| Condition |
T |
B |
F |
VP |
| Substitute words while reading or copying |
X |
X |
X |
|
| Read very slowly |
X |
X |
X |
|
| Headaches after intense visual activities such as reading or computer work |
X |
X |
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 |
| Difficulty tracking moving objects |
X |
X |
|
|
| Clumsiness or poor coordination |
X |
X |
X |
X |
| Difficulty with eye‐hand coordination sports such as baseball |
X |
X |
|
X |
| Unable to make a picture in your mind while reading |
|
|
|
X |
| Below grade level on standardized tests |
X |
X |
X |
X |
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Totals |
29 |
29 |
23 |
20 |
| Maximum Possible |
69 |
84 |
54 |
55 |
