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Q.1
Was your child a “late talker?"
*
Yes
No
Q.2
Does your child use fewer words than other children his age?
*
Yes
No
Q.3
Does your child say “stuff” or “things” instead of using specific words, even if she’s referring to a common object?
*
Yes – frequently
Sometimes
No – never
Q.4
Does your child say words out of order or leave words out entirely when speaking?
*
Yes – frequently
Sometimes
No – never
Q.5
Does your child get frustrated when speaking or complain that no one understands what she’s trying to say?
*
Yes – frequently
Sometimes
No – never
Q.6
Does your child use words incorrectly, seemingly without noticing?
*
Yes – frequently
Sometimes
No – never
Q.7
Does your child seem disinterested when other people are talking, rarely asking questions or making follow-up comments?
*
Yes – frequently
Sometimes
No – never
Q.8
Does your child seem to ignore directions he’s given or skip one or more steps?
*
Yes – frequently
Sometimes
No – never
Q.9
Does your child wait to start working until he sees what the children around him are doing?
*
Yes – frequently
Sometimes
No – never
Q.10
Does your child ever mix up common question words like “How,” “Why,” and “Where?” For example, if you ask her what she’s doing, does she ever respond with “Fine?”
*
Yes – frequently
Sometimes
No – never
Q.11
Does your child ask you to repeat yourself?
*
Yes – frequently
Sometimes
No – never
Q.12
Does your child repeat himself during conversation, seemingly without noticing?
*
Yes – frequently
Sometimes
No – never
Q.13
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