Screening Device LDRC
Screening Device LDRC
Name: ______________________________________________________________________
Age: __________________ Gender: _________________
A. Physical and Motor Characteristics
1. Is slightly lighter in weight than most children of his own group ____
2. Is shorter in height than most children of his own age group ____
3. Walks with stooping shoulders ____
4. Walks with uncoordinated swaying of the arms ____
5. Tendency to trip or stumble over objects while walking ____
6. Tendency to drop objects and articles ____
7. Has difficulty in maintaining balance while jumping, hopping, and skipping ____
8. Has difficulty in using scissors ____
9. Has difficulty in using knives for slicing, paring, and cutting ____
10. Finds difficulty in tying shoelaces, ribbons or sash ____
11. Is unable to hold pen or pencil correctly ____
12. Has difficulty in tracing circle, square and triangle ____
13. Has difficulty in drawing a circle ____
14. Has difficulty in drawing square ____
15. Has difficulty in drawing a triangle ____
16. Has difficulty in writing letters of the alphabet ____
17. Finds difficulty in writing numbers ____
18. Has the following physical deformities: ____
a. Slanted eyes with coordinated eye muscles ____
b. Protruding forehead ____
c. Large protruding tongue ____
d. Wide face ____
e. Disproportionately short hands and fingers ____
f. Broad hands with fingers having square ends ____
g. Teeth that are pegshaped and chalky ____
h. Swollen eyelids and eyes that are half-shut ____
i. Short thick neck ____
j. Short thick legs ____
k. Large head ____
l. Disproportionately small head ____
m. Dry, course and scaly skin ____
C. Learning Characteristics
1. Has short attention span ____
2. Has poor memory ____
3. Has difficulty in comprehending situations in communication ____
4. Is easily distracted around him ____
5. Has difficulty in finishing work that has been started ____
6. Perseverates or repeats unnecessary action ____
7. Has reversals in written work ____
8. Has difficulty in relating isolated facts into meaningful ideas ____
D. Spoken Language
1. Refuses to talk ____
2. Has the tendency to speak in words or phrases instead ____
3. Tendency to talk in sentences with grammatical errors ____
4. Has immature or improper vocabulary ____
5. Tendency to have articulation problems such as: ____
a. Omissions ____
b. Substitutions ____
c. Additions ____
d. Distortions ____
6. Gropes for words to express himself ____