PERSONAL AND READING SYMPTOMATOLOGY CHECKLIST

NAME OF STUDENT:

SEX:

AGE:

Name of Evaluator:

PERSONAL SYMPTOMATOLOGY

1. PERSONAL HISTORY

True False Don’t

Know
1.1 Is from a low socioeconomic home.
1.2 Comes from a broken home.
1.3 Has a bilingual background.
1.4 Has a familial history of reading disability. (Parents and/ or

siblings also have serious reading disabilities.)

1.5 Either the pupil or another family member is left- handed or

ambidextrous or exhibits left- right confusion. (He or she frequently

reverses in reading, has difficulty putting on garments in the correct

way, or does not know the difference between right and left.)
1.6 Was a premature child or survived some complication of

pregnancy. (The pupil’s mother experienced difficult labor, had Rh

blood complication, etc.)

1.7 Suffered some type of neurological injury, a high fever, a severe

head injury, a tumor, oxygen deprivation, encephalitis, etc.

1.8 Is an adopted child.
1.9 Was a late for his or her age in walking?
1.10 Is a boy.
1.11 Shows inadequate large muscle development. (Cannot climb on

a jungle gym, hop on one foot, bounce or catch a ball, or skip; has

abnormal knee reflex; etc.)

1.12 Has inadequate fine- muscle development. (The pupil cannot

fasten buttons, tie shoe laces, string beads, put puzzles together, or

copy letters and numerals. The writing is clumsy, jerky, and are

rhythmic; the characters are poorly formed, irregular, and

malaligned.)
1.13 Is generally a poor student. (The pupil has low motivation to

achieve, has low energy level, and daydreams a lot. Attention is poor,

and the pupil is often fatigued.)

1.14 Was introduced to formal teaching of reading before the age of

six.
1.15 Has frequently been absent from school.

2. PERCEPTION SKILLS (VISION, HEARING, EYE MOVEMENT)

2.1 Is unable to demonstrate at least 20/ 60 visual acuity at near

point. (Especially in the left eye.)

2.2 Has less than 20/ 30 visual acuity at far point.
2.3 Cannot focus at a distance of 20 inches or closer.
2.4 Has a hearing loss of 15 decibels or more.

3. ATTENTION
3.1 Has a short attention span for his or her age and grade.
3.2 Cannot easily shift attention. (The pupil perseverates excessively.)
3.3 Is unable to withhold attention from stimuli. (The pupil is very

distractible, excitable and hyperactive, shows rapid shifts of attention

and cannot see out distractions.)

3.4 Is very impulsive.
3.5 Attends equally to all stimuli. (Attention is not selective.)
3.6 Is lethargic.

4. COGNITIVE DEVELOPMENT
4.1 Exhibits low learning efficiency. (the pupil cannot name colors,

shapes, or sizes; cannot give name, age address, or telephone

number or etc.)
4.2 Has a verbal IQ that is significantly below the performance IQ

score.
4.3 Has a poor memory for sequences.
4.4 Thinks on a concrete level rather than on an abstract level.
a. Can count to 20 or recite the alphabet but cannot tell what

number comes after 8 or what letter comes after c.

b. Cannot categorize or classify objects.
4.5 Has difficulty remembering what is read.
4.6 Has a small recognition and speaking vocabulary for his or her

age.
4.7 Has an overall reading score that is substantially below grade

level.
4.8 Cannot deal with quantitative relationships and concepts.

5. LANGUAGE AND SPEECH

5.1 Was low in learning to speak.
5.2 Cannot speak in simple sentences: has a little sentence sense or

feel for the structure of the language.

5.3 Does not understand the function of word arrangement or of

intonation.
5.4 Cannot provide an ending to a story.
5.5 Exhibits speech that characterized by additions (athelete),

distortions (shister for sister), omissions (baw for ball), substitutions

(wawipop for lollipop), transpositions, slurring of speech sound and

dialect ( thoid for third ). (Encircle those that apply).

