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WOODBRIDGE SCHOOL DISTRICT

CLASSROOM / TEACHER PROBLEM IDENTIFICATION CHECKLIST

Child’s Name / Teacher(s) / Date
Referred by
Proceed with evaluation / Other Action

Check if problem exists in areas appropriate to the developmental level of the child.

MOTOR DEVELOPMENT
1. / Awkward in walking and climbing
2. / Cannot sit in chair for 15 minutes (elementary school)
3. / Easily fatigued
SPATIAL ORIENTATION (laterality, directionality, time, space)
1. / Disoriented in room, building and playground
2. / Confusion of left-right
3. / Confusion with directionality (near-far, front-behind, above-below, big-bigger-biggest)
4. / Misjudges distances in play and work activities (e.g., reacts too quickly or slowly in catching a ball;
Or reaches too far or short for things)
5. / Hypersensitivity to touching something or being touched
VISUAL PERCEPTION (Interpreting visual stimuli)
1. / Difficulty in matching (interpreting likenesses) color, form, shape, size
2. / Difficulty in discriminating differences - color, form, shape, size
3. / Difficulty in recognizing what is missing (eg., distinguishing a missing part from the whole)
4. / Frequently loses place on work page; uses finger or marker to guide eyes
5. / Difficulty with visual memory (recalling what was seen, e.g., sight words, spelling, math facts)
6. / Difficulty in interpreting reversed letters or words (after grade 2, e.g., d/b, or saw/was)
7. / Omitting, repeating and miscalling words
8. / Difficulty remembering what is read
9. / Dislike for tasks requiring sustained visual concentration
WRITTEN EXPRESSION (Visual-Motor Integration)
1. / Difficulty in cutting, pasting, coloring
2. / Difficulty in assembling simple puzzles
3. / Difficulty staying on line or within boundary lines
4. / Poor spacing of drawing or writing
5. / Difficulty in making simple forms
6. / Difficulty in reproducing simple patterns or design
7. / Reverses or rotates angles, letters or words
8. / Difficulty in copying material from the chalkboard
9. / Difficulty writing in cursive
10. / Holds chalk, crayon or pencil awkwardly
11. / Works very slowly on paper-pencil tasks
12. / Spidery, excessively sloppy, or very hard to read handwriting

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WRITTEN EXPRESSION (Written Composition)
1. / Punctuation
2. / Word Usage
3. / Simple Sentences
4. / Word Order
5. / Spelling
READING SKILLS / Word Attack / Comprehension
MATHEMATICS SKILLS / Calculation / Reasoning (Word Problems)
LISTENING SKILLS (Auditory-Perceptual Processing)
1. / Pays attention to instruction less than 50% of the time
2. / Short attention span: (Check the most appropriate time frame)
0-2 minutes / 5-15 minutes
2-5 minutes / 15-30 minutes
3. / Auditory attention is distracted by other stimuli (auditory or visual)
4. / Daydreams - attention drifts - not with it at times
5. / Novel stimuli (auditory or visual) needed to focus the child's attention
6. / Forgets what is said in a few minutes
7. / Does not remember simple routine things from day to day
8. / Problems recalling what was heard last week
9. / Cannot discriminate specific sounds in words differing by only one speech sound (cat, sat)
10. / Difficulty identifying or discriminating between initial consonants, final consonants, medial consonants, vowels, and/or consonant blends
11. / Cannot retain the sequence in a series of auditory stimuli, such as digits, sounds or words
12. / Cannot follow a series of oral directions when instructed to do more than one thing or often necessary to repeat instructions
13. / Cannot form words out of separated, orally presented sounds (b - a - t, bat) or difficulty in sound blending of syllables into words (ta - ble, table)
14. / Cannot identify the number of syllables in words of increasing length
15. / Cannot identify and discriminate prefixes and suffixes in complex words
LISTENING COMPREHENSION (Cognitive-Semantic Processing)
1. / Cannot comprehend selected vocabulary items such as verbs, adjectives, prepositions, pronouns or multiple-meaning words, antonyms, homonyms
2. / Cannot classify selected vocabulary items or concepts in the appropriate category (e.g., hammer, screwdriver, saw: tools)
3. / Cannot process and comprehend verbal analogies or logical relationships between words and concepts (e.g., A turtle is slow. A rabbit is . Are watermelons bigger than apples?)
4. / Cannot detect errors, inconsistencies, absurdities, and ambiguities in sentences and stories
5. / Cannot grasp and identify similarities and differences between the meanings of selected words and concepts
6. / Cannot predict possible outcomes
7. / Cannot identify cause-effect relationships that are expressed and/or by inference
ORAL LANGUAGE (Language Production)

A. Sound Production

1. / Cannot be understood
2. / Cannot say certain sounds or words (i.e., substitutes, omits, distorts or adds sounds)
3. / Repeats or prolongs sounds
4. / Has a cleft palate
5. / Has unusual voice quality (i.e., hoarseness, nasality, too high or too low pitch)

B. Morphology - Difficulty using the following in conversational speech

1. / Pronouns
2. / Verb tenses
3. / Plurals (regular and/or irregular)
4. / Comparative/superlatives

C. Syntax - In conversational speech, child has difficulty with:

1. / Expressing thoughts and ideas
2. / Word order in sentences
3. / Subjective-verb agreement
4. / Negatives
5. / Asking questions
Behavior (Describe the problem in your own words)

Pre-Kindergarten

Language / Math / Concepts
Vocabulary / Classification / Colors
Relationships / Time / Shapes
Syntax / Enumeration / Numbers
Interpretation / Capital letters
Auditory Perception / Lower case letters
Matching
Alphabetical order
Fine Motor & Perception / Motor / Social/Emotional
Visual Discrimination / Balance / Attention to Task
Eye-hand Coordination / Locomotion / Self Confidence
Visual Memory / Body Coordination / Listening
Beginning Writing / Responsibility
Social Relationships

Kindergarten

Reading
Writing
Listening
Speaking
Math
Fine/Gross Motor
Social
Emotional

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