Dyslexia Screener Does your child seem intelligent but struggle with reading, writing, spelling, or math? Yes NoPreviousNextDoes your child experience any of these reading problems? Check all that apply. Sometimes substitutes words when reading Sometimes omits words when reading Sometimes reverses words when reading Sometimes combines parts of words when reading? (the cat becomes that) Sometimes changes the order of words when reading Confuses visually similar words such as mop and map Letters jump between words ("kind wing" becomes "wind king") Complains of letters or words moving or jumping None of the abovePreviousNextDoes your child have difficulty learning and remembering sight words? Yes NoDoes your child: Loses place or skips lines when reading Uses finger to track lines when reading None of the aboveDoes your child Fatigue quickly when reading? Yes NoPreviousNextDoes your child have either of these comprehension problems? Has little or no comprehension of what was just read Re-reads sentences to try to get meaning NeitherDoes your child have difficulty sounding out new or unfamiliar words? Yes NoPreviousNextDoes your child have any of these spelling problems? Check all that apply. Has overall poor spelling Misspells even simple words Spells the same word differently even when used repeatedly Spells phonetically(sounds it out) Frequently misspells common words Spelling seems random or highly phonetic 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 writing problems? Reverses letters Mixes up order of letters when writing words Reverses words None of the aboveDoes your child have any of these difficulties while writing? Difficulty in organizing thoughts when writing Tests well orally but not written Has difficulty showing math steps on paper Uses incorrect punctuation Uses lots of run-on sentences Writing is very slow and labored Does not break up paragraphs Has poor grammar None of the abovePreviousNextDoes your child have any of these problems? Have trouble with associating the right names with objects? (you ask for a fork but are given a spoon) Often doesn’t understand jokes. Especially puns or jokes based on different meanings of words. Has trouble understanding proverbs and memes (short pithy sayings) Has trouble understanding idioms (like “It’s raining cats and dogs”) None of the aboveDoes your child have any of these problems? Frequently mispronounces words. Often mixing up syllables (pasgetti instead of spaghetti) Stammers, has difficulty expressing ideas or getting to the point Get’s frustrated trying to convey a thought or story None of the abovePreviousNextHow would you describe your child's reading speed? Reads quickly and fluently Reads at an average pace Reads slower than peers Significantly struggles with reading speedWhen reading aloud, how often does your child guess at unfamiliar words based on their shape or first letter? Rarely or never Sometimes Frequently Almost alwaysPreviousNextDoes your child have any of these problems? Check all that apply. Seems to have a smaller vocabulary than peers. Has trouble finding the right word Uses a lot of filler words such as “um” Uses the same phrase repetitively Has trouble learning new vocabulary words Confuses verb tense Doesn’t talk much but understands what other people say Is limited in the number of sentence structures used Has trouble reciting the alphabet None of the aboveDoes your child have any of these problems? Has difficulty with rhyming Has poor musical ability Has difficulty learning songs Has difficulty learning nursery rhymes None of the abovePreviousNextHow 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 recallDoes 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 aboveDoes your child confuse similar-sounding words (e.g., "specific" vs "Pacific")? Rarely or never Occasionally Frequently Very frequentlyPreviousNextDoes 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 aboveDoes 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 knowIs your child light-sensitive? Especially under fluorescent lights Yes NoPreviousNextDoes 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 aboveDoes 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 abovePreviousNextDoes 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 aboveDoes 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 NoIs 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 abovePreviousNextWas any of the following true during your child's early developmental stages? Was late in learning to talk Was late in learning to crawl Was late in learning to walk Did not crawl much but went straight to walking Did not crawl much due to some condition or situation Had ear infections early on or is prone to ear infections None of the aboveDyslexia CalculationAuditory CalculationVisual CalculationSpatial CalculationMotor CalculationDysgraphia 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
