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Adult Self Test
Adult Self Test
Step
1
of
3
33%
READING
When reading
Do you unintentionally skip lines, repeat lines or lose your place?
Yes
No
Do you have to re-read in order to understand?
Yes
No
Are you easily distracted?
Yes
No
Do you avoid reading whenever possible?
Yes
No
Do you experience headaches or fatigue?
Yes
No
EYESTRAIN
When reading:
Do your eyes hurt, burn, itch, water, become tired, ache?
Yes
No
Does it take energy and effort to see the words clearly?
Yes
No
On the computer do your eyes hurt, burn, itch, water, become tired, ache?
Yes
No
Does it become progressively worse as reading continues?
Yes
No
PRINT RESOLUTION
When reading do words ever:
Blur or seem fuzzy?
Yes
No
Move or merge?
Yes
No
Double, distort or fade?
Yes
No
Get darker in colour?
Yes
No
Have halos or shadows?
Yes
No
LIGHT SENSITIVITY
Do you find:
Sunlight too bright and/or sunglasses a necessity?
Yes
No
Fluorescent lighting too bright?
Yes
No
It uncomfortable to read or work under fluorescent light?
Yes
No
It easier to read in dull or dim light?
Yes
No
White pages too white, bright or glary?
Yes
No
You squint when outside because the light bothers you?
Yes
No
You have difficulty adjusting from bright lights to darkness and/or darkness to bright lights?
Yes
No
Computer screens / white boards seem bright?
Yes
No
Magazine or text book pages seem shiny or glossy, so you adjust the book in order to eliminate glare?
Yes
No
Headlights or streetlights bother you or have halos?
Yes
No
FATIGUE
Do you:
Experience headaches or migraines?
Yes
No
Experience discomfort, strain, fatigue, headaches when using computers?
Yes
No
Fatigue after work?
Yes
No
DEPTH PERCEPTION
Do you:
Hold onto the railing while walking up or down stairs?
Yes
No
Have difficulty getting on and off escalators?
Yes
No
Bump into objects when walking e.g. table edges or door jams?
Yes
No
Veer into people when walking beside them?
Yes
No
Ever feel dizzy when walking?
Yes
No
Have difficulty judging the distance of oncoming traffic?
Yes
No
See yourself as clumsy?
Yes
No
Experience motion sickness?
Yes
No
Have trouble catching, hitting or following a ball while watching sport on TV?
Yes
No
When driving do you:
Have difficulty judging the distance of oncoming traffic?
Yes
No
Leave lots of room between your car and the car ahead?
Yes
No
Have difficulty making lane changes or are extra cautious?
Yes
No
Feel nervous about passing cars on a two lane road?
Yes
No
Tailgate or do your passengers tense when you change lanes?
Yes
No
Have difficulty parking the car?
Yes
No
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