication, and relationships.

Examples: listening, following verbal directions, focusing with background noise, having comfort with sound, understanding tone of voice, discriminating sounds

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Is it hard for you to listen to voices and/or other sounds? *

2. Do you have trouble following verbal instructions? *

3. Do you have trouble focusing in a lot of background noise? *

4. Do you find some sounds uncomfortable or even painful? *

5. Do you struggle in understanding meaning in others' tone of voice? *

6. Do you confuse words that sound similar? *

How easily can you express yourself?

Your Communication

Area 4 of 7

Communication is your ability to exchange information, thoughts, and opinions through verbal and written expression, including speech, language, voice, and writing, as well as nonverbal expression such as gesture, facial expressions, and body language.

Examples: verbal comprehension, oral and written communication, voice quality, reading comprehension, being understood by others, understanding body language

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you misunderstand what others are saying? *

2. Do you have trouble expressing your thoughts or ideas? *

3. Do you have poor vocal / speaking quality? *

4. Do you have trouble understanding written information? *

5. Do others struggle to understand your articulation or explanations? *

6. Do you struggle to interpret body language / facial expressions? *

Are you clumsy?

Your Motor Coordination

Area 5 of 7

Motor coordination is the harmonious functioning of body parts that involve movement. This includes gross motor skills (walking, skipping, running, throwing), fine motor movement (handwriting, buttoning a shirt, keyboarding), and motor planning (the ability of the brain to conceive, organize, and carry out purposeful movements).

Examples: balance, body awareness, coordination, fine motor skills, gross motor skills, activity level

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you stumble and have difficulty with your balance? *

2. Do you have a poor sense of personal space / body awareness? *

3. Do you have uncoordinated body movement / poor athletic skills? *

4. Do you have messy handwriting and/or poor fine motor skills? *

5. Do you have a poor sense of rhythm and/or timing of movement? *

6. Do you have an atypical drive for movement and/or touch? *

How organized are you?

Your Executive Functioning

Area 6 of 7

Executive function is an umbrella term for a set of high-level mental processes that control and regulate other abilities and behaviors. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel asks and situations. Executive functions allow us to anticipate outcomes and adapt to changing situations.

Examples: attention, memory, behavior, organization, time management, self control

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you have trouble concentrating / staying focused? *

2. Do you have difficulty retaining new information? *

3. Do you have difficulty adapting to changing environments? *

4. Do you have difficulty with organizing your space and/or your time? *

5. Do you have trouble starting and/or finishing tasks? *

6. Do you have difficulty controlling your impulses? *

How creative are you?

Your Creative Expression

Area 7 of 7

Creative expression is your ability to express yourself using original and open thinking, imagination, problem solving, and movement to create something new and/or respond to opportunities.

Examples: musicality, opening thinking, visual arts, creative writing, innovation, problem solving

Answer each question below with a number, 1-5, based on the following:

Strongly Disagree: This never occurs
Disagree: This rarely occurs
Neutral: This sometimes occurs
Agree: This often occurs
Strongly Agree: This always occurs

1. Do you struggle with keeping a beat, singing, playing instruments? *

2. Are you closed minded / not open to new ideas? *

3. Do you struggle artistically: drawing, sketching, painting? *

4. Do you have difficulty with creative writing? *

5. Do you have difficulty coming up with original ideas? *

6. Do you have difficulty with problem solving? *

Where do you struggle the most?

From the dropdown choices below, rank your areas of concern.

Each area of concern should only be listed once.

First area of concern *

Second area of concern *

Third area of concern *

Fourth area of concern

Fifth area of concern

Sixth area of concern

Seventh area of concern

A few more details:

How did you learn about The Listening Program and/or Regina Sweeney, Certified Provider of The Listening Program? *

This Brain Score is for . . . *

myself

my child (under 18) living with me

my child (under 18), not living with me

a loved one, 18 or older

About your loved one

From 1-5, how comfortable is your loved one with headphone usage (NOT ear buds)? (1 being extremely comfortable, to 5 being extremely UNcomfortable) *

What's your main reason for wanting to know your loved one's Brain Score? *

Medical condition disclosure: does your loved one have any medical conditions? Please specify, including but not limited to any history of seizures, strokes, migraines, or prescription medications. If none, type "None". *

Drumroll, please . . .

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What's your Brain Score?