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Childs Name
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Does your child attend school?
Does your child have a diagnosis or disability?
Please tick the following areas of concern:
Speech - The physial production of words
Dificulty producing sounds in words and sentences
Inability to make the mouth movements required to say words
Language - The ability to understand both oral and written language and the ability to effectively communicate ideas and intentions both orally and in written format
Reduced vocabulary skills
Reduced expressive language skills (e.g. inability to sequence words and sentences logically together to make meaningful conversation)
Reduced receptive language skills (e.g. difficulty following both written and verbal directions)
Auditory Processing – the ability to discriminate between sounds and focus attention to associate meaning to sounds
Reduced auditory decoding of sounds
Reduced short term memory skills
Pragmatics – the social conventions for how we interact with each other
Poor eye contact and reduced ability to read non-verbal gestures
Poor knowledge of the unspoken rules of conversations and social situations
Inappropriate language with strangers
Literacy – spelling and reading skills
Reduced phonological awareness skills
Fluency – the smooth rhythm and pattern of talking (stuttering)
Voice – the production of sound by vibrating the vocal cords (e.g. raspy voice)
No concens
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