BIT BEHAVIORAL CHECK LIST (copyright Susan McCrossin, Learning Enhancement Center, Boulder, CO)
NAME: __________________________ DATE: ___________________________
Please check anything which might apply, and put two checks for anything which is especially important.
___ Accident prone
___ Allergies (feel tired or hyper-active after eating)
___ Clumsy
___Constipated
___Daydreams excessively
___ Difficulty budgeting time
___ Difficulty concentrating
___ Difficulty focusing eyes
___ Difficulty following directions
___ Difficulty giving directions
___ Difficulty telling time
___ Dizziness / vertigo / balance problems
___ Eye strain / rubs eyes a lot
___ Fear of speaking in front of a group
___ Has trouble remembering directions
___ Has trouble remembering months of the year
___ Has trouble remembering names
___ Over or under active
___ Poor eye-hand co-ordination
___ Poor handwriting
___ Poor organizational skills
___ Poor reading comprehension
___ Poor reading skills
___ Poor balance
___ Poor spelling
___ Poor arithmetic
___ Poor at sports or rhythmic activities
___ Rests head on arm while working
___ Short attention span
___ Slow in completing work
___ Stops in the middle of a game
___ Test or performance anxiety
___ Timid / shy
___Phobias / fears (explain)
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Speech difficulties (explain)
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Other: (explain)
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___ Has trouble remembering right/left
___ Has trouble remembering times tables
___ Has trouble differentiating colors
___ Headaches
___ Impatient / restless
___ Impulsive
___ Inappropriate drowsiness
___ Lacks confidence
___ Leaves projects incomplete
___ Letter / number reversal
___Lies
___ Mood swings