Does the student receive special assistance at school e.g. speech therapy, special education, NEP?

YesNoNot presently, but has in the pastNot presently, but will be in the future

If yes or will be, please list supports

Auditory Processing Disorder (APD) tends to impact children most in complex settings such as the classroom. This questionnaire is to gauge the student’s general performance in the classroom when compared to their peers.

Please rate the student on the consistency of their performance over time by circling the appropriate number

Academic Achievement Level

Compare the student’s academic performance to others in the class for the following subjects

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Reading

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Maths

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Spelling

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Writing (i.e. Written Expression)

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Art

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Music

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Sport

1 (well below average)2 (below average)3 (average)4 (above average)5 (well above average)

Rate the student’s confidence in his/her own academic abilities

Below AverageAverageAbove Average

Please indicate any of the following that describe the student in comparison to other students in the class

YesNoUnsure

Difficulty developing reading strategies e.g. sounding out new words

YesNoUnsure

Difficulty reading aloud

YesNoUnsure

Difficulty comprehending written text/stories

YesNoUnsure

Reverses letters in written work e.g. /b/ becomes /d/

YesNoUnsure

Has difficulty maintaining attention to individual tasks for an appropriate duration of time

YesNoUnsure

In comparison to others in the class, does the student...

NeverSometimesOftenAlways

Commence new tasks readily

NeverSometimesOftenAlways

Complete tasks set for them

NeverSometimesOftenAlways

Attempt to figure out meaning

NeverSometimesOftenAlways

Ask other students for assistance when unsure

NeverSometimesOftenAlways

Ask the teacher for more information when unsure

NeverSometimesOftenAlways

Participate socially in the classroom setting

NeverSometimesOftenAlways

Please comment on the student's overall social engagement

Does the student demonstrate the following behaviours?

NeverSometimesOftenAlways

Shows confusion

NeverSometimesOftenAlways

Shows fatigue

NeverSometimesOftenAlways

Shows anxiety

NeverSometimesOftenAlways

Is impulsive

NeverSometimesOftenAlways

Works well independently

NeverSometimesOftenAlways

Works well in groups

NeverSometimesOftenAlways

Please indicate if any of the following apply to the student

YesNoUnsure

Is successful in relating to their peers

YesNoUnsure

Is disorganised

YesNoUnsure

Has a short attention span

YesNoUnsure

Is always on the go

YesNoUnsure

Please comment on the student's overall temperament

Speech and Language Skills

In comparison to others in the class, does the student…

NeverSometimesOftenAlways

Express themselves easily?

NeverSometimesOftenAlways

Contribute to discussions in the classroom

NeverSometimesOftenAlways

Successfully retell an incident or a joke

NeverSometimesOftenAlways

Respond to questions without undue hesitation

NeverSometimesOftenAlways

Respond appropriately to questions after a story

NeverSometimesOftenAlways

Pronounce new words accurately

NeverSometimesOftenAlways

Have good articulation i.e. of speech sounds

NeverSometimesOftenAlways

Relate what is heard to what is seen

NeverSometimesOftenAlways

Forget what is said in a matter of minutes

NeverSometimesOftenAlways

Please indicate if any of the following describes the student

NeverSometimesOftenAlways

Understands what is said one to one

NeverSometimesOftenAlways

Understands what is said in a group

NeverSometimesOftenAlways

Looks uncertain following auditory information/instructions

NeverSometimesOftenAlways

Requires shorter messages/instructions

NeverSometimesOftenAlways

Requires repetition of instructions

NeverSometimesOftenAlways

Is able to carry out tasks when the speaker speaks slowly

NeverSometimesOftenAlways

Does not always realise when they have not understood something

NeverSometimesOftenAlways

Follows instructions well i.e. in the appropriate order

NeverSometimesOftenAlways

Please comment on the student's overall speech and language skills

Does the student have difficulty

YesNoUnsure

Sounding out words when reading?

YesNoUnsure

Blending sounds when reading/spelling?

YesNoUnsure

Reverse numbers when writing?

YesNoUnsure

Reverse letters when writing?

YesNoUnsure

Please comment on the student's literacy skills

Listening Inventory for Education - Revised (LIFE-R)

Instructions: Based on your observations, please mark the response that best describes the student’s level of challenge when listening and learning in each of the situations described below. If you have no idea how to answer an item, leave the item blank. Thank you for your assistance.