Speech and Language Screener: Ages 8+ First Name *Last Name *Age *Date of Birth *Grade *School Attends *Parent InformationFirst Name *Last Name *Phone *Email Address *Examiner * Purpose: To screen for potential speech sound disorders, language delays, fluency issues, or voice concerns in children aged 8 and older. I Background Referral Reason: *Difficulty being understoodStruggles with pronunciationTrouble forming sentences or telling storiesDifficulty following directionsStuttering or fluency issuesUnusual voice quality (hoarse, nasal, etc.)Other Parent/Teacher Questionnaire Answer Yes/No (with examples if "Yes")Q1. Does your child have trouble being understood by people outside the family? *NoYesQ2. Do they mispronounce certain sounds (e.g., “r,” “s,” “l,” “th”)? *NoYesQ3. Do they have trouble telling a story in the correct order? *NoYesQ4. Do they have difficulty following multi-step directions? *NoYesQ5. Do they use shorter or simpler sentences than peers? *NoYesQ6. Do they struggle to recall or find the right words? *NoYesQ7. Do they stutter or repeat sounds/words? *NoYesQ8. Do they have an unusual voice (hoarse, monotone, nasal)? *NoYes Speech Screening Tasks Sound Production (Articulation) Instructions: Have the child repeat the following words and sentences, listening for any mispronunciations. Word list: rabbit, slide, three, yellow, crown, spaghetti, remember, birthday, basketball Sentence: “The rabbit hopped around the red rock.” Sentence: “She threw three free throws.” Sentence: “I saw the yellow slide at the park.” Observation: Note any sounds that are substituted, omitted, or distorted (e.g., “wabbit” for “rabbit”). Fluency (Stuttering) Task: Have the child talk for 1–2 minutes about a favorite hobby or recent event.Observation: Look for repetitions of sounds/syllables, prolonged sounds, or visible struggle/tension while speaking. Voice Task: Have the child count from 1–10 and sustain the vowel sound “ah” for 5 seconds.Observation: Note hoarseness, breathiness, strain, or nasality. Language Screening Tasks Following Directions Give 2–3 step directions: “Touch your nose, clap your hands, and stand up.” “Pick up the red crayon, draw a circle, and put it back.” Vocabulary & Word Retrieval Ask: “Name as many animals as you can in 30 seconds.” “What do you do with a fork?” “Tell me three things you see in this room that start with the letter B.” Sentence Formulation Show a picture (or describe a scenario) and ask: “Tell me what is happening in this picture.” “Make a sentence with the word ‘because.’” “Tell me about your favorite day at school.” Storytelling Prompt: “Tell me about what you did yesterday from the morning until bedtime.”Observation: Look for logical sequence, complete sentences, and appropriate grammar.Submit
