(C-SIP)

Cooper Screening of Information Processing

Short Form (Red);  Full Screening (Red and Black)


This screening was developed by Dr. Richard Cooper as part of two 353 projects in 1992, one in Pennsylvania and one in South Carolina. It is not meant to be a standardized test but rather a diagnostic teaching instrument. This screening is not designed to enable teachers to diagnose learning disabilities, but it may be the first stage of an evaluation process which ultimately results in such a diagnosis. A student who answers yes to the majority of the questions on the screening may have a learning disability. This student should be referred for further testing.

In response to many requests for a short form of this screening, the creator, Dr. Richard Cooper has restructured the screening to provide a short form within the original C-SIP.  The short form, printed in red, includes the basic information needed to determine if the person should be referred for more testing for a diagnosis of a learning disability.   The short form is included within the original because the person administering the screening may want to use the short form on all students and the full C-SIP on only those who evidence problems.   If the administrator of the C-SIP wants the full screening, he or she should ask all the questions (red and black). 

The best results are obtained from students who have a good and honest knowledge of themselves. Sometimes adult students will not understand the severity of their own difficulties. For example, when asking a student about spelling, the student might believe that spelling is not a problem because he or she can write simple sentences. However, when compared to others, the student might indeed have a spelling problem. In those cases, the administrator of the screening needs to make a judgment rather than simply record the student’s response. The more one uses this screening, the more information one can obtain from it about the students. The screening takes about 50 minutes to administer for most individuals. It takes less time to administer to students with very low skills or who have limited self-awareness, and it takes more time to administer to those students who talk a great deal and try to explain each answer.


Learning disAbilities Resources (free catalog 1-800-869-8336) has a videotape of Dr. Cooper administering the C-SIP to a student followed by an explanation of the process.  There is an Administration Manual and an Interpretation Manual that provides answers to many questions about how to use and interpret the C-SIP.  If you have questions about the screening and how to administer it, you can call Dr. Cooper at 610-446-6126 or contact him through our web site (www.learningdifferences.com).  Dr. Richard Gacka, Director of the Pennsylvania Learning Differences Center, has prepared a scoring assistant for the C-SIP.  The scoring assistant provides graphs of the results that can be printed and given to the student.  You can access the scoring assistant at:  www.able.state.pa.us/able/cwp/view.asp?a=15&q=88413. 
 

I have read, or have been told, and understand the purpose of this screening.  I realize I am free to withdraw my consent and to withdraw from this activity at any time.

                                                                                                                                                                                                                        

Participantís Printed Name                                Signature                                                                      Date Signed         
When informed consent is required and participant is under 18, parent/guardian signature is required. 

I have read, or have been told, and understand the purpose of this screening.

                                                                        
                                                                                                                                               

Parentís/Guardianís Printed Name                     Signature                                                                      Date Signed     

 

 

Cooper Screening of Information  Processing

 

Evaluation Date ____/____/____                     Client’s Date of Birth ____/____/____                  Age ____

Client’s Name ____________________________        Interviewer___________________________

Address ________________________________         Agency _______________________________

             _________________________________        Martial Status     S ___   M ___   D ___   W __

City ____________________________________       State ______       Zip ___________

Phone      ____________________________________           ___________________________________
Reason for the Screening        _____________________________________________________________
Referred by _________________________________ at _____________________________________

 

Educational History

 

Current grade, last grade completed, or the number of years the person attended school. __________
Schools ____________________________________________
            _____________________________________________    Best Subject ___________________

           _____________________________________________    Worst Subject __________________

Did you drop out of high school before graduation?

Yes ____
      Did you like school? (Mark yes if the person disliked school.) Yes ____
Did you ever fail a subject or repeat a grade? Yes ____
      Did you ever have to attend summer school to make up work? Yes ____

Did you have difficulty with English or Language Arts classes?

Yes ____
      Did you have difficulty with math classes? Yes ____
Were you ever in special education classes? Yes ____
      Were you ever tested for a learning disability, ADD or other problems? Yes ____
            If yes, at what age? ____________
Were you ever labeled?  (e.g. LD, ADD, dyslexic, brain damaged, Yes ____
            emotionally disturbed, retarded, behavioral problem, slow learner, etc.)
What Label (s) ___________________________________________________________
Reported Problems ________________________________________________________

 

Summary of Educational History:                Number yes          Short total _____           Total red and black _____       


Do you have any vision problems or wear glasses?              _________________________________


Do you have any hearing problems or use a hearing aid?   _________________________________

 

 

Attention

 

Were you an active child? 