5.6 Does not give the whole word form, its proper intonation and

accent.
5.7 Cannot find or formulate the words to express oneself even though

he or she knows what to say.

5.8 Stutters, lisps, stammers, has cleft palate speech: has speech that

is cluttered, stumbling or explosive; speaks with an abnormal amount

of hesitation. (Encircle those that apply).

5.9 Speaks too loudly or too softly, without expression, with too - high

pitch, or in monotone (Encircle those that apply).

6. MOTIVATION AND SOCIAL CHARACTERISTICS

6.1 Has a low self – image, lacks confidence.
6.2 Concentration is inappropriate for age and grade.
6.3 Has difficulty in maintaining sustained effort.
6.4 Is not motivated to use cognitive and perceptual abilities. (The

pupil is slow in finishing work, does not apply himself or herself, day –

dreams a lot, and does not attend to stimuli – turns off the instructor,

etc.)
6.5 Has an aversion to reading.
6.6 Has a low frustration tolerance. (The pupil is easily discouraged,

cries easily, fights readily, gives up easily, quarrelsome or

argumentative, sasses, tears up his work, destroys game, etc.)

6.7 Is not emotionally or socially ready to cope with the intra – and

inter personal pressures of the classroom. (The pupil is tense, high

strung, does not like to work with others, unfriendly, seems afraid of

the teacher, unsociable, prefers to be alone, misinterprets the actions

of others, withdraws, etc.)

6.8 Has an unrealistic self – appraisal.
6.9 Is unwilling to attempt new task.

7. READING BEHAVIORS
7.1 Move lips and vocalizes excessively during silent reading.
7.2 Uses finger – pointing while reading.
7.3 Is tense or nervous while reading, fidgets, wiggles, etc.
7.4 Holds book either too close or too far away.
7.5 Exhibits reading performance that is exceedingly variable and

inconsistent. (Good one day and poor the next).

READING SYMPTOMATOLOGY

1. AUDITORY DISCRIMINATION, MEMORY, BLENDING, COMPREHENSION

True False Don’t

Know
1.1 Cannot tell whether 2 words spoken are alike or different.
1.2 Is deficient in auditory in audition.
1.3 Cannot tell whether two spoken words begin with the

same sound.
1.4 Cannot discriminate between the phonemes of the

language:
a. Cannot identify and differentiate the late- developing

sounds- /z/, /s/, /r/, /wh/, /ch/, and /j/.

b. Has difficulty with the high frequency sounds- /f/,

/v/, /s/, /z/, /sh/, /zh/, /th/, /t/, /d/, /p/, /b/, /k/, and /g/.
1.5 Cannot remember words spoken to him or her. (The pupil

has a very short auditory memory and retention span.)

1.6 Has a poor memory for auditory sequences and is unable

to tell how many sounds there are in spoken words.

1.7 Cannot blend phonemes to form a complete word.
1.8 Has poor listening comprehension ability for his or her

age; Cannot comprehend or understand what is spoken and

frequently misunderstands the teacher.

1.9 Cannot interpret sentences modified by intonation.

2. VISUAL DISCRIMINATION
2.1 Cannot distinguish differences between visual stimuli;

does not note similarities and differences in the form of

objects, pictures, geometric figures, shapes, letters and

words; cannot identify words; does not see the word as an

entity or whole (this is shown in wild guessing at words and

in frequent requests for help with the same word).

2.2 Cannot match forms, numbers, letters and/ or words.
2.3 Cannot copy shapes abstract designs, or sequences or

draw geometric figures.

2.4 Cannot recognize shapes when they are oriented

differently in space.
2.5 Cannot remember a visual stimulus or has a weak visual

memory for the sequences of the various elements or

component parts. (The pupil has the faulty memory for letter

sequences; his or her spelling is often odd or peculiar.)

2.6 Cannot perceive or notice detail; cannot perceive the

minute differences between letters and words.

