Reading

The student can decode but loses place, skips lines, re-reads, or fatigues within a few minutes of sustained text.

• Separate accuracy from endurance: a student who reads well for two minutes and falls apart at ten has an efficiency or capacity problem, not a decoding problem.
• Confirm visual access first — acuity, contrast, and print size have been addressed or are documented as corrected.
• Ask what changes with print size, spacing, and lighting. A large change points to access; no change points to efficiency or processing.
• Rule out undiagnosed change: new headaches, diplopia, or a sudden decline is a referral, not a treatment target.

• Level 1: Visual Access

  Print too small or too low-contrast for the student's usable vision.

• Level 2: Visual Efficiency

  Saccadic inaccuracy and convergence demand drive place-loss and re-reading.

• Level 5: Functional Integration

  Performance is adequate briefly, then degrades across a school day.

Nothing tagged for this step yet.

Nothing tagged for this step yet.

• Line guide or window card during sustained reading, faded as accuracy holds.
• Increase leading (line spacing) before increasing font size.
• Chunk long passages; build in a distance-viewing break every 10 minutes.
• Allow audio support for content load while visual endurance is being built.

• Short, daily reading at the child's easy level rather than long weekend sessions.
• Reading light behind and to the side, not overhead glare on the page.
• Notice and note when the child stops — time, not pages, is the useful data.

• Minutes of sustained reading before place-loss or complaint.
• Lines skipped per 100 words of oral reading.
• Teacher rating of independent reading participation.

Re-screen the limiting level after 6–8 weeks of consistent intervention. If the occupational problem has not changed while the contributing level has, look upstream for a different limiting factor. If neither has changed, or symptoms are worsening, refer out rather than continuing to treat.