INFORMAL LANGUAGE ASSESSMENT CHECKLIST



5 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 |

|( Y ( N – Identifies 6 colors |( Y ( N – Answers Yes/No questions |Pronouns: (circle) |

|( Y ( N – Identifies body parts |( Y ( N – Answers who, what, why, where, when how many(up to #4) |( Y ( N – Singular & Plural Subjective |

|( Y ( N - Sequences an event |questions |I/ you/ he/ she/ we / they/ it |

|( Y ( N - Gives descriptions |( Y ( N – Asks questions |( Y ( N – Singular & Plural Objective |

|( Y ( N – Gives functions |( Y ( N – Repeat sentences up to 9 words in length |me / you/ him/ her/ us/ them |

|( Y ( N - Problem solves events |( Y ( N – Follow directions (2-3 part) |( Y ( N – Singular & Plural Possessive |

|( Y ( N – Understands |( Y ( N – Prepositions |my/ mine/ your/ yours/ his/ hers/ theirs/ its/ |

|comparative/superlatives |( Y ( N – Number concepts |ours |

|( Y ( N – Understands opposites |( Y ( N – Time concepts (today, yesterday, etc.) |( Y ( N – Reflexive Pronouns (circle) |

| |( Y ( N – Answers how things are the same |herself/ himself/ itself/ yourself/ myself |

| |( Y ( N – Answers how things are different | |

| | |( Y ( N – Present prog. –“ ing” |

| | |( Y ( N – plural marker –s, -es |

| | |( Y ( N – Semiauxiliaries (gonna, gotta, wanna) |

| | |( Y ( N – Possessive –s (girl’s hat) |

| | |( Y ( N – Present tense auxiliary (can, will, be,|

| | |do) |

| | |( Y ( N – “BE” verb + pres. prog. “-ing” |

| | |( Y ( N – Past tense “be” (she was…) |

| | |( Y ( N – Uses “be” verb (is / are/ am) |

| | |( Y ( N – Regular past tense “-ed” |

| | |( Y ( N – Irregular past tense |

| | |( Y ( N – Articles “a” “the” etc. |

|NOTES: | |

| |

|MEAN LENGTH OF UTTERANCE & SENTENCE STRUCTURE |

|( Y ( N - 4.5 + may still have difficulty with double negatives |

|( Y ( N - Uses 3-5 words in a sentence |

| |

|LITERACY & NARRATIVE SKILLS |

|( Y ( N – Told personal narratives |( Y ( N – Stories included people |( Y ( N – Retells stories/TV shows/procedure |

|( Y ( N – Told with adult prompting | |( Y ( N – Stories told in random order |

|( Y ( N – Told independently |( Y ( N – Stories included setting |( Y ( N – Listens to short books/ stories |

|( Y ( N – Stories sequenced |( Y ( N – Stories included outcomes |( Y ( N – Points & labels pictures |

| |( Y ( N – Retells a story in sequence | |

| |

|PRAGMATICS- (Use of language in communicative interactions) |

|SPEECH INTELLIGIBILITY - ( 90-100% |

|( Y ( N – Appropriate turn taking |( Y ( N – Terminate topics in conversation |( Y ( N – Were utterances |

|( Y ( N – Associative play |( Y ( N – Maintain topics in conversation |sequenced? |

|( Y ( N – “Conversation” with dolls |( Y ( N – Looks for missing toys |( Y ( N – Were utterances told in |

|( Y ( N – Engages in simple, make believe |( Y ( N – Holds up fingers to tell age |random order? |

|activities |( Y ( N – Helps put away toys |( Y ( N – Makes conversational repairs |

(Leave ‘Not Observed’ skills unchecked)

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