Name

1 Do you confuse visually similar words such as cat and cot? Rarely (3)Occasionally (6)often (9)Most of the time (12)

2 Do you lose your place or miss out lines when reading? Rarely (2)Occasionally (4)often (6)Most of the time (8)

3 Do you confuse the names of objects, for example table for chair? Rarely (1)Occasionally (2)often (4)Most of the time (4)

4 Do you have trouble telling left from right? Rarely (1)Occasionally (2)often (4)Most of the time (4)

5 Is map reading or finding your way to a strange place confusing? Rarely (1)Occasionally (2)often (4)Most of the time (4)

6 Do you re-read paragraphs to understand them? Rarely (1)Occasionally (2)often (4)Most of the time (4)

7 Do you get confused when given several instructions at once? Rarely (1)Occasionally (2)often (4)Most of the time (4)

8 Do you make mistakes when taking down telephone messages? Rarely (1)Occasionally (2)often (4)Most of the time (4)

9 Do you find it difficult to find the right word to say? Rarely (1)Occasionally (2)often (4)Most of the time (4)

10. How often do you think of creative solutions to problems? Rarely (1)Occasionally (2)often (4)Most of the time (4)

11. How easy do you find it to sound out words such as e-le-phant? Easy (3)Challenging (6)Difficult (9)Very Difficult (12)

12. When writing do you find it difficult to organize thoughts on paper? Easy (2)Challenging (4)Difficult (6)Very Difficult (8)

13. Did you learn your multiplication table easily? Easy (2)Challenging (4)Difficult (6)Very Difficult (8)

14. How easy do you find it to recite the alphabet? Easy (1)Challenging (2)Difficult (3)Very Difficult (4)

15. How hard do you find it to read aloud? Easy (1)Challenging (2)Difficult (3)Very Difficult (4)

Copyright Ian Smythe and John Everatt, 2001