SOUTH CUMBRIA DYSLEXIA ASSOCIATION

Transcription

1 SOUTH CUMBRIA DYSLEXIA ASSOCIATION c/o Stricklandgate House, 92 Stricklandgate, Kendal, LA9 4PU address: ADULT QUESTIONNAIRE Section 1: Personal Details: Name: Date of Birth: address: Contact address and phone number: Section 2: Background information: Does anyone in your family have issues with spelling/reading/learning? Are you right or left handed? Do you have any problems with eyesight? For example, a lazy eye, squint, shortsighted? When was your eyesight last tested? When you read, does the print seem to move or blur? Have you had your hearing tested? Have you had any problems with hearing? Did you have any ear infections, glue ear or continual sore throats as a child? Do you find it difficult to concentrate when there is background noise?

2 Were there any problems with your birth? Did you have any problems learning to walk or talk? Have you needed speech therapy? Have you suffered from any serious illnesses or accidents? Do you suffer from migraines or allergies? Do you take any regular medication that might affect your learning? Is English your first language? If not, do you have issues reading or writing in your first language? Do you speak any other languages? Did you have any trouble learning them? Section 3: School Experience At school, did you have any difficulty with the following activities? Reading No Slight Yes Spelling No Slight Yes Handwriting No Slight Yes Mathematics No Slight Yes Essays No Slight Yes Exams No Slight Yes Sports or catching a ball No Slight Yes Learning the alphabet No Slight Yes Learning times tables No Slight Yes Telling the time No Slight Yes Learning to speak or pronounce words No Slight Yes Learning to tie shoelaces No Slight Yes

3 At school what were you good at? Overall, would you say your school experience was good? Did you work hard at school? Did you miss much or school or were there any family disruptions that interfered with your schooling? Did you get any extra help? Were you ever assessed for learning difficulties or dyslexia? Section 4: Work Experience If you are working, are you having any difficulties with reading, writing or memory? What is your job? Have you taken any other courses or got any qualifications since leaving school? Section 5: Current Difficulties Do you currently have any problems with the following? Getting information from textbooks Yes No Remembering what you ve read Yes No Taking notes from text books Yes No Getting information from lectures/seminars Yes No Taking notes in lectures Yes No Exam results Yes No Exam revision Yes No Do you find it difficult to express your ideas in writing? Yes No Do you need to rewrite work or spend more time on it than others? Yes No Is organizing written information difficult? Yes No Do you miss out full stops, commas and other punctuation? Yes No Do you write long rambling sentences? Yes No Is your handwriting hard to read? Yes No Do you avoid using words you cannot spell? Yes No Do you make a lot of spelling errors? Yes No Do you miss out words or the endings of words? Yes No Do you have trouble finding your own mistakes? Yes No

4 Do you tend to write down everything as it comes into your head? Yes No Do you start sentences then forget what to put? Yes No Do you find it hard to meet assignment deadlines? Yes No Do you put off starting essays until the last minute? Yes No Do you get confused over dates, times and appointments? Yes No Is map reading or finding your way to a strange place confusing? Yes No Do you have difficulty in saying long words? Yes No Can you give examples? Do you confuse left and right? Yes No Do you get confused if you have to speak in public? Yes No Do you find it difficult to take phone messages? Yes No Do you find it hard to remember sequences of numbers or letters such as telephone numbers or car registrations? Yes No Do you forget people s names? Yes No Do you have problems learning new words? Yes No Section 6: Coping strategies What do you do to help you overcome your current difficulties? Do you use a computer or word processor? Yes No Do you have your own or easy access to one? Yes No Do you use a pocket spell checker regularly? Yes No Do you have someone who can check your work? Yes No Do you use a tape recorder for recording information? Yes No What help do you get from others? How do you feel others could help you more? What other strategies have you developed to help you get round your difficulties?

5 Section 7: Samples of your word processing: We know you probably won t like this bit, but we do need to see samples of your writing and word processing. Could you please spend exactly 10 minutes producing a piece of word processed work. It is very important that you stick strictly to the time limit. Section 8: Samples of your writing: Could you please spend exactly 10 minutes producing a piece of handwritten work about any topic. Again it is very important that you stick strictly to the time limit.