Speech & Language Developmental Checklist
Please complete this short screening to learn if your child's speech and language development is on track with his/her age.
Name of person completing the checklist:
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First Name
Last Name
Relationship to child:
Phone Number:
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Please enter a valid phone number.
Email (Results from screening will be sent to email provided):
*
example@example.com
Where did you receive this free screening flyer?
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Child's Name:
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First Name
Last Name
Child's Date of Birth:
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-
Month
-
Day
Year
Date
Child's Gender:
Female
Male
Has had two or more ear infections?
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Yes
No
Do you have concerns about your child's speech and/or language development?
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Yes, I have concerns
No, I think my child is on track for his/her age
I'm not sure
Age of Child:
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1 year to 1 year 11 months
2 years to 2 years 11 months
3 years to 3 years 11 months
4 years to 4 years 11 months
5 years to 5 years 11 months
6 years to 6 years 11 months
My 1 year old child (check all that apply):
Points to a few body parts when you ask
Follows 1-part directions, like "Roll the ball" or "Kiss the baby"
Responds to simple questions, like "Who's that?" or "Where's your shoe?"
Listens to simple stories, songs, and rhymes
Points to pictures in a book when you name them
Uses a lot of new words
Uses p, b, m, h, and w in words
Starts to name pictures in books
Asks questions, like "What's that?", "Who's that?", and "Where's kitty?"
Puts 2 words together, like "more apple," "no bed," and "mommy book"
My 2 year old child (check all that apply):
Uses 2-3 word phrases regularly, such as "mommy go", "eat more please"
Demonstrates verbal turn taking
Has at least 100 consistent words
Can be understood by listeners 25-50% of the time
Follows simple 2 step commands, such as "pick up your block and put on the table"
Eats table foods with different textures
Points to at least 7 body parts
Understands spatial concepts like "under", "on", "in", etc.
Answers simple WH questions
My 3 year old child (check all that apply):
Communicates in sentences that are 4-5 words in length
Has at least 1000 consistent words
Is understood by listeners 75% of the time
Follows simple 3 step commands, such as "pick up your block, walk to the kitchen, put on the table "
Eats table foods with different textures including meat and raw veggies
Points to at least 7 body parts
Understands spatial concepts like "under", "on", "in", etc.
Asks questions, such as "What's that?" "Where mommy go?"
Responds to "what" and "where" questions
Understands negatives, such as "the baby that is not crying"
Uses plurals (dogs, horses, houses, etc)
My 4 year old child (Check all that apply):
Communicates in sentences of 5 or more words in length
Is understood by listeners 75% of the time
Can ask hypothetical questions, such as "What do you do when you're hungry?"
Can tell simple stories using full sentences
Follow/understands multi-step directions such as "Go downstairs, put your shoes on, and get in the car."
Understands pronouns like "I, Me, My, Mine, Myself"
Makes meaningful eye contact during interactions
Takes turns in a conversation
Eats more than 20 different foods
Participates in imaginary/role play activities
My 5 year old child (Check all that apply):
Communicates in sentences of 5 or more words in length
Appropriately uses word endings such as "s" (for plurals), "ed", and "ing"
Appropriately uses possessive pronouns such as "his" and "hers"
Names most letters correctly
Understands complex sentences
Follows/understands multistep directions such as "Go downstairs, put your shoes on, and get in the car."
Makes meaningful eye contact during interactions
Participates in imaginary/role play activities
Shows an awareness of emotions such as, feeling shame for poor choices
My 6 year old child (Check all that apply):
Uses a variety of grammatically correct sentences
Responds to why questions by giving a reason
Identifies words that rhyme
Understands quantitative concepts such as (each, every)
Understands/follows 3-5 step verbal and written directions
Makes inferences from information presented verbally
Produces all speech sounds correctly
Uses language for different reasons such as greeting, informing, demanding, and requesting
Demonstrates sophisticated play skills such as negotiating, following rules, etc.
Engages in age-appropriate conversations with familiar and unfamiliar others
If you have any area of concern with your child's speech or language development or are wondering if something is "typical", please describe.
Response Total 1yo
Response Total 2yo
Response Total 3yo
Response Total 4yo
Response Total 5yo
Response Total 6yo
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