Wellington Medical Centre

Mantle Street, Wellington, Somerset, TA21 8BD

Asthma Control test ACT for children 4 to 11 years

Asthma Control test ACT for children 4 to 11 years

Step 1 Let your child respond to the first four questions (1 to 4). If your child needs help reading or understanding the question, you may help, but let
your child select the response. Complete the remaining three questions (5 to 7) on your own and without letting your child’s response influence
your answers. There are no right or wrong answers.
Step 2 Select the number of each answer in the score box provided.
Step 3 Add up each score box for the total.
Step 4 Take the test to the doctor to talk about your child’s total score
If your child’s score is 19 or less, it may be a sign that your
child’s asthma is not controlled as well as it could be. No
matter what the score, bring this test to your doctor to talk
about your child’s results

Please complete the following questions on your own.