Yes ____  

      Were you ever called hyper or hyperactive, even informally?

  Yes ____
Are you an active person now? Yes ____  
      Do you have a high energy level compared to your peers?   Yes ____
Do you find your mind racing so you get too many ideas or thoughts at once? Yes ____  
      Do you have many tasks, projects, going on at once?   Yes ____
Do you have a short attention span?  Yes ____  
      Do you have a tendency to day dream?   Yes ____
 Do you leave doors and drawers open? Yes ____  
      Are you easily distracted?   Yes ____
     
Summary of Attention Problems Yes Total # ___  

  

 

Motor Skills

Do you have poor handwriting? 

Yes ____
       Did you avoid playing sports as a child? Yes ____
Do you avoid playing sports now?  Yes ____
       Do you find driving difficult? Yes ____
Are you a poor driver? Yes ____
       Do you frequently drop or spill things? Yes ____
Do you consider yourself clumsy? Yes ____
       Do you have problems with hand/eye coordination? Yes ____
Summary of motor problems Yes Total # ___

  

 

Auditory

Do you find yourself listening to more than one conversation at a time? 

Yes ____  
      Rhyme the word:    

           CAT     ______________  ______________  __________________

   
           SLOW  ______________  ______________  __________________    
          QUICK ______________  ______________  __________________    
      Person has difficulty rhyming?    Yes ____
Do you often mishear words that are said to you?  Yes ____  
      Do you misinterpret what is said to you?    Yes ____
Do you take things that are said too literally or miss double meaning or jokes?  Yes ____  
      Do you have difficulty paying attention to long conversations or lectures?    Yes ____
Do you have difficulty hearing what one person is saying when there are    
a lot of people talking? Yes ____  
      Does your mind race ahead thinking about the first things that was said    
      to you so you do not hear or pay attention to the rest of what was said?    Yes ____
Do you have difficulty with spelling?  Yes ____  
Do you have difficulty reading (decoding or sounding out) unfamiliar words?   Yes ____
     
Summary of Auditory Problems:         Number yes         Short total _____          Total red and black _____    

 

Right/Left Discrimination

Do you confuse right and left?

Yes ____
   Check: How do you know your right and left? ___________________________________________
       Did you reverse letters or numbers as a child?  Yes ____

Do you reverse letters or numbers now, or get phone numbers wrong? 

Yes ____
       Do you have to stop and think when someone tells you to turn right or left?  Yes ____

Do you have difficulty making choices (what to eat, where to go, what to do)? 

Yes ____
       Do you have to stop and think which way to loosen a screw that is tight? Yes ____
Do you point one way when you mean the other or say the opposite as you point?  Yes ____

      Do you have difficulty with North, South, East and West? 

Yes ____
Do you find True and False questions difficult or do you read too much into questions?  Yes ____
      Do you find the same is true for some multiple choice questions, or have  Yes ____
      difficulty deciding between two answers which are similar?
Do you find yourself stopping for green lights?  Yes ____
      Do you get lost in large buildings, malls or parking lots? Yes ____

Do you have difficulty reading maps or have to turn them to match the direction you

 Yes ____

are traveling?

Summary of Right/Left Discrimination:   Number yes                          Short total ____ Total red and black ____

 

 

Organizational Skills

     
Are you organized or disorganized?        disorganized  Yes ____  

      Do you tend to collect too many things? 

  Yes ____
Is your living or work space messy or disorganized?  Yes ____  
      Do you misplace or lose things, especially little things such as keys, combs   Yes ____
      glasses, pens, pencils, homework, tools, utensils, etc.?    
Are you often late? Yes ____  
      Do you have difficulty planning or using free or unstructured time?   Yes ____
Do you have difficulty organizing your ideas when you write?  Yes ____  
      Do you have difficulty organizing your ideas when your speak?   Yes ____
     
Summary of Organizational Skills:   Number yes                              Short total _____ Total red and black ___

 

 

Employment

Are you employed or unemployed?       unemployed  

Yes ____
      Do you have difficulty learning new jobs? Yes ____
Do you have difficulty completing tasks on the job? Yes ____

      Have you ever been fired because of such problems? 

Yes ____
Are you or have you been a client of Vocational Rehabilitation?  Yes ____
      What types of jobs have you had?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Summary of Employment  Yes Total # ___  

 

 

 

Emotional

Are you a moody person?   

