Before you start

This form records what you see in class. It is not a diagnosis. Diagnosis is made by a licensed professional, usually a psychologist or psychological associate. In Quebec, a speech-language pathologist (orthophoniste) can also diagnose. Rules differ by province.

The International Dyslexia Association notes that early oral language weaknesses often come before reading problems. It also notes that early help is especially effective. Use this form to act early.

Student: ________ Grade: ________ Teacher: ________ Observation dates: ________ to ________

How to record

Tick each sign you see more than once. Write a short example. Observe over two to four weeks.

Sounds and spoken language

• Struggles to hear or make rhymes. Example: ________
• Has trouble clapping syllables in a word. Example: ________
• Cannot say the first sound in a word. Example: ________
• Mixes up sounds in long words, like "aminal" for "animal". Example: ________
• Has trouble finding the right word when speaking. Example: ________

Letters and sounds

• Has trouble learning letter names. Example: ________
• Has trouble linking letters to sounds. Example: ________
• Forgets letter sounds taught days before. Example: ________

Reading words

• Guesses words from the first letter or picture. Example: ________
• Reads slowly with many errors. Example: ________
• Cannot sound out simple new words. Example: ________
• Reads a word on one page but not the next. Example: ________

Spelling and writing

• Spells the same word many ways. Example: ________
• Leaves out sounds when spelling. Example: ________
• Avoids writing tasks. Example: ________

Behaviour and feelings

• Avoids reading aloud. Example: ________
• Shows stress or frustration at reading time. Example: ________
• Understands stories read aloud much better than stories read alone. Example: ________

Strengths

List what this student does well.

Other factors to check

• Recent vision check
• Recent hearing check
• Learning English or French as an additional language
• Attendance concerns

Summary

Number of signs ticked: ________ Most common area: ________

Next steps

• Continue to observe for ________ weeks.
• Add small-group sound and letter practice.
• Share with the school team on ________.
• Talk with the family on ________.
• Discuss referral for assessment with the school team.

Signature: ________ Date: ________