Part 1 Rubs eyes frequently Never Rarely Sometimes Often Always
Blinks frequently Never Rarely Sometimes Often Always
Poorer sustained near attention Never Rarely Sometimes Often Always
Tired/Strained eyes Never Rarely Sometimes Often Always
Poor reading stamina Never Rarely Sometimes Often Always
Excessive head movement during reading Never Rarely Sometimes Often Always
Habitually covers one eye Never Rarely Sometimes Often Always
Does a head turn to look via one eye Never Rarely Sometimes Often Always
Skips words or lines during reading Never Rarely Sometimes Often Always
One eye gradually drifts or turns in or out Never Rarely Sometimes Often Always
Views work too closely Never Rarely Sometime
Tends to hold the paper very near to his/her face or leans forward too much to achieve the same effect
Certain types of lighting causes discomfort Never Rarely Sometimes Often Always
Difficulties with copying from the board Never Rarely Sometimes Often Always
Finger tracking Never Rarely Sometimes Often Always
Uses a finger to keep track of the position of the words as he/she reads
Words blur or moves Never Rarely Sometimes Often Always
Example: Moving/doubling words; Letters moving apart or changing sizes; Halo effect around the words
Part 2 Symbol confusion Never Rarely Sometimes Often Always
Example: "b, d, p, q" or "2, 3, 8, 9" confusion;
Confused by similar-looking signs (e.g. + and - ; < and > )
Reversals Never Rarely Sometimes Often Always
Reverses letters, numbers or any symbol
Figure-ground issues Never Rarely Sometimes Often Always
Example: Dislike piecing puzzles; Dot to dot tasks; Difficulty in distinguishing foreground and background
Poor spatial concepts Never Rarely Sometimes Often Always
Difficulty in understanding concepts like "before, after, in front or behind".
Difficulty with directions Never Rarely Sometimes Often Always
Word confusion Never Rarely Sometimes Often Always
Misreads common words, such as "a" for "and", "the" for "a", "from" for "for"
Poor sight memory Never Rarely Sometimes Often Always
Unable to recognise or spell words of high frequency accurately despite repeated exposure or practising
Auditory issues Never Rarely Sometimes Often Always
Issues with auditory processing (e.g. poor phonemic awareness; issues with listening when more than two people are speaking at the same time)
Part 3 Timetables difficulties Never Rarely Sometimes Often Always
Poor number retention Never Rarely Sometimes Often Always
Difficulty in remembering the number while attempting math sums
Poor math logic Never Rarely Sometimes Often Always
Mental sums issues Never Rarely Sometimes Often Always
Messy work Never Rarely Sometimes Often Always
Poor handwriting Never Rarely Sometimes Often Always
Struggles with multi-step instructions Never Rarely Sometimes Often Always
Performance disparity Never Rarely Sometimes Often Always
May perform much better when the task is performed orally as compared to written work
Part 4 Dizziness Never Rarely Sometimes Often Always
Headaches Never Rarely Sometimes Often Always
Blurry vision Never Rarely Sometimes Often Always
Double vision Never Rarely Sometimes Often Always
Poor eye coordination Never Rarely Sometimes Often Always
Cannot walk straight Never Rarely Sometimes Often Always
Feeling of falling Never Rarely Sometimes Often Always
Cannot perceive depth Never Rarely Sometimes Often Always
Light sensitivity Never Rarely Sometimes Often Always
Screen intolerance Never Rarely Sometimes Often Always
Seeing 'things' Never Rarely Sometimes Often Always
Example: Afterimages; Feeling of seeing someone at the corner of your eye
Hearing 'things' Never Rarely Sometimes Often Always
Example: Hears voices; Lag between a person speaking and hearing the person's voice; Distorted sound
Visual stress Never Rarely Sometimes Often Always
Example: Discomfort in crowded or busy areas; Bothered by complex patterns
Poor visual memory Never Rarely Sometimes Often Always
Motion sensitivity Never Rarely Sometimes Often Always
Example: Intolerance to moving things in the environment; Watching sporting events on TV; Scrolling on a screen
Profile
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