= not applicable (child is too young)

0

= never or rarely

1

= sometimes

2

= often

3

= always

• Tends to put volume lower (audio devices, TV, etc)

N/A

0

1

2

3

• Is overly sensitive or irritated by certain rounds (complains that some voices/music “hurt” him/her)

N/A

0

1

2

3

• Is overly distracted by ambient noises

N/A

0

1

2

3

• Tends to hum or make involuntary voices noises   

N/A

0

1

2

3

• Easily overwhelmed by sound / verbal information – tends to “blank out” or yawn (information overload)

N/A

0

1

2

3

• Tends to hear unusually faint sounds

N/A

0

1

2

3

• Needs instruction repeated

N/A

0

1

2

3

• Tends to put volume higher (audio devices, TV)

N/A

0

1

2

3

• Misinterprets what has been said

N/A

0

1

2

3

• Confuses similar sounding words

N/A

0

1

2

3

• Is inattentive when spoken to

N/A

0

1

2

3

• Has difficulty remembering names

N/A

0

1

2

3

• Fidgets specifically when listening

N/A

0

1

2

3

• Has difficulty following multiple instructions

N/A

0

1

2

3

• Has short attention span in the classroom

N/A

0

1

2

3

• Has long delay time before responding to questions

N/A

0

1

2

3

• Has difficulty in remembering melodies

N/A

0

1

2

3

• Performs better in a quiet environment

N/A

0

1

2

3

• In reading, has difficulty converting letters into rounds (decoding)

N/A

0

1

2

3

• Reads slowly

N/A

0

1

2

3

• Needs the support o fan image to understand what he / she reads

N/A

0

1

2

3

• Tires easily when reading (“my eyes get tired”)

N/A

0

1

2

3

• In math – good in calculation but has difficulty with word problems

N/A

0

1

2

3

• Views reading as a “boring” activity

N/A

0

1

2

3

• Has difficulty understanding math concepts

N/A

0

1

2

3

• Needs to underline with finger when reading

N/A

0

1

2

3

• Can read the words but poor comprehension

N/A

0

1

2

3

• Reverses letters / words when reading

N/A

0

1

2

3

• Reacts to reading with discomfort

N/A

0

1

2

3

• Has difficulty catching a ball

N/A

0

1

2

3

• Has difficulty with balance (i.e. lemming to ride a bike or to skate or roller blade)

N/A

0

1

2

3

• Has poor posture

N/A

0

1

2

3

• Has difficulty sitting still, tends to fidget

N/A

0

1

2

3

• Has low muscle tone

N/A

0

1

2

3

• Tends to stumble, trip, Gump into things and / or to be accident prone

N/A

0

1

2

3

• Tends to misread non verbal cues

N/A

0

1

2

3

• Confuses left and right

N/A

0

1

2

3

• Has a poor sense of direction

N/A

0

1

2

3

• Has difficulty following time schedules

N/A

0

1

2

3

• Tends to learn “in spurts” rather than in a continuous flow

N/A

0

1

2

3

• Has craving for movement (trampoline, swings, pacing)

N/A

0

1

2

3

• Has difficulty learning times tables

N/A

0

1

2

3

• Fears or feels uncomfortable in darkness

N/A

0

1

2

3

• Feels uncomfortable in high places (fear of heights, fear of falling)

N/A

0

1

2

3

• Tends to shy away from and / or be uncomfortable with physical contact

N/A

0

1

2

3

• Has difficulty with Business (crowded classroom, playground, shopping mall, etc.)

