THANK YOU FOR SCHEDULINGYou are almost done, but we could use a little more information to help us determine what evaluation might be best. Name * First Name Last Name Email * LISTENING Check all that apply to the person of concern. Has a difficult time paying attention. Has a difficult time following spoken directions. Has a difficult time remembering what others say. Has a difficult time understanding language. Needs repetitions and clarifications to understand language. Has a decreased vocabulary as compared to peers. Does not seem to understand basic concepts such as before and after. Has a difficult time grasping new ideas. SPEAKING: Check all that apply to the person of concern. Was or is a late talker. Speech is unintelligible. Speech is unclear, at times, and when understood after age 3, has the following types of errors: shortening long words: Example: puta for computer, ka for cat, i for hi Speech remains unclear at times, after age 4, and has some of the following types of errors when understood: Bock or bwock for block / Lello or wewo for yellow / Sebra or sebwa for zebra Speech is understandable but not age appropriate compared to peers of the same age. Gets upset when others do not understand what they are trying to say. May flip sounds and words and word parts around when speaking words such as: pacific for specific, hangaburger for hamburger, butterbee for bumblebee. Has decreased use of pronouns combined with verbs such as: they is, him are, him is, she are, her is, him have, etc. Uses poor grammar when speaking as compared to peers of the same age. Has a difficult time answering questions. akes a long time to process and answer questions. Struggles to ask questions or ask for help. May throw a tantrum if not understood. Has difficulty using a variety of vocabulary words when talking. Gets stuck trying to remember a specific word and resorts to using vague terms such as: thingy, whachamacallit, and stuff, etc. Has trouble expressing thoughts. Has disorganized expressive thoughts that are hard to follow. Has difficulties staying on the subject in a conversation. Has difficulties getting to the point. Loses track of what they were saying, and then says, “I don’t know” often. READING Check all that apply to the person of concern. Has a difficult time sounding out words. Guesses at words while reading. Has been flagged at school for decreased Oral Reading Fluency. Has a difficult time with rhyming and hearing individual sounds in words. Has difficulties learning sight words for reading. Does not remember or understand what they read. Does not understand the sequence of the story. Cannot identify the main idea. Misses details in a story that were important to the story line and comprehension. Has troubles following written directions. WRITING Check all that apply to the person of concern. Has a difficult time getting their thoughts written down. Verbal speaking is much stronger and written language. Uses poor grammar when writing. Has a difficult time writing in sentences. Does not understand or use much capitalization or punctuation in written work. Has a difficult time writing details and correctly structured sentences. Has a difficult time writing a story or paragraph in an orderly, sequential and logical sequence of events. When done with a written story and they read it back to you, it sounds different than what is on the paper. Decreased spelling. May spell the same word in different ways within the same paragraph or page. Has a difficult time learning to spell sight words. Can pass spelling tests by working hard, but does not remember how to spell the word when actually writing a sentence or story. SOCIAL PRAGMATIC LANGUAGE Has a hard time looking at people when listening to a speaker or talking to someone. Does not seem to interpret facial expressions, body language or gestures the way peers do. Seems only interested in their own thoughts and not what others are thinking. Difficulties with turn taking in a conversation. Perseverates on topics of interest. Difficulties problem solving with peers. Inflexibility. Has behaviors related to not getting their wants and needs met. Checkbox STUTTERING/FLUENCY OF SPEAKING Sound, syllable, whole word, whole phrase or whole sentence repetitions in verbal speech. Blocks in verbal speech. Has symptoms of a physical tic that is associated with trying to get out of a moment of stuttering or dysfluency. Thank you!