2.7 Cannot perceive part - whole relationships and has

difficulty with figure- ground discriminations; sees the word

as an undifferentiated design.
2.8 Cannot write on a straight line, has difficulty staying

within the lines when coloring.

2.9 Cannot visually blend parts into wholes.
2.10 Cannot identify the letters or differentiate one letter from

another.
2.11 Cannot distinguish between lower case and capital

letters.
2.12 Cannot name the letters of the alphabet.
2.13 Cannot write letters dictated:
a. Has not mastered manuscript writing.
b. Has not mastered cursive writing.

3. PHONEME- GRAPHEME CORRESPONDENCE

3.1 Cannot associate the phoneme with its proper grapheme,

has difficulty dealing with phoneme and grapheme

correspondences, and is generally poor in phonics skills.

3.2 Cannot recognize initial consonant sounds in spoken
words, cannot associate them with the letters representing

these sounds, and has not mastered beginning consonant

substitution.
3.3 Cannot recognize sounds represented by vowel symbols

and cannot identify printed words in which these sounds are

represented.
3.4 Cannot recognize final consonant sounds in spoken

words and cannot identify the letters representing these

sounds:
a. Cannot identify phonograms or spelling patterns at

the end of the words.

b. Cannot deal with rhyming words or word families

either auditorially or visually.

3.5 Cannot recognize beginning and ending consonant

blends and/ or consonant digraphs in spoken words; Cannot

identify the letters groups representing these sounds.

3.6 Cannot recognize long vowels in spoken words; and

cannot identify the letters representing these sounds.

3.7 Cannot use beginning consonant and the context to

identify the word.

4. STRUCTURAL OR MORPHEMIC-ANALYSIS SKILLS
4.1 Cannot deal with inflectional endings and

changes (plurals, third-person singular

ending in s, passive, etc.)

4.2 Cannot break a compound word into its

two more simple words

4.3 Cannot interpret simple contractions (I’m

= I am.).
4.4 Cannot identify the number of prefixes

and/orSounds that prefixes and suffixes

Represent.
4.5 Cannot identify the number of syllables in

Spoken and printed words.

4.6 Cannot use the rules for dividing words

Into syllables.
4.7 Cannot identify the accented syllable in words

5.DEVELOPMENT OF A SIGHT VOCABULARY

5.1 Cannot identify words on his or her age or grade level:
a. Has substantial difficulty decoding unfamiliar words.
b. Decodes even familiar words slower than is average

for his or her age or grade level.

 c. Has an unusual amount of difficulty with high- utility

words (the core words).

5.2 Cannot discriminate between two words similar in both

sound and appearance: Has much difficulty remembering

and recalling similar appealing words.

6. ERRORS IN ORAL READING

6.1 The pupils oral reading is characterized by:
a. Omissions
b. Additions and Insertions
c. Substitutions (mispronunciations, contractions,

misplaced accent)
d. Repetitions or Regressions
e. Words Aided
f. Reversals
g. Word- by word Reading
h. Poor phrasing
i. Loss of place
j. Hesitations
6.2 Reverses letters (b↔d, p↔b, p↔q, u↔n, o↔e, e↔c,

q↔b etc.)
6.3 Reverses entire words.
6.4 Transposes letters or syllables in words (animal becomes

aminal).
6.5 Shows inversions (u↔n).
6.6 Can read upside down with ease.
6.7 Can read mirror images with ease.

7. EYE MOVEMENT DIFFICULTIES

7.1 Makes too many fixations and regressions for his or her

age and grade level.

7.2 The fixations in reading are too long.
7.3 The eye movements are inflexible. (The pupil does not

change eye movements to fit the difficulty of the material.)

7.4 The reading lacks rhythm.
7.5 The return sweep in reading is faulty. (The pupil has

difficulty moving from the end of one line to the beginning of

another.)
7.6 Sequences eye movement too rapidly, thus skipping

material.

