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
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