LAFAYETTE PARISH SCHOOL SYSTEM



LAFAYETTE PARISH SCHOOL SYSTEM DATE__________________

STUDENT_____________________________

MIDDLE/HIGH SCHOOL SPEECH AND LANGUAGE SCREENING

SCREENING RESULTS: _____ Passed _____ Failed

____ Rescreen (area): ___Language ___Articulation ___Voice ___Fluency

IDENTIFICATION INFORMATION:

DOB _________________ AGE _______ SEX _______ RACE ________ GRADE ________

SCHOOL _____________________________ TEACHER____________________________

PARENT’S NAME: ________________________________ PHONE ___________________

The teacher reported the following speech-language behaviors in the classroom:

__________________________________________________________________________________________

__________________________________________________________________________________________

Date parent contacted __________________ Parent comment/reaction _____________________________

__________________________________________________________________________________________

Medical History __________________________________________________________________________________________

__________________________________________________________________________________________

LANGUAGE

______ 1. Class Schedule – Tell each subject and the teacher in the order they occur.

Do you have any brothers or sisters? Tell me about them.

Name the months of the year in order.

_____ 2. Word Associations: Which one does not belong? Why? 3/5 passes

1. Wheel rectangle circle square shape

2. Puppy horse kitten lamb baby/small animals

3. Bush hair tree grass plant/green/grows in the ground

4. Inch minute day month time word

5. Tired cheerful cloudy frustrated emotion/mood/feelings

_____ 3. Morphology Competency. Make a sentence using the word. 3/5 passes

1. faster

2. hopeless

3. dishonest

4. heaviest

5. because

_____ 4. Idioms – Relationships – Ambiguities

These phrases have double meanings. Tell me what each one means. 3/5 passes

1. I could eat a horse.

2. Get off my back.

3. The early bird catches the worm.

4. Celia was sharp as a tack.

5. Put your foot in your mouth.

_____ 5. Say these sentences exactly the way I say them. 2/3 passes

1. The little brown squirrel buried the large nut.

2. The girl mailed a package to the man who moved away last month.

3. The boys drew and colored the pictures and taped them on the wall.

_____ 6. Definitions: Tell me what ___________ means. 3/5 passes

Middle School Level High School Level

stadium (hold sports, arena) occupation (job career, profession, make a living)

famous (popular, well known) autobiography (book written by yourself)

conference (meeting, lecture) conceal (hide, cover up, keep secret, don’t reveal)

curious (wonder, want to know) discount (lower price, markdown, percent off)

disturbed (bother, annoy, upset) minority (less than 50%/half the group, under legal age 18/21, person who is not white)

_____ 7. Synonyms: Tell me a word that means the same thing as______________. 3/5 passes

Middle School Level High School Level

afraid (scared, frightened) attorney (lawyer, legal advisor)

same (alike, like, identical, penalty (fine, punishment)

similar, equal) confidential (private, top secret)

humorous (funny, hilarious) supervisor (boss, employer, manager)

begin (start, commence) inaccurate (wrong, mistaken, false, incorrect)

shout ( yell, holler, scream)

_____ 8. TOLD-1:2 Malapropisms: Say “I am going to say a sentence that has a mistake in it. The mistake is that I have used a wrong word. Fro example I might say ‘Rock the baby to sheep’.

1. John took a phonograph of his family. (photograph)

2. She ate bread and better with dinner. (butter)

3. Since Mother was tired, she relapsed all weekend. (relaxed)

4. She wrote true stories and friction. (fiction)

5. A lot of water has flown under the bridge. (flowed)

_____ 9. Word Classes: I’m going to say 4 words. Listen to the words and tell me the two that go together best. 4/6 passes

1. tiger lion tree baby 2. spoon bathtub car garage

3. run cry eat laugh 4. truck teacher bus horse

5. covered connected slanted joined 6. cold rough hard smooth

ARTICULATION

______Adequate ______Inadequate Norms __________________

Connected Speech

_____ Readily intelligible _____unintelligible

_____ Intelligible with noticeable errors _____ other errors noted in conversation______________

Errors noted:_______________________________________________________________________

VOICE

______ Within normal limits ______ At risk

______ Atypical nasal resonance and/or nasal emission _____Chronic hoarseness

______ Possible structural abnormalities of hard or soft palate _____ Inappropriately low pitched

Comments: _________________________________________________________________________

____________________________________________________________________________________

FLUENCY

_______Within normal limits _____ At risk

Excessive repetitions: _____ Sounds _____Syllables ____ Words ____ Phrases

Excessive hesitations: _____ Prolongations _____ Blocks _____ Circumlocutions

Secondary Characteristics (list): ________________________________________________________

ORAL-PERIPHERAL EXAMINATION

1. Teeth Comments

A. General Condition: _____ Adequate _____ Inadequate __________________________

B. Occlusion: _____ Adequate _____ Inadequate __________________________

2. Palate

A. Intactness of Hard Palate: _____Normal _____Abnormal __________________________

B. Intactness of Soft Palate: _____ Normal _____ Abnormal __________________________

C. Condition of Uvula: _____ Normal _____ Abnormal __________________________

3. Tonsils: _____ Present _____ Absent

4. Tongue:

A. Appearance: ____ Normal ___ Abnormal ________________________________

B. Carriage: ____ Normal ___ Abnormal ________________________________

C. Movement: ____ Normal ___ Abnormal ________________________________

HEARING SCREENING

250 500 1K 2K 4K 8K

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