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Which Sign You Have Noticed?
Pleae fill out this form
Student Name:
Class:
Guardian Name:
GRN:
Doesn't Pay Attention or Can't Sit Still
Has trouble focusing on an activity for an extended time
Has trouble keeping up in conversations
Fidgets and fiddles with things
Interrupts a lot or talks constantly
Is Angry or Has Meltdowns
Gets frustrated quickly and gives up
Gets unreasonably upset when something goes wrong
Has trouble letting go of things that are upsetting
Feels hurt, misunderstood, or picked on
Struggles With Reading
Has trouble sounding out words
Skips or substitutes words when reading aloud
Has trouble explaining what a story was about
Avoids reading or acts out when it's time to read
Struggles with Math
Has trouble understanding amounts
Has trouble understanding math symbols, like “7” means “seven”
Has trouble estimating
Avoids math class when there’s a quiz or a test
Loses Track of Items or Thoughts
Often loses objects
Forgets to take important items back and forth from school
Has trouble following directions
Has trouble telling a story in a logical way
Is Stressed or Anxious
Worries too much or too long over minor things
Cries easily or seems overly sensitive
Says and thinks “what if” often
Complains unexpectedly about not feeling well
Struggles with Writing
Has trouble forming letters
Has trouble holding and controlling a pencil
Has trouble coming up with ideas for what to write
Has trouble organizing thoughts in writing
Other (Like Friend Issues)
Has trouble responding to social cues
Says inappropriate things
Withdraws from conversations with other kids
Plays too rough
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