Academic Questionnaire

1. I am a poor reader.

2. I do not like reading.

3. I make mistakes when reading like skipping words or lines.

4. I read the same line twice

5. I have problems remembering what I read even though I have read all the words.

6. I reverse letters when I read (such as b/d, p/q).

7. I switch letters in words when reading (such as god and dog).

8. I complain that my eyes hurt or water when I read.

9. Words tend to blur when I read.

10. Words tend to move around the page when I read.

11. When reading I have difficulty understanding the main idea or identifying

12. I have “messy “ handwriting.

13. My work tends to be messy.

14. I prefer print rather than writing in cursive.

15. My letters run into each other or there is no space between words.

16. I have trouble staying within lines.

17. I have problems with grammar or punctuation.

18. I am a poor speller.

19. I have trouble copying off the board or from a page in a book.

20. I have trouble getting thoughts from my brain to the paper.

21. I can tell a story but cannot write it.

22. I have trouble with knowing my left from my right.

23. I have trouble keeping things within columns or coloring within lines.

24. I tend to be clumsy, uncoordinated.

25. I have difficulty with eye hand coordination.

26. I have difficulty with concepts such as up, down, over or under.

27. I tend to bump into things when walking.

28. I have difficulty expressing myself in words.

29. I have trouble finding the right word to say in conversations.

30. I have trouble talking around a subject or getting to the point in conversations.

31. I have trouble keeping up or understanding what is being said in conversations.

32. I tend to misunderstand people and give the wrong answers in conversations.

33. I have trouble understanding directions people tell me.

34. I have trouble telling the direction sound is coming from.

35. I have trouble filtering out background noises.

36. I am poor at basic math skills for my age (adding, subtracting, multiplying and dividing)

37. I makes “careless mistakes” in math.

38. I tend to switch numbers around.

39. I have difficulty with word problems.

40. I have trouble getting everything in the right order when I speak.

41. I have trouble telling time.

42. I have trouble using the alphabet in order.

43. I have trouble saying the months of the year in order.

44. I have trouble understanding jokes people tell me.

45. I tend to take things too literally.

46. My notebook/paperwork is messy or disorganized.

47. My room is messy.

48. I tend to shove everything into my backpack, desk or closet.

49. I have multiple piles around my room.

50. I have trouble planning my time.

51. I am frequently late or in a hurry.

52. I often do not write down assignments or tasks and end up forgetting what to do.

53. I have trouble with my memory.

54. I remember things from long ago but not recent events.

55. It is hard for me to memorize things for school or work.

56. I know something one day but do not remember it to the next.

57. I forget what I am going to say right in the middle of saying it.

58. I have trouble following directions that have more than one or two steps.

59. I have few or no friends.

60. I have trouble reading body language or facial expressions of others.

61. My feelings are often or easily hurt.

62. I tend to get into trouble with friends, teachers, parents or bosses.

63. I feel uncomfortable around people I do not know well.

64. I am teased by others.

65. Friends do not call and ask me to do things with them.

66. I do not get together with others outside of school or work.

67. I am light sensitive. Bothered by glare, sunlight, headlights or streetlights.

68. I become tired, experience headaches, mood changes, feel restless or an inability to stay focused with bright or fluorescent lights.

69. I have trouble reading words that are on white, glossy paper.

70. When reading words or letters shift, shake, blur, move, run together, disappear or become difficult to perceive.

71. I feel tense, tired, sleepy, or even get headaches with reading.

72. I have problems judging distance and have difficulty with such things as stairs, ball sports, or driving.

Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities

Often has difficulty sustaining attention in tasks or play activities

Often does not seem to listen when spoken to directly

Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

Often has difficulty organizing tasks and activities

Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)

Is often easily distracted by extraneous stimuli

Is often forgetful in daily activities

Often fidgets with hands or feet or squirms in seat

Often leaves seat in classroom or in other situations in which remaining seated is expected

Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

Often has difficulty playing or engaging in leisure activities quietly

Is often "on the go" or often acts as if "driven by a motor"

Often talks excessively

Often blurts out answers before questions have been completed

Often has difficulty waiting turn

Often interrupts or intrudes on others (e.g., butts into conversations or games)