4 YEAR OLD - INFORMAL LANGUAGE SAMPLE CHECKLIST

Student: ______Birthdate: ______CA:____

Examiner: ______Date of Sample: ______

THIS CHILD DEMONSTRATED THE FOLLOWING SKILLS DURING THE SAMPLE:

CONCEPTS, PROCESSING, AUDITORY COMPREHENSION

/ MORPHOLOGY/ GRAMMAR
q Y q N – Identifies colors
q Y q N – Identifies body parts
q Y q N - Sequences an event
q Y q N - Gives descriptions
q Y q N – Gives functions
q Y q N - Problem solves events
q Y q N – Understands comparative/superlatives
q Y q N – Repeats 4 digits if given slowly / q Y q N – Answers Yes/No questions
q Y q N – Answers who, what, why, where, when how many(up to #4) questions
q Y q N – Asks questions
q Y q N – Repeat sentences containing 4-5 words.
q Y q N – Follow simple directions (2-3 part)
q Y q N – Prepositions
q Y q N – Number concepts
q Y q N – Time concepts (today, yesterday, etc.)
q Y q N – Categorizing: selects items that are the same
q Y q N – Categorizing: selects items that are the different / Pronouns: (circle)
q Y q N – Singular & Plural Subjective
I/ you/ he/ she/ we / they/ it
q Y q N – Singular & Plural Objective
me / you/ him/ her/ us/ them
q Y q N – Singular & Plural Possessive
my/ mine/ your/ yours/ his/ hers/ theirs/ its/ ours
q Y q N – Present prog. –“ ing”
q Y q N – plural marker –s, -es
q Y q N – Semiauxiliaries (gonna, gotta, wanna)
q Y q N – Possessive –s (girl’s hat)
q Y q N – Present tense auxiliary (can, will, be, do)
q Y q N – “BE” verb + pres. prog. “-ing”
q Y q N – Uses “be” verb (is / are/ am)
q Y q N – Regular past tense “-ed”
q Y q N – Irregular past tense
q Y q N – Articles “a” “the” etc.
NOTES:
MEAN LENGTH OF UTTERANCE & SENTENCE STRUCTURE
q Y q N - 3.75-4.5
q Y q N - Uses 3-5 words in a sentence
LITERACY & NARRATIVE SKILLS
q Y q N – Told personal narratives
q Y q N – Told with adult prompting
q Y q N – Told independently
q Y q N – Stories sequenced
q Y q N – Points & labels pictures / q Y q N – Stories included people
q Y q N – Stories included setting
q Y q N – Stories included outcomes
q Y q N – Turns pages
q Y q N – Retells a story in sequence / q Y q N – Retells stories/TV shows/procedure
q Y q N – Stories told in random order
q Y q N – Listens to short books/ stories
q Y q N – Holds a book correctly
q Y q N – Listens to simple nursery rhymes, songs

PRAGMATICS- (Use of language in communicative interactions)

SPEECH INTELLIGIBILITY - q 75-95%
q Y q N – Appropriate turn taking
q Y q N – Associative play
q Y q N – “Conversation” with dolls
q Y q N – Engages in simple, make believe activities / q Y q N – Terminate topics in conversation
q Y q N – Maintain topics in conversation
q Y q N – Looks for missing toys
q Y q N – Holds up fingers to tell age
q Y q N – Helps put away toys / q Y q N – Were utterances
sequenced?
q Y q N – Were utterances told in
random order?
q Y q N – Makes conversational repairs

(Leave ‘Not Observed’ skills unchecked)