Dyslexia Testing: Questionnaire - A Preliminary Diagnosis

Objective

This questionnaire is to provide information on a person's possible strengths and weaknesses when performing some basic everyday tasks, particularly communicative ones. If an individual consistently performs poorly in particular areas then the information provided from this questionnaire can be the first step in finding out why.

This questionnaire is available as a printable PDF (Opens in new window)

Who fills the questionnaire out?

To be filled out by:

  1. Anyone who is suspected of having a language disability.
  2. A family member, partner, or close friend of the individual.

How is it to be filled?

Indicate with a circle (O) along the scale indicating the degree to which you, or the person you are assessing possesses the feature.

5 = strong yes,  4 = often,  3 = sometimes,  2 = not often,  1 = strong no

For example, for the feature 'Difficulty understanding when reading':

  • A circle around 4 means 'often has difficulties understanding'
  • A circle between 5 and 4 means 'very often has difficulties understanding'

Questions can be omitted if they are not applicable. Just answer as many as possible the best you can. If you are family member, partner, or close friend of the individual, use a different coloured pen to the person being tested.

Understanding
1) Difficulty understanding when reading, particularly novels, magazines, newspapers, text-books, poetry. 5
yes
4
often
3
sometimes
2
not often
1
no
2) Difficulty understanding when listening, particularly jokes, stories, discussions and lectures. 5
yes
4
often
3
sometimes
2
not often
1
no
3) Difficulty interpreting and filling out forms. 5
yes
4
often
3
sometimes
2
not often
1
no
4) Difficulty understanding abstract ideas. 5
yes
4
often
3
sometimes
2
not often
1
no
Memory
5) Difficulty remembering information from listening, e.g. taking messages in a phone conversation. 5
yes
4
often
3
sometimes
2
not often
1
no
6) Difficulty remembering information from reading, e.g. simple facts, names, dates, times, places, etc. 5
yes
4
often
3
sometimes
2
not often
1
no
7) Difficulty remembering names of people, places, items, and times of events. 5
yes
4
often
3
sometimes
2
not often
1
no
Use of Langauge
8) Meaning is sometimes vague when speaking. 5
yes
4
often
3
sometimes
2
not often
1
no
9) Difficulty summarising or making a point, i.e. tends to go round the subject. 5
yes
4
often
3
sometimes
2
not often
1
no
10) Struggles when describing and explaining things in detail, e.g. stories or events. 5
yes
4
often
3
sometimes
2
not often
1
no
11) Poor writing skills, e.g. inappropriate word choice, poor sentence construction, grammar, spelling, and punctuation. 5
yes
4
often
3
sometimes
2
not often
1
no
12) Lacks spontaneity to questions and requests. 5
yes
4
often
3
sometimes
2
not often
1
no
13) Difficulty learning other languages. 5
yes
4
often
3
sometimes
2
not often
1
no
14) Slow with mathematical calculations or difficulty understanding mathematical ideas. 5
yes
4
often
3
sometimes
2
not often
1
no
Concentration
15) Short concentration span on tasks. 5
yes
4
often
3
sometimes
2
not often
1
no
16) Can concentrate only on one thing at a time, e.g. cannot write and listen at the same time. 5
yes
4
often
3
sometimes
2
not often
1
no
17) Daydreams. 5
yes
4
often
3
sometimes
2
not often
1
no
18) Poor natural awareness of surroundings*. 5
yes
4
often
3
sometimes
2
not often
1
no
Knowledge and Learning
19) Has poor general knowledge. 5
yes
4
often
3
sometimes
2
not often
1
no
20) Consistently low academic grades in some subjects. 5
yes
4
often
3
sometimes
2
not often
1
no
21) Overall, finds academic learning difficult. 5
yes
4
often
3
sometimes
2
not often
1
no
Organisation
22) Is disorganized and messy. 5
yes
4
often
3
sometimes
2
not often
1
no
23) Difficulty planning, particularly when implementing an idea. 5
yes
4
often
3
sometimes
2
not often
1
no
24) Difficulty ordering and sequencing. 5
yes
4
often
3
sometimes
2
not often
1
no
25) Difficulty following instructions. 5
yes
4
often
3
sometimes
2
not often
1
no
Time
26) Is slow to complete routine tasks, e.g. dressing, showering, cleaning etc. 5
yes
4
often
3
sometimes
2
not often
1
no
27) Struggles to be on time and is frequently late. 5
yes
4
often
3
sometimes
2
not often
1
no
Behaviour
28) Is clumsy. 5
yes
4
often
3
sometimes
2
not often
1
no
29) Often loses or misplaces items. 5
yes
4
often
3
sometimes
2
not often
1
no
30) Exhibits laziness and slow at beginning tasks. 5
yes
4
often
3
sometimes
2
not often
1
no
31) Periods of lacking confidence and low self-esteem. 5
yes
4
often
3
sometimes
2
not often
1
no
32) Lacks initiative and relies on others for motivation. 5
yes
4
often
3
sometimes
2
not often
1
no
33) Dislikes reading and/or rarely reads novels, magazines, or journals. 5
yes
4
often
3
sometimes
2
not often
1
no
34) Possesses a particular interest in non-academic areas such as arts, crafts, music, photography. 5
yes
4
often
3
sometimes
2
not often
1
no
35) Has occasional behavioural problems, e.g. loses temper, disruptive. 5
yes
4
often
3
sometimes
2
not often
1
no
Physicality
36) Is sensitive to background noise, e.g. holding a conversation against background sounds. 5
yes
4
often
3
sometimes
2
not often
1
no
37) Has a poor sense of direction, i.e., finds it difficult to get around in a strange place. 5
yes
4
often
3
sometimes
2
not often
1
no
38) Is slow to learn sports or follow drill instructions, including dance steps. 5
yes
4
often
3
sometimes
2
not often
1
no

*Natural awareness (q.18) refers to the ability to automatically be aware of one's surroundings without the need to concentrate. A typical daily example: I dress my child in the morning then spend a whole day with her. If she suddenly went missing I would be unable to describe what clothes she had on.

Understanding the Results

If the markings are consistently along the left side of the scale from 3 to 5 (the 'sometimes' to 'yes' region) in a particular area, then further investigation is recommended.

Further Analysis

Think about:

  1. How often you need to compensate for your weaknesses and inabilities, this includes making excuses, misleading and lying to hide them. Describe how and why you need to compensate.
  2. Any language related tasks you avoid or try to avoid doing on a regular basis and/or ones you do but dislike intensely. Describe why you avoid doing or dislike these tasks.

 
This questionnaire is available as a printable PDF (Opens in new window)