Instructions
Important Disclaimer: This worksheet is an educational tool for parents and caregivers. It is not a diagnostic test. Its purpose is to help you organize your observations and better understand common signs associated with various learning differences and neurodevelopmental conditions. A formal diagnosis can only be made by qualified professionals, such as a child psychologist, developmental pediatrician, or neuropsychologist. Use this checklist to gather specific examples you can share with a professional if you have concerns.
For each statement below, consider your 9-year-old and 15-year-old student. Place a checkmark (✓) or "Y" for Yes in the column if the behavior is frequently observed. Make notes of specific examples in the space provided. It's normal for all children to show some of these traits occasionally; this checklist is for identifying consistent and significant patterns.
Section 1: Reading and Written Language (Signs often associated with Dyslexia)
| Observation | 9-Year-Old | 15-Year-Old |
|---|---|---|
| Has difficulty sounding out or decoding unfamiliar words. | ||
| Confuses letters that look similar (b/d, p/q) or sound similar (f/v). | ||
| Reading is slow, choppy, and requires great effort. | ||
| Struggles with spelling, even common words or words they have studied. | ||
| Avoids reading aloud or becomes anxious when asked to. | ||
| Has trouble remembering facts or summarizing a story after reading it. | ||
| Writing shows many grammatical errors, poor sentence structure, or is difficult to understand. |
Notes on specific examples:
Section 2: Attention & Executive Function (Signs often associated with ADHD)
ADHD includes Inattentive and Hyperactive/Impulsive traits. A person might have one or both types.
Part A: Inattentive Traits
| Observation | 9-Year-Old | 15-Year-Old |
|---|---|---|
| Makes careless mistakes in schoolwork or other activities. | ||
| Has trouble sustaining attention on tasks or during play/leisure activities. | ||
| Does not seem to listen when spoken to directly (mind seems elsewhere). | ||
| Struggles to organize tasks and activities (e.g., messy work, poor time management). | ||
| Frequently loses things necessary for tasks (pencils, books, keys, phone). | ||
| Is easily distracted by external stimuli (a noise, something outside). | ||
| Is forgetful in daily activities (e.g., chores, returning calls). |
Part B: Hyperactive / Impulsive Traits
| Observation | 9-Year-Old | 15-Year-Old |
|---|---|---|
| Often fidgets with or taps hands/feet, or squirms in seat. | ||
| Leaves seat in situations where remaining seated is expected. | ||
| Seems to be "on the go" or "driven by a motor." For teens, this may be more of an internal feeling of restlessness. | ||
| Talks excessively. | ||
| Blurts out an answer before a question has been completed. | ||
| Has difficulty waiting their turn. | ||
| Interrupts or intrudes on others (e.g., butts into conversations or games). |
Notes on specific examples:
Section 3: Social & Behavioral Patterns (Signs often associated with Autism Spectrum)
Autism Spectrum Disorder (ASD) involves persistent challenges in social communication and interaction, alongside restricted or repetitive patterns of behavior or interests.
Part A: Social Communication & Interaction
| Observation | 9-Year-Old | 15-Year-Old |
|---|---|---|
| Has difficulty initiating or maintaining back-and-forth conversations. | ||
| Shows limited sharing of interests or emotions with others. | ||
| Struggles to understand nonverbal cues like body language, facial expressions, or tone of voice. | ||
| Has difficulty developing and maintaining friendships appropriate to their age. | ||
| Takes figures of speech, idioms, or sarcasm literally. |
Part B: Restricted or Repetitive Behaviors & Interests
| Observation | 9-Year-Old | 15-Year-Old |
|---|---|---|
| Has intense, highly focused interests in specific subjects. | ||
| Shows strong adherence to routines; becomes distressed by small changes. | ||
| Has repetitive motor movements (e.g., hand-flapping, finger-flicking, rocking). | ||
| Shows unusual reactions to sensory input (over-sensitive to sounds, textures, smells, or under-reactive to pain/temperature). |
Notes on specific examples:
Answer Key and Explanations
Reminder: This is not a scoring system for diagnosis. This section is designed to help you understand what your observations may suggest and what your next steps could be.
Understanding Your Observations
Section 1: Reading and Written Language (Dyslexia)
What it is: Dyslexia is a specific learning difference that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. It is not a sign of low intelligence.
What your checks may mean: If you checked many boxes in this section for either child, it indicates they may be facing challenges consistent with dyslexia. For the 9-year-old, this might look like a struggle to learn foundational reading skills. For the 15-year-old, they may have developed coping mechanisms, but reading remains slow and tiring, impacting their ability to keep up with complex high school material.
Section 2: Attention & Executive Function (ADHD)
What it is: Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting executive functions like attention, impulse control, and organization. "ADD" is an outdated term, now classified as ADHD, Predominantly Inattentive Presentation. A person can also have Predominantly Hyperactive-Impulsive Presentation or Combined Presentation.
What your checks may mean:
- A pattern of checks in Part A (Inattentive) may point to challenges with focus, organization, and follow-through. This can be easily missed, sometimes being misinterpreted as laziness or apathy.
- A pattern of checks in Part B (Hyperactive/Impulsive) points to difficulties with self-regulation, restlessness, and acting without thinking. In teens, hyperactivity can become less physical and more of an internal sense of restlessness.
- Checks across both sections may indicate a Combined Presentation.
Section 3: Social & Behavioral Patterns (Autism Spectrum)
What it is: Autism Spectrum Disorder (ASD) is a developmental condition characterized by a wide range of symptoms, skills, and levels of disability. The core challenges are in social communication/interaction and the presence of restricted, repetitive patterns of behavior, interests, or activities.
What your checks may mean: If you checked many boxes across both Parts A and B, it might suggest traits associated with autism. Challenges in social understanding combined with very specific, intense interests, a need for routine, or sensory sensitivities are key areas to note. It's a "spectrum" because it presents very differently in each individual.
Recommended Next Steps
- Document, Don't Diagnose: Use your notes from this worksheet to create a list of specific, concrete examples. Instead of "is forgetful," write down "Forgot their math book at home on Monday, Wednesday, and Thursday this week." Specifics are much more helpful to professionals.
- Talk to Your Child: Open a supportive, non-judgmental conversation. You might say, "I've noticed that reading seems really frustrating for you sometimes. Can you tell me what that feels like?" or "It seems like it's hard to sit still during lessons. What's going on in your mind then?" Their perspective is invaluable.
- Consult a Professional: Your first step is usually your pediatrician or family doctor. Share your organized list of concerns with them. They can rule out other medical issues and provide a referral for a comprehensive evaluation.
- Seek a Formal Evaluation: For a formal diagnosis, you will need to see a specialist. This might be a developmental pediatrician, a child psychologist, a psychiatrist, or a neuropsychologist. They will use a variety of tools, interviews, and observations to make an accurate assessment.
An assessment, whether it leads to a diagnosis or not, provides valuable information about your child's unique strengths and challenges, which can help you tailor their education to better suit their needs.