| Condition |
T |
B |
F |
VP |
| Read very slowly |
X |
X |
X |
|
| Poor reading comprehension, difficulty remembering what you’ve read |
X |
X |
X |
X |
| Squint, close or cover one eye while reading |
|
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
X |
|
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Poor spelling skills |
|
|
|
X |
| Letters or lines “run together” or words appear to “jump” when reading |
X |
X |
|
|
| Make errors when copying |
X |
X |
X |
X |
| Poor word recall & recognition |
|
|
|
X |
| Uses fingers to count for math |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
X |
| Below grade level on standardized tests |
X |
X |
X |
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Avoid near tasks such as reading |
X |
X |
X |
|
| Confuse right and left directions |
|
|
|
X |
| Excessive eye rubbing |
X |
X |
X |
|
| Totals |
28 |
34 |
25 |
31 |
| Maximum Possible |
69 |
84 |
54 |
55 |
