This information is optional. It is not stored and used only for inclusion on the assessment result printout.
Child's First Name:
Child's Surname:
Age:
Does your child:
Have difficulty playing independently or only likes playing independently of others?
Have difficulty inviting peers to play with them or asking to join in others' play?
Have difficulty waiting to take their turn within play, or have difficulty following the rules of a game (e.g. taking turns in a game of snakes and ladders)?
Have difficulty playing co-operatively with others (e.g. negotiating and deciding on rules of game with peers)?
Only like playing with adults or children younger than themselves?
Get easily distracted?
Have difficulty concentrating by looking and listening so they need a lot of prompting to remain engaged in an activity?
Have difficulty attending to an adult's choice of activity for an extended period of time (e.g. 10-15 min)?
Have difficulty listening/attending to an age appropriate book being read to them?
Have difficulty sitting, looking and listening in group times at school/socially?
Find it hard to start and keep a conversation going?
Tend to switch topics regularly when talking so it is hard to follow their conversation?
Label things when looking at a picture, but is unable to make up a story about the picture (e.g. names the cat, dog and the tree in the picture, but is not able to say "The dog is chasing the cat up the tree")?
Have difficulty providing detail when describing an object, picture or event so it is difficult to know what they are talking about?
Seem overly quiet or loud in the classroom or busy social situation?
Not seem to know as many words as their peers?
Have difficulty understanding concepts (e.g. time; yesterday vs. today vs. tomorrow or size tiny vs. huge)?
Have difficulty following longer instructions and often require repetition?
Have difficulty understanding more complex concepts (e.g. although, before, until)?
Find it hard to respond to questions about what has happened in the immediate past (i.e. questions like "Where have you been"? "What did you have for lunch"? "Was Tom at school today"? )?
Often look 'blank' when asked a question or respond by giving incomplete or irrelevant answers?
Seem to understand what is said in quiet one to one situations but has difficulty in more busy or noisy environments?
Find it difficult to attend to what the teacher is saying in class and show behaviours like fiddling, looking around, looking 'blank'?
Have difficulty understanding the grammar of the sentences (e.g. understanding plural 's' means more than one thing or understanding past tense -ed means it happened yesterday)?
Have difficulty understanding age appropriate stories that are read to them?
Have difficulty recognising letters and sounds?
Have difficulty reading and sounding out simple 3-4 letter words which are unfamiliar?
Have difficulty learning and retaining sight words at school?
Rely on pictures to understand the content of the sentence/paragraph/story read?
Have difficulty reading fluently (e.g. without lots of pausing, sounding out of many words, repeating of words and parts of words) so that the passage can be easily comprehended?
Know lots of words but has difficulty using those words to name items (e.g. pauses when trying to find the word, uses words like "that", "this", "thingy" instead of using the actual name, uses lots of "um", "uh" words while trying to search for the word")?
Find it hard to combine 5-6 words together appropriately (e.g. "Look at man in car daddy")?
Have difficulty producing longer sentences that express more complex ideas (e.g. "The man was eating the spaghetti instead of the fish because he doesn't like fish")?
Have difficulty re-telling a simple story?
Have difficulty making up and telling stories with a clear beginning, middle and end?
Make errors with grammatical endings on words (e.g. indicating past and present tense e.g. kicking vs. kicked, plural's' cat vs. cats)?
Leave out small words from sentences (e.g. words like it, is, a, the) causing language to sound immature?
Have difficulty using linking words such as and, because or but to join phrases together?
Put words in the wrong order (e.g. "The ball is garden in it")?
Have difficulty forming questions (e.g. Has difficulty knowing whether to use the word "what", "who" or "why") or changing a statement into a question (e.g. changing "The red ball" into "Can I please have the red ball?")?
Have difficulty sounding out words phonetically (i.e. by sound, not necessarily correct spelling -e.g. "cat" = "c...a...t")?
Have difficulty retaining and remembering the 'rules of spelling' (e.g. There is a silent 'k' in the word know, you put the 's' and 'h' together to spell "shoe", a short vowel becomes a long vowel if there is an 'e' on the end)?
Have difficulty writing sentences so that the words are in the correct order and make sense?
Have difficulty using grammar in written language (e.g. present and past tense -ing vs ed, plurals- cat vs cats)?
Have difficulty writing age appropriate descriptive paragraphs and/or stories?
Have difficulty being understood by others?
Have a voice that often sounds 'nasal' (i.e. like the child has a blocked nose)?
Use a very loud voice or shout often, which affects the sound of their voice?
Repeat sounds in words, part of words or phrases when talking (e.g. "C...c...can I have a biscuits" or "Gi...gi...give me the ball), gets physically stuck on words (i.e. word or sound just won't come out) or lengthens words (e.g. Loooook at the cat?)?
Have difficulty getting the word or sentence out so that they get frustrated?
Have speech that sounds unclear compared to their same aged peers?
Have speech than sounds immature for their age?
Have speech that contains vowel 'substitutions' that makes their speech sound like they have an accent?
Have speech which contains sound 'substitutions' that other children their age don't make (e.g. "c" sounds replaced by "t" sounds - "car" becomes "tar")?
Have difficulty recognising rhyming words (e.g. cat, hat, mat)?
Have difficulty identifying beginning sounds in words (e.g. "car" starts with the 'c' sound)?
Have difficulty clapping or drumming out syllables in words (e.g. "caterpillar has 4 claps Cat..er..pill..ar)?
Have difficulty matching sounds to letters?
Have difficulty recognising that the printed word represents the spoken word?