Yes ____            
      Are you a nervous person? (more than most)           Yes ____
Are you a worrier?  Yes ____
      Any problems with alcohol?  Yes ____

Any problems with drugs? 

Yes ____
       Do you, or have you suffered from test anxiety?  Yes ____
Have you ever gone blank, or froze, on a test?  Yes ____
      Have you ever been on medication for psychological reasons?  Yes ____
                (e.g. depression, anxiety, etc.)
Have you ever been hospitalized for psychological reasons? Yes ____
      Did you ever have a severe head injury?    If yes, at what age? _______ 
      Did you have problems in school before the injury? _________________  Yes ____
Summary of Emotional Yes Total # ___

 

 

Social and Family

Are you shy or outgoing?                                                       shy 

Yes ____  

         Do you have difficulty making friends? 

  Yes ____
Would you say you have only a few friends? Yes ____  

         Do you have difficulty getting along with members of the opposite sex? 

  Yes ____
Would you consider yourself a social person or a loner?       loner  Yes ____  
         Do you have any children?    

                 If yes, how many? ________ ages? _____________

   
         Do they or did they have any learning problems or difficulties in school?   Yes ____

Do you have any siblings?

   
                 If yes, how many? Brothers ___________ Sisters ______________    
         Do they or did they have any learning problems or difficulties in school? Yes ____  
Your father’s occupation? ______________________________    
        Did he have any learning problems or difficulties in school?    Yes ____
Your mother’s occupation? ______________________________    

         Did she have any learning problems or difficulties in school? 

Yes ____  
     
Summary of Social and Family Yes Total # ___

 

 

Oral Communication

Do you believe that your speaking vocabulary is smaller than others? 

Yes ____  

         When you speak, do people have difficulty understanding what you

   

         are trying to communicate to them? 

  Yes ____

Are there any words which you have difficulty pronouncing or get you tongue-tied? 

Yes ____  

         Do you have a tendency to ramble, changing the topic often? 

  Yes ____

Do you talk too much? (Check: Does the person talk too much or take too long

   

to answers these questions?) 

Yes ____  

         Do you interrupt others? 

  Yes ____
     
Summary of Oral Communication:                              Number yes                        Short total ____ 

 Total red and black ____

 

 

Writing

Do you have difficulty with spelling? Yes ____  

        Do you write a lot or only what you have to?      Only what one must  

  Yes ____

Is expressing your thoughts and ideas in writing difficult for you? 

Yes ____  

          Do you have difficulty deciding what to write about? 

  Yes ____

Do you have difficulty taking notes? 

Yes ____  

            Spelling ___ Handwriting ___ Main Idea ___ Can’t write and listen ___

   

         Do you speak better than you write? 

  Yes ____

Do you find that when you write some of your sentences are incomplete? 

Yes ____  

          Do you often write run-on sentences? 

  Yes ____

Do you have difficulty with grammar or with the less-used grammar rules? 

Yes ____  

          Do you have difficulty with punctuation (e.g. commas, semicolons, etc)? 

  Yes ____

Do you skip words when you write? 

Yes ____  

          Do you procrastinate on writing assignments? 

  Yes ____
     
Summary of Writing:                                                    Number yes                        Short total ____  Total red and black   ____

 

 

 

 Handwriting

Turn to the handwriting sample page and have the person do the following:

 

Print your full name.

Write your full name in cursive, script, sign your name.

Write a sentence about why you are here.

If not able to write that, can you write a sentence about anything.

(If the person is not able to write anything, move to the next item.)

Write or print the alphabet.

Write the numbers 1 to 20.

Draw a picture.

 

Is the person’s handwriting slanted up or down the page?  Yes ____  

         Is the person’s handwriting difficult to read? 

  Yes ____

Are the letters oversized for his/her age? 

Yes ____  

         Is the alphabet incomplete? 

  Yes ____

Does the person mix capital and small letters? 

Yes ____  

         Are there any reversals? 

  Yes ____

Does the sentence have any errors? Spelling ___ Missing words ___ Incomplete ___  

Yes ____  

         Does the person write the second digit before the 1 when writing the teen numbers? 

  Yes ____

Does the person hold the pen or pencil in an unusual way? 

Yes ____  

         Is the person’s drawing disproportionate, too simple, very unusual? 

  Yes ____

Notable observations __________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

     
Summary of Handwriting:                    Number yes                         Short total ____

Total red and black ____

 

 

Basic Math Skills

Do you often count on your fingers or in your head? 

Yes ____  

          Does the person have difficulty with the addition facts? 

