DYSLEXIA SYMPTOMS CHECKLIST/QUESTIONNAIRE (School-age children must evidence three or more of the following criteria in addition to having difficulty with spelling tasks to warrant further testing for dyslexia.) □ Does anyone in your family have a diagnosis of dyslexia or have symptoms associated with dyslexia? □ Does your child have directionality issues (i.e. difficulty discriminating left vs. right, confusion or delays when telling time on a clock with hands, north/south/east/west confusion, difficulty with before/after concepts, confusion in math particularly with carrying numbers in addition tasks, etc.)? □ Does your child have or has your child ever had difficulty with retrieval of “random” facts from long-term memory (i.e. months of the year or days of the week in sequence, alphabet, multiplication facts, a sequence of mathematical steps, address, phone number, etc.)? □ Was your child a late talker (i.e. not speaking at all by his/her first birthday or a limited vocabulary at age two or three years)? □ Was your child late establishing a dominant hand? □ Are any of your child’s words phonologically out of sequence (i.e. flutterby for butterfly, constonant for consonant, aminal for animal, etc)? □ Did your child ever stutter or have dysfluent speech? □ Does your child have errors in speech productions, or has your child had a history of a speech disorder (i.e. substitutes one sound for another, leaves out sounds in words, etc. Example: Says /l/ sounds for /r/ sounds such as flustrated for frustrated)? □ Does your child have difficulty processing information presented auditorily (i.e. requires more time to process information heard, difficulty following multi-step directions, difficulty discriminating sounds in similar word pairs, difficulty segmenting words or blending sounds, etc.)? □ Does your child have difficulty with reading fluently and/or have difficulty with reading comprehension? □ Does your child have difficulty rhyming words (by the age of four years)? □ Does your child have difficulty finding the correct word when speaking (i.e. “thingies” and “whatyamacallits”)? □ Does your child have slow, non-automatic handwriting that is difficult to read? □ Does or did your child have difficulty learning to tie his/her shoes? □ Does your child have an unusual pencil grip and/or letter formation? □ Does your child have difficulty with spelling and written expression? □ Does your child have difficulty with “inventive” spelling? □ Does your child reverse letters (i.e. /b/ for /d/, /d/ for /b/, /p/ for /b/, /q/ for /p/, etc.) when writing? (NOTE: These reversals are NOT due to the child seeing the letters backwards. The child is typically guessing the letter formation due to difficulty with directionality---left vs. right, visual imagery---a mental picture of the letter, and recall of the sequence involved with writing the letter.) □ Does your child dread going to school, complain of stomach aches or headaches, and/or have nightmares about school? Information compiled from seminar materials presented by Susan Barton, www.BrightSolutions.us.
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