Is your child very hands-on? (i.e., loves to build, take things apart, etc.) YesNo
Is your child action oriented? (e.g., fast paced activities, outdoors, etc.) YesNo
Is your child showing signs of discouragement in school and with academics (typically starting in third-fourth grade)? YesNo
Can your child sit for hours with visual activities, but have limited attention for reading, and other language-based activities? YesNo
Does your child seem to dislike reading more than you would expect for his or her age? YesNo
Is writing a painful chore for your child? YesNo
Is your child showing signs of disliking school more than you would expect for his or her age? YesNo
Did one or both parents show signs of struggling in school? YesNo
Is one or both of the parents in a field, profession or occupation that involves business or that is visual and more hands-on in nature? YesNo
Are you getting increasingly frustrated in terms of managing your child’s academic issues? YesNo
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