  Yes ____

          Check: 9 + 7 _____             *A__ D__ LD__ NR__ G__ CF__ CH__

   

                      8 + 6 _____             *A__ D__ LD__ NR__ G__ CF__ CH__

   

Does the person have difficulty with subtraction facts? 

Yes ____  

          Check: 17 - 9 _____            *A__ D__ LD__ NR__ G__ CF__ CH__

   

                      12 - 5 _____            *A__ D__ LD__ NR__ G__ CF__ CH__

   

          Did you have difficulty learning the multiplication tables? 

  Yes ____

Does the person have difficulty with multiplication facts? 

Yes ____  

          Check: 8 x 7 _____              *A__ D__ LD__ NR__ G__ CF__ CH__

   

                     7 x 6 _____               *A__ D__ LD__ NR__ G__ CF__ CH__

   

                     9 x 6 _____               *A__ D__ LD__ NR__ G__ CF__ CH__

   
     
Summary of Basic Math Skills           Number yes      Short total ____   Total  ____
*Automatic Recall__ Delay in Auto Recall __ Long Delay__ Number Relationship__
Guess__ Counting on Fingers__ Counting in Head__    

 

 

 

Math Skills

Was it difficult for you to learn long division? 

Yes ____  
          Is it still difficult for you?    Yes ____
Was it difficult for you to learn fractions?  Yes ____  
          Is it still difficult for you?    Yes ____
Was it difficult for you to learn decimals?  Yes ____  
          Is it still difficult for you?   Yes ____
Was it difficult for you to learn percentages?  Yes ____  
          Is it still difficult for you?    Yes ____
Was it difficult for you to learn positive and negative numbers?  Yes ____  
          Is it still difficult for you?   Yes ____
Were word problems difficult? Yes ____  
          Have you taken algebra? If yes, did you have difficulty with algebra?  

 Yes ____

Have you taken geometry? If yes, did you have difficulty with geometry? Yes ____  

           Have you taken other math? ____________ If yes, did you have difficulty with it? 

  Yes ____
     
Summary of Math Skills Number Yes Total ____

 

 

Math Vocabulary

Does the person have difficulty defining:                             (For young children or adults with limited ability use the terms in parenthesis)
Mark "C" (correct) if the person can define the word.  If the person cannot define the word but can use the word  in a sentence,
mark "S" (sentence).  If the person cannot define the word, mark "I" (incorrect).
 
EQUAL  (Equal) _______________________________ C ____ S ____ I ____
AVERAGE (Add) _______________________________ C ____ S ____ I ____
UNIT  (Subtract) _______________________________ C ____ S ____ I ____
VARIABLE (Multiply) _______________________________ C ____ S ____ I ____
COMPOUND INTEREST (Divide) _______________________________  C ____ S ____ I ____
         
Summary of Math Vocabulary   Short total "I" ____ Total "I" ____

 

 

Reading

Do you read a lot or only what you have to? Only what you have to 

Yes ____  
         Do you like to read? dislikes reading    Yes ____
Are you embarrassed to read out loud?  Yes ____  
         Do you tilt your head when you read or study?    Yes ____
     

Have the person read from the progressive reading list starting where you think the person will begin to have difficulty.

   
     

Does the person have poor word attack skills? 

Yes ____  
         Does the person have poor phonic skills?    Yes ____
Does the person leave off word endings?  Yes ____  
         Does the person add endings to words?    Yes ____

Does the person leave off or change prefixes? 

Yes ____  
         Does the person misread many words?    Yes ____
     

Have the person read something from a book, newspaper, magazine.

   
     
Does the person add words?  Yes ____  
         Does the person skip words?    Yes ____
Does the person evidence Flickering? (misreading of "a-the", "in-on" etc.)   Yes ____  
          Does the person substitute words for similar words?    Yes ____
Does the person read synonyms for some words?  Yes ____  
          Does the person have difficulty pronouncing words?    Yes ____
Does the person ignore punctuation?  Yes ____  
          Does the person have a tracking problem?    Yes ____

Does the person use a finger or a marker as a guide? 

Yes ____  
          Does the person skip lines?    Yes ____
     
Reading Summary Number Yes Short total _____  Total red and black  ____

 

 

Reading Comprehension

Do you have difficulty paraphrasing, or summarizing in your own words, what you read? 

Yes ____  

          Do you find yourself reading whole pages without knowing what you read?

   Yes ____

Are you distracted by some of the words on the page (Fireworks)? 

