TeacherObservationQuestionnaireforDyslexia

Student NameGrade

TeacherSchool

Date

Please circle the term that indicates the degree of your concern regarding each skill area.

PhonologicalAwareness Skills

This student has:

Difficulty recognizing or reproducingrhyming words / Rarely / Often
Difficulty isolating sounds in beginning, final, and/ormedial position / Rarely / Often
Difficultysegmentingindividual sounds in words / Rarely / Often

Alphabet

This student has:

Difficulty learning or recallingnames of letters / Rarely / Often
Difficulty learning or recallingsounds of letters / Rarely / Often

Decoding and Word Recognition

This student has:

Difficultysounding out unfamiliarwords / Rarely / Often
Difficulty reading words in isolation / Rarely / Often

Fluency

This student has:

Difficulty reading accuratelyin context / Rarely / Often
Difficulty reading grade level material at expected rate / Rarely / Often

Spelling

This student has:

Difficultymemorizing words for spelling tests / Rarely / Often
Difficultyspelling in context / Rarely / Often

Comprehension

This student has difficulty with readingcomprehensionRarelyOften

Written Expression

This student has:

Difficultyconstructing sentences / Rarely / Often
Difficultyorganizinggradeappropriatewrittencompositions / Rarely / Often
Difficultyproducingsufficientwritten output / Rarely / Often

Cognitive/AcademicAbility

TexasScottishRiteHospitalforChildren–2011

This student appearsto haveintellectualability equal to or above grade level peers. / No / Yes
This student has grade levelmath calculation skills. / No / Yes
This student has grade levelmathreasoning skills / No / Yes
This student has reading difficultiesthat are unexpectedcompared to other abilities. / No / Yes

Oral Language

When listening,this student has:

Difficultyunderstanding verbal directions / Rarely / Often
ifficultyunderstandingstories readto him/her / Rarely / Often

When speaking,this student has:

Difficulty acquiring new oral vocabulary / Rarely / Often
Difficulty finding the right word / Rarely / Often
Difficultyspeaking in grammaticallycorrect sentences / Rarely / Often
Difficultyexplainingideas or elaborating onthoughts / Rarely / Often

Attention

This student:

Displays difficultyorganizing time and materials / Rarely / Often
Is easily distracted by sights or sounds / Rarely / Often
Does many things too quickly / Rarely / Often
Is often overactive or fidgety / Rarely / Often
Is inconsistent with production of classwork and homeworkassignments / Rarely / Often

Handwriting

This student:

Is slow withhandwritingand copying tasksRarelyOftenDisplays overall poor quality/illegiblehandwriting on writtenassignmentsRarely Often

Student’s Academic Development

English isasecond language for this student.NoYesThis student was retained in grade.

Thisstudenthasbeeninspecialprograms.(SpecialEducation,ReadingRecovery,etc.)NoYesPlease identify these:

Suggested work samples to include:

1.The student’smostrecentspelling test

2.A sample of the student’sunedited writing (journal entry,creative story, etc.)

3.The student’s mostrecentprogress report or report card

4.A copy of the most recent TPRI/early reading assessmentresults

This TeacherObservationQuestionnaire for Dyslexiamay be duplicatedandutilized in educationalsettings as a toolfor documenting parent concernsand observations. If it is edited or adapted, pleasecredit the source byincluding thestatement:“Adapted from the TeacherObservationQuestionnaire for Dyslexia,Texas ScottishRite Hospital forChildren.”

TexasScottishRiteHospitalforChildren–2011