Dyscalculia Screener Does your child seem intelligent but struggle with reading, writing, spelling, or math? Yes NoPreviousNextWhich subjects does your child struggle with? Math Reading Writing SpellingPreviousNextHow well does your child remember and follow multi-step verbal instructions? Excellent memory and execution Generally remembers with occasional reminders Often needs instructions repeated Consistently struggles with sequence and recallPreviousNextDoes your child have trouble with learning and naming numbers? Yes NoPreviousNextHas difficulty understanding the meaning of numbers? (what they represent) Yes NoPreviousNextStruggles to compare quantities? (greater than/less than) Yes NoPreviousNextHas trouble with number sequencing? (counting forward/backward) Yes NoPreviousNextDifficulty recognizing patterns in numbers? (counting by 2’s, 3’s, etc) Yes NoPreviousNextHas trouble with basic addition facts? Yes NoPreviousNextHas trouble with basic subtraction facts? Yes NoPreviousNextConfuses + and - ? Yes NoPreviousNextHas difficulty remembering multiplication tables? Yes NoPreviousNextCan count but has difficulty counting objects? Yes NoPreviousNextConfuses similar-looking numbers? (6/9, 2/5) Yes NoPreviousNextReverses numbers when writing them? Yes NoPreviousNextStruggles with number placement on a number line? Yes NoPreviousNextHas difficulty with spatial organization of numbers on paper? Yes NoPreviousNextStruggles with aligning numbers in columns? Yes NoPreviousNextHas trouble remembering math procedures? Yes NoPreviousNextDifficulty recalling number facts previously learned? Yes NoPreviousNextUses fingers for math? Yes NoPreviousNextHas trouble with days of the week or months of the year? Yes NoPreviousNextHas difficulty estimating time duration? Yes NoPreviousNextStruggles with time management? Yes NoPreviousNextHas trouble counting money or counting back change? Yes NoPreviousNextHas difficulty telling time on an analog clock? Yes NoPreviousNextDifficulty understanding word problems? Yes NoPreviousNextStruggles to identify relevant information in word problems? Yes NoPreviousNext Has trouble breaking down complex problems? Yes NoPreviousNextHas difficulty with estimation skills? Yes NoPreviousNextStruggles with mental math? Yes NoPreviousNextDoes your child have any of these problems? Hearing is fine, but says “Huh” or “what” a lot Easily distracted in environments with background noise Struggles with oral math problems Has a difficult time following conversations None of the abovePreviousNextDoes your child have any of these spatial awareness or directionality problems? Confuses left and right Confuses over under Seems to have trouble learning to tie their shoes Has trouble reading charts or graphs Has trouble reading a map Is prone to motion sickness None of the abovePreviousNextDoes your child have any of these writing legibility problems? Check all that apply. Has illegible handwriting Writing drifts Writing is of inconsistent size Switches back and forth between print and cursive Spaces words and letters in odd ways Has difficulty with pencil grip, unusual pencil grip, or tight pencil grip None of the abovePreviousNextDoes your child have any of these motor problems? Is clumsy or uncoordinated Difficulty skipping Difficulty with balance Difficulty with rhythm None of the abovePreviousNextIs your child mixed dominant? Mixed dominant means they are right-handed but the left eye is dominant. Or vice versa. An easy test to see which is the dominant eye is to hand them a camera or telescope and watch which eye they use. Yes No I don't knowPreviousNextDoes your child have any of these symptoms? Frequent headaches, especially before school or during homework time Stomach aches, nausea, or digestive issues that appear on school days Sleep problems - either difficulty falling asleep or excessive fatigue Muscle tension, particularly in the neck and shoulders Changes in appetite - either decreased or increased eating Physical restlessness, inability to sit still Complaints of feeling hot/cold or sweaty palms before academic tasks Shallow breathing or complaints of chest tightness when facing challenging work Complaints of dizziness while studying None of the aboveDo these symptoms improve during weekends or breaks from school? Yes NoPreviousNextDoes your child ever? Sometimes says things like, “I’m not smart” Sometimes says things like “I’m not good at___” Expresses that they feel dumb Has poor self-esteem None of the abovePreviousNextDoes your child do any of the following? Hides that they are having problems Gets emotional about going to school Gets emotional about reading Avoids reading out loud Gets emotional about math Gets emotional about tests None of the abovePreviousNextGuesses at math answers? Yes NoPreviousNextDoes your child have any of these attentional problems? Daydreams excessively or zones out Difficulty paying attention Seems hyperactive or easily distracted while doing academics Has dramatically more difficulty when under stress None of the abovePreviousNextDoes your child exhibit any of these traits? Has a strong sense of justice Is emotionally sensitive Is a perfectionist Has Mood swings Experiences Depression None of the abovePreviousNextDoes your child avoid sports or other coordination activities? Yes NoPreviousNextIs your child extremely orderly or extremely disorderly? Is extremely orderly Is extremely disorderly Is neitherPreviousNextDoes your child have any of these talents? Is extremely social and can entertain Extremely talented at art Extremely talented at engineering type activities such as legos Extremely talented at sports Extremely talented at dancing Extremely talented at storytelling Extremely talented at drama None of the abovePreviousNextHas your child ever been given any of these labels by someone? Considered by others to be lazy. (Doesn’t try, doesn’t work at full potential) Considered by others to be unintelligent Considered by others to be careless Considered by others to be immature Considered by others to be a behavioral problem Called the class clown Called a troublemaker Considered overly quiet None of the aboveDyscalculia CalculationMath Sense CalculationVisual-Spatial CalculationEmotional CalculationPreviousNextFirst NameLast NameChild's NameChild's Age 5 6 7 8 9 10 11 12 13 14 15 16 17Child's Gender Male FemalePreviousNextYour Email Previous Submit Form