8. COMPREHENSION SKILLS
8.1Lacks silent – reading comprehension skills appropriate

for his or her ability level. (The pupil fails to comprehend

when reading silently materials at ability level.)

8..2 Lacks silent – reading comprehension skills appropriate

for his or her age and grade level.

8.3 Reading comprehension is significantly lower than is

lower is listening comprehension.

8.4 Produces errors in reading that do not conform to the

semantic meaning of the selection.

8.5 Makes many uncorrected errors (especially in oral

reading) that disturb the meaning of the text.

8.6 Miscues in reading do not conform to the syntactic

structure of the sentences of which they are substituted.

8.7 Cannot use syntactic cues to identify words and to read

with comprehension.
8.8 Cannot use redundancy cues to work out the meaning of

a sentence.
8.9 Lack oral reading comprehension skills appropriate for

his or her ability, age, or grade level.

8.10 Has an inadequate vocabulary.
8.11 Is content to settle in the first meaning that comes to

mind.
8.12 Cannot infer meaning from context cues; cannot derive

the pronunciation and meaning of a word from the way it is

used in a sentence.
8.13 Cannot grasp the meaning of larger segments of text

(phrase, clause, sentence, paragraph, etc.)

8.14 Cannot answer questions about a sentence or

paragraph that call for a literal, denotative meaning.

a. Cannot identify or understand the main idea.
b. Cannot recognize and recall significant facts or

details.
c. Cannot follow the directions given in the material
d. Cannot recognize the sequence of a passage.
8.15 Cannot answer question about a sentence or paragraph

that call for an analysis, synthesis or organization of ideas of

information explicitly stated.

8.16 Cannot answer questions about the material read that

require the pupil inferential, interpretative or connotative

meaning
8.17 Cannot answer questions about material read that
requires the pupil to make judgments or critical evaluations
8.18 Cannot answer questions requiring an awareness of

literary techniques, forms and styles used by the writer

8.19 Cannot read for learning or for study purposes:
a. Cannot locate information in encyclopedias, card

catalog, etc. and the use of table of contents, index or

appendix of a book.
b. Cannot read maps, graphs, charts, etc.
c. Cannot use the dictionary
8.20 Has a rate of comprehension that is significantly below

the norm for his or her age and grade level

8.21 Cannot read textbooks on an instructional level. (With a

95% accuracy score and a 75%comprehension score.)

A. INTEREST INVENTORY
Name:______________.Age: ____________Date: _______________

Grade: Grade_____ Sex:

Do you like to read?

How much do you like to read? _______________________________

A little ________ A lot ___________ Not at all

What is the best book you ever read?

What other books have you liked?

What do you usually do after school?____________________

What do you like to do best of all?

What games do you like?

What do you like to make?

Do you have pets?

What things do you collect?

What are your hobbies?

If you could have one wish that might come true, what would it be?

What is your favorite TV program?

What others do you watch?

Do you have any books of your own? How many?

Does anyone read to you? How often?

Do you go to the library?

Do you have a library card?

Do you read comic book?

What is your favorite comic book?

Do you read comic strips in the in newspapers?

What magazines do you read?

What newspapers do you read?

What is your favorite section in the newspaper?

What kinds of book do you like best? __________________________

Animal stories ____ Humor _____________________

Adventure stories ___________ Romance _________________

Mystery stories _____________ Sports ____________________

Science fiction ______________ History ___________________

Home and Family life __________________

Problems of growing up ________________

What kind of work do you want to do when you finish school?

What school subject do you like best?

What school subject do you like least?

How many hours a day do you watch television?

How many hours a day do you listen to the radio and to records or tapes?

Where have you traveled in the last three years?

D. SUMMARY OF DIAGNOSIS
 Specific Areas needing Remediation Tools/
Improvements strategies
Strengths Weakness

Diagnostic Remarks:
For remediation:

For corrective

For developmental

Daily Narrative Journal

Reflection