Dyslexia Risk
This screener helps identify potential risk factors for dyslexia and related reading difficulties. It is not a diagnosis. Results help determine whether your child may benefit from a full evaluation or structured-literacy support.
I understand this tool does not diagnose dyslexia and is used for educational screening purposes only.
Yes
Student's Name
*
First Name
Last Name
Parent(s) Name or Guardians
*
First Name
Last Name
Parent/Guardian Name
*
Email
*
Phone Number
*
School
*
Student Grade
*
Student Date of Birth
*
-
Month
-
Day
Year
Date
Referred by:
Optional
Family History
Language(s) spoken at home:
Optional
Family history of reading difficulties? Parents, siblings, grandparents with reading difficulties, dyslexia, ADHD?
Yes
No
Unsure
Other
Previous support:
Reading Tutor
Speech Language Therapy
IEP
504 Plan
Retained a grade
None
Other
Concerns noticed since:
Preschool
Early Elementary (k-2)
Later Elementary (3-5)
Middle School
Recently
Other
Has your child had reading tested at school?
Yes- Below Grade Level
Yes- At or Above Grade Level
No
Unsure
Other
Core Risk Factors
Answer to the best of your knowledge and ability. 0=Never, 1=Sometimes, 2=Often, 3= Always
Difficulty breaking words into sounds (ex: c- a-t)
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficult difficulty blending sounds into words
0
1
2
3
Never
Always
0 is Never, 3 is Always
Confuses similar sounds (f/th, b/p, t/d)
0
1
2
3
Never
Always
0 is Never, 3 is Always
Struggles(d) to remember similar sounds
0
1
2
3
Never
Always
0 is Never, 3 is Always
Struggles(d) to learn to remember sight words or irregular words
0
1
2
3
Never
Always
0 is Never, 3 is Always
Guesses words based on the first letter or picture
0
1
2
3
Never
Always
0 is Never, 3 is Always
Avoids reading aloud
0
1
2
3
Never
Always
0 is Never, 3 is Always
Slow, effortful reading, especially compared to peers
0
1
2
3
Never
Always
0 is Never, 3 is Always
Struggles with multisyllabic words
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficulty reading nonsense words (lat, mig, trab)
0
1
2
3
Never
Always
0 is Never, 3 is Always
Spells phonetically, but inconsistently
0
1
2
3
Never
Always
0 is Never, 3 is Always
Consistently inconsistent with reading/spelling
0
1
2
3
Never
Always
0 is Never, 3 is Always
Mixed letter sequences (bried for bride)
0
1
2
3
Never
Always
0 is Never, 3 is Always
Frequent letter reversals beyond 2nd grade
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficulty writing clear organized sentences
0
1
2
3
Never
Always
0 is Never, 3 is Always
Calculation
Associated Signs
Late to talk
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficulty remembering nursery rhymes
0
1
2
3
Never
Always
0 is Never, 3 is Always
Struggles following multi-step directions
0
1
2
3
Never
Always
0 is Never, 3 is Always
Problems retrieving words ("tip of the tongue")
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficulty memorizing math facts
0
1
2
3
Never
Always
0 is Never, 3 is Always
Slow recall of days, months, left/right
0
1
2
3
Never
Always
0 is Never, 3 is Always
Needs instructions repeated
0
1
2
3
Never
Always
0 is Never, 3 is Always
Becomes easily overwhelmed by schoolwork
0
1
2
3
Never
Always
0 is Never, 3 is Always
Avoids reading and writing tasks
0
1
2
3
Never
Always
0 is Never, 3 is Always
Homework takes unusually long
0
1
2
3
Never
Always
0 is Never, 3 is Always
Difficulty staying organized (desk, backpack, materials)
0
1
2
3
Never
Always
0 is Never, 3 is Always
Low confidence about school
0
1
2
3
Never
Always
0 is Never, 3 is Always
Other signs based on educational age
In Preschool
delayed speech
mixing up the sounds and syllables in long words
chronic ear infections
severe reactions to childhood illnesses
constant confusion of left versus right
late establishing a dominant hand
difficulty learning to tie shoes
trouble memorizing their address, phone number, or the alphabet
can't create words that rhyme
a close relative with dyslexia
Other
In Elementary School
dysgraphia (slow, non-automatic handwriting that is difficult to read)
letter or number reversals continuing past the end of first grade
extreme difficulty learning cursive
slow, chopping inaccurate reading: guessing based on shape or context, skips or misreads prepositions (at, to, of), ignores suffixes, can't sound out unknown words
terrible spelling
often can't remember sight words (they, were, does) or homonyms (their, they're, there)
difficulty telling time with a clock with hands
trouble with math: memorizing multiplication tables, memorizing a sequence of steps, directionality
when speaking, difficulty finding the correct word: lots of "whatyamacallits" and "thingies," common sayings come out slightly twisted
extremely messy bedroom, backpack, and desk
dreads going to school: complains of stomach aches or headaches, may have nightmares about school
Other
In High School: All of the above plus:
limited vocabulary
extremely poor written expression: large discrepancy between verbal skills and written compositions
unable to master a foreign language
difficulty reading printed music
poor grades in many classes
may drop out of high school
Other
In Adults: Education history similar to above, plus:
slow reader
may have to read a page 2 or 3 times to understand it
terrible speller
difficulty putting thoughts onto paper: dreads writing memos, emails, letters
still has difficulty with right versus left
often gets lost, even in a familiar city
sometimes confuses b and d, especially when tired or sick
Other
Oral reading fluency:
If known
Decoding test results:
If known
Teacher comments:
If known
Previous testing results:
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