| 1. My child says he or
she cant see clearly while reading. |
N
S O A |
| 2. My child gets tired
while reading. |
N S O
A |
| 3. My child cannot
concentrate well when reading. |
N S O
A |
4. My childs vision
seems worse in the afternoon/evening than in the
morning. |
N S O
A |
| 5. My child has learning
problems. |
N S O
A |
| 6. My childs eyes
tear a lot. |
N S O
A |
7. Reading or working at
a computer for a few hours gives my child a
headache. |
N S O
A |
| 8. My child closes one
eye when reading. |
N S O
A |
| 9. My child rubs his or
her eyes at the end of the day. |
N S O
A |
| 10. My child is a slow reader. |
N S O
A |
| 11. My child has difficulty
understanding what he or she is reading. |
N S O
A |
| 12. My child has a short attention
span. |
N S O
A |
| 13. My child skips or repeats lines
when reading. |
N S O
A |
| 14. I see one of my childs eyes
wandering outwards or inwards. |
N S O
A |
| 15. My child gets car sick. |
N S O
A |
| 16. My child finds it difficult to
read in a car or on a bus. |
N S O
A |
| 17. My child is not performing up to
his or her potential |
N S O
A |
| 18. My child cant keep up with
assignments in school. |
N S O
A |
| 19. My child tries to avoid doing
homework and other reading. |
N S O
A |
| 20. My child complains of itching or
irritation in his or her eyes |
N S O
A |