Part 1: Lower Brain Development
Please select all that apply.
Did not crawl or only for a short time, early walker
Frequently falls out of chairs/seats or clumsy
Uncoordinated, poor balance (difficulty learning to ride a bike)
Fidgets or prefers to be moving; rocks, wiggles, bounces
Easily angered or upset, impulsive
High or low pain tolerance, complains tags, or clothing is uncomfortable
Picky eater/ complains about food textures
Frequently zones out when someone is speaking to him or her
Does not remember a series of oral instructions
Poor posture, slumps when sitting down
Does homework laying on belly, back or with head laying on the desk/table
Taps foot, hand, hums, or other ‘distracting behaviours’
Says “what?” or “huh?” a lot, difficulty following oral instructions or misinterprets instructions
Becomes motion sick easily
Disorganized
Does not understand concept of personal space
Poor handwriting, writes to dark or too faint, awkward pencil grip
Chews on clothing, hair, pencils, etc.
Plays too rough, breaks items unintentionally
Poor spacing between letters and/or words
Delayed speech or speech difficulties
Difficulty retelling events or sequencing a story
Can’t catch a ball, dislikes sports
Part 2: Reading Difficulty
Please select all that apply
Uses finger to follow when reading or covers one eye when reading
Moves head when reading instead of just eyes, tilts head when reading
Complains letters/ words move, blur or reverse
More errors in reading and writing towards end of work, oral reading starts smooth but then becomes more laboured
Rests head on arms when reading or writing, turns body or paper at an extreme angle to read or write
Face is really close to the paper when reading or writing
Poor reading comprehension, difficulty retelling events or sequencing a story, yawns when reading
Makes mistakes when copying words from the board or another text
Did not crawl or only for a short time
Poor posture, slumps when sitting down
Does work laying on belly, back or with head laying on the desk/table
Poor spacing between letters and/or words
Phonics sounds don’t stick, guesses at words
Sounds out same word over and over, inconsistency from one day to next even when reading at same level
Delayed speech or speech difficulties, mixes words up –says ‘aminal’ instead of ‘animal’
Confuses left and right or had difficulty learning it, has mixed dominance – sometimes left, other times uses right
