PLS.5 Home Questionnaire

PLS.5 Home Questionnaire

Preschool Language Scales Fifth Edition
Dear Parent/Caregiver:

This questionnaire will help us learn about your child's communication skills. The questionnaire includes communication behaviors for children age: birth to 2 1/2 years. There are two parts. The questions in Part 1 ask about who your child spends time with and how he or she spends the time. Questions in Part 2 ask about your child's communication and play behaviors.
Complete the questionnaire. Check ALL behaviors that your child has previously exhibited or currently exhibits.
PART 1
My child has:

The language(s) spoken to my child is/are:

My child spends most of the day at:

When at home, my child spends time with:

When at home, my child usually:

When playing with other children, my child sometimes:

Rows	My child:	Days
Plays beside other children without sharing their toys
Plays with other children by following what they do or say
Plays with other children by telling them what to do
Plays with other children by sharing toys and talking
My child does not play with other children

When playing, my child:
My child pays attention to what's happening around him or her. For example, my child:
My child enjoys attention. For example, my child:
My child follows directions when I:
My child tells me how he or she feels and what he or she wants. For example, my child:
My child says words. For example, my child says:

My child's speech is understood by:

Complete the questionnaire. Check ALL behaviors that your child has previously exhibited or currently exhibits.