N/A

0

1

2

3

• Finds it difficult adjusting to a new environment or situation

N/A

0

1

2

3

• Is prone to motion sickness (rides, spinning, car)

N/A

0

1

2

3

• Tends to overreact or to be overly defensive or unpredictable (short temper, “thin skin”)

N/A

0

1

2

3

• Tends to seek attention by whining, crying, complaining

N/A

0

1

2

3

• Tends to shy away from physical activity (sports)

N/A

0

1

2

3

• Is overly shy or self – conscious in public

N/A

0

1

2

3

• Feels uncomfortable or fearful participating in group activities or sports

N/A

0

1

2

3

• "Freezes" or "blanks out" when asked to Speedy up (i.e. when under a time constraint)

N/A

0

1

2

3

• Is uncoordinated in his/her movements (clumsy, awkward)

N/A

0

1

2

3

• Has a poor sense of rhythm (i.e. has difficulty repeating rhythmic pattern or dancing)

N/A

0

1

2

3

• Has difficulty getting organized

N/A

0

1

2

3

• Has difficulty staying on task

N/A

0

1

2

3

• Has difficulty planning a series of tasks to be carried out (sequencing)

N/A

0

1

2

3

• Speaks with poor sentence structure

N/A

0

1

2

3

• Has a poor gross motor skills (i.e. difficulty swimming, dumping, running)

N/A

0

1

2

3

• Procrastinates (“all talk, no action”)

N/A

0

1

2

3

• Is attracted by computer games and / or other activities which ask for attention to small details

N/A

0

1

2

3

• Has difficulty relating to the peer group (making friends)

N/A

0

1

2

3

• Speech flow is choppy (redundant speech, verbal ticks)

N/A

0

1

2

3

• When talking, has difficulty maintaining coherent and consistent story line

N/A

0

1

2

3

• Confuses or reverses letters / numbers in writing

N/A

0

1

2

3

• In spelling, tends to write words as they sound (misteak/mistake, bol/ ball, nacher/nature)

N/A

0

1

2

3

• Has difficulty with eye – hand coordination in Sports (throwing a ball)

N/A

0

1

2

3

• Has messy handwriting

N/A

0

1

2

3

• When writing has difficulty with construction sentences (grammar, syntax)

N/A

0

1

2

3

• Has difficulty copying from the blackboard

N/A

0

1

2

3

• When reading out loud has difficulty pronouncing words

N/A

0

1

2

3

• Has poor expression & a tendency to mumble when reading out loud

N/A

0

1

2

3

• When writing tends to misspell the words that sound similar (cheap, sheep, ship, chip)

N/A

0

1

2

3

• Has difficulty with note taking

N/A

0

1

2

3

• Can have a good mark on an oral spelling test but can not apply when writing

N/A

0

1

2

3

• Has a limited vocabulary in creative writing

N/A

0

1

2

3

• Tends to speak too loudly

N/A

0

1

2

3

• When speaking, mispronounces similar sounding words

N/A

0

1

2

3

• Speaks using Reddy – made sentences (i.e. general cliché - "stuff like that”, “whatever")

N/A

0

1

2

3

• Has a monotone voice

N/A

0

1

2

3

• Has weak vocabulary when speaking

N/A

0

1

2

3

• Tends to fidget when speaking

N/A

0

1

2

3

·  when speaking, has difficulty finding the right word (Ï have it on the tip of my tongue”)

N/A

0

1

2

3

• Has slow / hesitant speech

N/A

0

1

2

3

• Has difficulty spelling words out loud

N/A

0

1

2

3

• Tends to “act out” of frustration of not being able to “speak out”

N/A

0

1

2

3

• Has a poor singing voice

N/A

0

1

2

3

• When speaking, the intonation of the voice doesn’t suit the meaning of the message  

N/A

0

1

2

3

• Tends to speak too softly

N/A

0

1

2

3

• Has a tendency to talk to him / herself Turing play or when on his own.

N/A

0

1

2

3

• Avoids / shies away from verbal interaction / discussions

N/A

0

1

2

3

• When anxious or upset tends to freeze and loose capacity to argue his / her point

N/A

0

1

2

3

• Dislikes talking / singing / performing in public

N/A

0

1

2

3

• Tends to apologize, gives the impression that his / her input is an intrusion 

N/A

0

1

2

3