Assessment of children

Name: ______Hospital File no: ______

Age:______Gender: ______

Date of Birth: ______

Home language: ______

Caregiver’s concerns:

Feeding and oral-motor
Speech and intelligibility
Fluency
Voice

Receptive language

Expressive language
Hearing

History of current condition: ______

______

______

Significant family history: ______

______

______

______

Significant early history: ______

______

______

______

Significant medical history: ______

______

______

______

Feeding and oral-motor skills in infant

Overview:
Criterion / Yes / No / Comment
Turns towards stimulated cheek
Opens mouth when stimulated
Sucking reflex present
Attains lip seal
Coordinated suck-swallow-breathe rhythm
No nasal regurgitation
No signs of aspiration
No tongue thrust

Feeding and oral-motor skills in child

Overview:

Criterion

/ Yes / No / Comment

Able to follow instructions

Opens and closes mouth appropriately
Maintains lip seal
Able to bite food
Able to chew food
Able to suck through straw
Able to drink from cup
No problems with different consistencies
  • Liquids fine

  • Paste fine

  • Thick solids fine

No signs of aspiration
No gurgly voice
Coordinated swallow
No delayed trigger of swallow
Normal laryngeal elevation
Normal base of tongue movement
No residue after swallowing
  • None in sulci

  • None on tongue

  • None on palate

Able to feed self
DDK rate within norm
DDK range of movement within norm
DDK coordination within norm
Structure of lips within norm
Lip movement within norm
Structure of tongue within norm
Tongue movement within norm
Structure of jaws and teeth within norm
Movement of jaws within norm
No dental malocclusion present
Structure of hard and soft palate within norm
Movement of soft palate within norm
Structure of cheeks within norm
Movement of cheeks within norm
Normal breath control during /a:/
Able to cough on command
Able to phonate on command
Adequate pulmonary function

Speech and intelligibility

Overview:
Degree of unintelligibility
Reason for unintelligibility

Criterion - Articulation

/ Yes / No / Comment
No consonants affected
  • No substitutions

  • No omissions

  • No distortions

  • No additions

No vowels affected
  • No substitutions

  • No omissions

  • No distortions

  • No additions

Criterion - Phonology / Yes / No / Comment
No backing
No fronting
No weak syllable deletion
No cluster reduction
No stopping
Criterion - Nasality / Yes / No / Comment
No hypernasality
No audible nasal escape
No facial grimacing
No hyponasality
Criterion – Apraxia and Dysarthria
No limb apraxia
No oral apraxia
No apraxia of speech
Alternating motion rate within norm (PPP)
Sequential motion rate within norm (PTK)
Normal rate of speech
No vocal fatigue
No groping behaviours
No prolonged vowels
Polysyllabic words fine

Fluency

Overview:

Criterion: Stuttering

/ Yes / No / Comment
Repetitions within norm
  • Repetitions of schwa within norm

  • Repetitions of first sound within norm

  • Repetitions of first syllable within norm

  • Repetitions of words within norm

Hesitations within norm
  • Duration within norm

Prolongations within norm
  • Duration within norm

Revisions are within the norm
Blocks are not present
Secondary symptoms not present
No breaking eye contact
No pitch changes
No facial grimacing
No movements of upper limbs
No movement of lower limbs
No movements of torso
No jargon
No avoidance behaviours
No irregular breath control
Criterion: Cluttering / Yes / No / Comment
No omission of syllables
No omission of words
Normal rate of speech
No monotonous speech
Awareness by patient

Effect of fluency on vocation, feelings and attitudes, communicative competence

Voice

Overview:

Criterion

/ Yes / No / Comment
Normal voice quality
No breathiness
No hoarseness
No harshness
Not wet or gurgly
Not incorrectly pitched
Not monotonous
Not absent
No trauma
No surgery
No disease
No vocal abuse
No psychogenic cause
No hormonal problem
No dysphagia

Receptive language

Overview:

Criterion: Understands:

/ Yes / No / Comment
Gestures/sign language
Objects
Pictures
Writing
Single words
Short phrases
Simple commands
Two-step commands
Complex sentences
Quantity
Numbers
Colours
Shapes
Comparatives
Time
Conditionality
Prepositions of place
Deictic words
Pronouns
Criterion: Vocabulary /

Yes

/ No / Comment
Under 20 words
20 – 50 words
50 – 100 words
Over 100 words

Expressive language

Overview:

Criterion: Uses:

/ Yes / No / Comment
Crying
Babbling
Jargon
Gestures/sign language
-Pointing
-Greeting gestures
-Commands (e.g. raising arms to be picked up)
-Informal sign language
-Formal sign language
Single words
Two-word phrases
Short phrases >2 words
Simple sentences
Complex sentences
Questions
Vocabulary - under 20 words
Vocabulary - 20 – 50 words
Vocabulary - 50 – 100 words
Vocabulary - over 100 words
Criterion: Errors / Yes / No / Comment
No telegrammatic speech
Uses pronouns correctly
-I
-Third person
Uses correct word order
No tense errors
Uses deictic words correctly
Uses plurals
Uses vocabulary/concepts:
-Quantity and size
-Numbers
-Colours
-Shapes
-Time
-Prepositions of place
Criterion: Pragmatics / Yes / No / Comment
Appropriate eye-contact
Appropriate turn-taking
Appropriate topic maintenance
Acknowledges speaker
Is aware of emotion

Hearing

Overview:
Criterion: /

Yes

/ No / Comment
Calms when hears caretaker’s voice (baby)
Startles to loud noise (baby)
Turns towards source of sound
Aware of sounds
Responds to own name
Can follow spoken instructions
Responds when called from another room
Normal quality of speech
Normal speech development