Irlen East for the east of England

07745 333314

Self test form

Please tick all questions where you notice you or your child have difficulty

Bothered by sunlight
Bothered by glare
Do you frequently wear sunglasses
Bothered by bright or fluorescent lights
Anxious, tired or drowsy under bright or fluorescent lights
Get a headache from bright or fluorescent lights
Feel fidgety under bright or fluorescent lights
Harder to listen under bright or fluorescent lights
Performance deteriorates under bright or fluorescent lights
Feel like there is not enough light when reading
Feel like there is too much light when reading
Read in dim light
Use fingers or other marker to block out part of the page
Do you shade the page with your hand or body
Problems concentrating with reading or writing
Easily distracted when reading or writing
Easily distracted when listening
Easily distracted when taking tests
Daydreams in class or at lectures
Problems staying on task
Problems starting tasks
Difficulty with multiple choice answer sheets
Doing paper and pencil tasks
Working on the computer or reading from a screen
Watching TV, films, or live stage productions
Copying material
Doing maths assignments
Texting or gaming on the phone
Writing long assignments
Doing visually-intensive activities like sewing, puzzles,etc
Working under bright or fluorescent lights
Looking at stripes, patterns, bright colours and contrast
Difficulty getting on and off escalators
Bump into table edges or door jams
Difficulty walking up and/or down stairs
Difficulty judging distances
Drop or knock things over
As a child, accident prone or have bruises on your shins
When walking next to someone, do you drift into the person
When walking, do you feel dizzy or light headed
Difficulty getting on or off moving objects
Skip words or lines
Repeat or reread lines
Read for short periods
Lose place
Read in a “stop and go” rhythm
Omit small words
Poor reading comprehension
Reading becomes harder as you continue
Avoid reading
Reversals of letters and/or numbers
Rub your eyes
Move closer to or further away
Open eyes wide
Incorporate breaks
Change position to reduce glare
Close or cover one eye
Move head
Read word by word
Unable to speed read
Write up or down hill
Unequal or no spacing between letters or words
Unequal letter size
Unable to write on the line
Leave out words, letters, or punctuation marks
Lose place
Leave out words
Slower than average
Incomplete or missing elements
Careless errors
Blink or squint
Difficulty refocussing
Difficulty copying things onto or from the computer screen
Problems with punctuation
Problems proofreading
Leave out letters or words
Write without rereading
Misalign digits in number columns
Difficulty seeing numbers in the correct column
Sloppy or careless errors
Use finger, or other marker when working with numbers
Difficulty seeing signs, symbols, numbers, decimal points
Reversals of numbers
Problems sight reading notes
Prefer to memorise rather than read music
Prefer to play by ear
Use finger to track notes
Lose your place
Trouble reading the notes or notes and words together
Difficulty interpreting the music notations
Little progress in spite of regular practice
As a passenger, do you become drowsy
When driving, do you become drowsy
Bothered by glare off the rear window of the car in front of you
Bothered by headlights and street lights at night
Avoid driving at night
Have night blindness
Bothered by red rear lights on cars
Bothered by red traffic lights
Stressful to drive in the rain (glare)
Difficulty parallel parking
Do you feel like you will hit the car in front when parking
When parking, do you hit the curb or leave too much space
Difficulty judging when to turn in front of oncoming traffic
Extra cautious when making lane changes
Do passengers tell you that you tailgate
Overly cautious, leaving extra room between you and car ahead
Problems tracking a flying ball like golf, rounders, or tennis
Trouble following the ball when watching sports on TV
With TV-sports, can you follow the ball but not anything else
Trouble catching a ball
Difficulty hitting the ball when playing cricket or tennis
Trouble learning how to ride a bike
Trouble skipping?
Trouble playing games such as volley ball or netball
On playground equipment is it hard to go from one to the other

Call us: + 07745 333314

Copyright Irlen East 2019

 All Rights Reserved


Irlen East the Irlen Centre covering East of England

Copyright © 1998-2006 by Perceptual Development Corp/Helen Irlen. All rights reserved

Copyright © 1998-2019 by Perceptual Development Corp/Helen Irlen. All rights reserved