Patient Symptom Checklist And Teacher Observations (Page 2 of 2) in pdf

Patient Symptom Checklist And Teacher Observations Page 2

_____ Difficulty with word recognition

_____ Reverses letters and numbers when reading/writing

_____ Child does not know right from left

_____ Transposes letters/numbers (ie. 12 instead of 21)

_____ Failure to complete work in allotted time

_____ Difficulty copying from the board

_____ Poor printing or handwriting

_____ Mistakes words with similar beginnings or endings

_____ Fails to recognize the same word in the next sentence

_____ Child shows lack of coordination when playing sports

_____ Child is clumsy and trips a lot

School Performance _____ Child is in Special Education classes

AND

_____ Child has repeated a year in school

Behavior

_____ Low self-esteem, poor self image

_____ Child gives up too easily or doesn’t try to do a task

_____ Child cries frequently or has temper tantrums

_____ Short attention span, easily distracted, daydreams

_____ Child gets frustrated easily

_____ Patient shows “Attention-Deficit” type symptoms

Other comments:

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Patient Symptom Checklist And Teacher Observations Page 2