Yes ____  

           Do you have difficulty identifying the main idea when you read? 

  Yes ____

Do you have difficulty finding details when you read? 

Yes ____  

          Do you have difficulty going back and finding something that you read? 

  Yes ____

Are you easily distracted when you read? 

Yes ____  

          Do you find reading textbooks difficult? 

  Yes ____

Do you find that there are many words you don’t know the meaning of when you read? 

Yes ____  

Do you need to read things more than once? 

  Yes ____
     
Summary of Reading Comprehension:                      Number yes             Short Total _____    Total red and black _____

     

 

Vocabulary

Does the person have difficulty defining the following words?   There are three sets of words. (two sets for the short form).  They are for different age or ability groups or to provide the administrator with many words to check a person who evidences particular difficulty with vocabularyMark "C" (correct) if the person can define the word.  If the person cannot define the word but can use it in a sentence, mark "S" (sentence).  If the person cannot define the word, mark "I" (incorrect).

 Level I

Level I LAKE ___________________________________  C _____  S _____  I _____
  SLOW  ___________________________________ C _____  S _____ I _____
  CAPTURE  ___________________________________ C _____  S _____ I _____
  SMOKE  ___________________________________ C _____  S _____ I _____
  REVERSE  ___________________________________ C _____  S _____ I _____
  BEAUTIFUL ___________________________________   C _____  S _____ I _____
  DEVELOP ___________________________________  C _____  S _____ I _____
  BIOLOGY  ___________________________________  C _____  S _____  I _____ 
  CAUTION ___________________________________ C _____  S _____ I _____
  NECESSARY ___________________________________ C _____  S _____ I _____

LEVEL II

SECTION  ___________________________________  C ____ S ____ I _____
PASSIVE ___________________________________ C ____ S ____ I  _____
DEDICATE  ___________________________________ C ____ S ____ I  _____
MOTIVE ___________________________________  C ____ S ____ I  _____
FOREIGN  ___________________________________ C ____ S ____ I  _____
ARTIFICIAL ___________________________________ C ____ S ____ I  _____
DEVISE ___________________________________ C ____ S ____ I  _____
Level II PHILOSOPHY ___________________________________ C _____ S ____ I  _____
INNOVATION  ___________________________________ C ____ S ____  I  _____
PRECISE  ___________________________________ C ____ S ____ I _____

   LEVEL III

 

THEORY 

___________________________________ C ____ S ___ I _____
  RELUCTANT ___________________________________ C ____ S ___  I _____
 

TRANQUILIZE

___________________________________ C ____ S ___  I _____
  DILEMMA ___________________________________ C _____ S ___ I _____
  UNANIMOUS ___________________________________ C ____ S ___ I _____
  EXTENSIVE  ___________________________________  C ____ S ___  I _____
  CONTEMPLATE

 ___________________________________ 

C ____ S ___  I _____
 

ANTHROPOLOGY

___________________________________  C ____ S ___  I _____
  RENAISSANCE _________________________________ C ____ S ___ I _____
  COLLECTIVE  ___________________________________  C ____ S ___  I _____
           
Is the person’s vocabulary underdeveloped?    Yes ____  
          Is the person’s vocabulary ambiguous?     Yes ____
Does the person define with another part of speech? (e.g. tranquilize - pill)   Yes ____  
           
Summary of Vocabulary Level I      Number "C" ____ Number "S" ____    
    Level II     Number "C" ____ Number "S" ____    
      The total "I" for one Level + the Number of Yes _____

 

 

Avoidance

Is there anything or are there any activities that you completely avoid? 

Yes ____  
         If yes, what? _______________________________    
     
        Is there anything you are very fearful of in any area of your life?    Yes ____
        If yes, what? _______________________________    
     

Is there anything, in any area of your life, you really dislike to do? 

Yes ____  
        If yes, what? _______________________________    
     

        Is there anything, in any area of your life, that you are unable to do? 

  Yes ____
        If yes, what? _______________________________    
     

Are there any school (academic) subjects you are fearful of? 

Yes ____  

        If yes, what? _______________________________

   
     

        Are there any school (academic) subjects you really dislike? 

  Yes ____

        If yes, what? _______________________________

   
     

Are there any school (academic) subjects that you are unable to do? 

Yes ____  

         If yes, what? _______________________________

   
     

          Do you ever get angry about school work? 

  Yes ___

          If yes, about what? _______________________________

   

          Angry with: myself _____ the subject matter _____ teachers _____ school _____