Parent Checklist
Parent Checklist
Fill out the following checklist to give us a better sense of how we can help.
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Does your child have difficulty with receptive language, or understanding language in his or her environment?
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Is your pediatrician concerned?
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Did you child meet all developmental milestones on time?
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Is your child’s weight typical for his or her age?
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What is your primary area of concern?
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Does your child have difficulty with expressive language, or communicating with others (verbally and/or nonverbally)?
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Is there a history of late talking on either side of the family?
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Can your child label body parts?
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Did you child pass the newborn hearing screening?
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When did your child produce his or her first word?
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How many new words does your child produce each week?
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How many words does your child use confidently?
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Does your child show frustration when he or she has difficulty communicating with others?
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Does your child use gestures to communicate?
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Does your child exhibit excessive drooling?
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Does your child frequently babble or make other vocalizations?
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Does your child follow directions?
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Is there anything remarkable to note about your child’s medical history or overall health?
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Does your child have challenges with specific speech sounds?
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Do you notice any social effects for your child?
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Does your child have difficulty with receptive language, or understanding language in his or her environment?
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Does your child have difficulty with expressive language, or communicating with others (verbally and/or nonverbally)?
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About what percent of your child’s speech do you and other family members understand?
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About what percent of your child’s speech do unfamiliar listeners understand?
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Which speech sounds does your child have trouble pronouncing?
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Is there anything remarkable to note about your child’s medical history or overall health?
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How long has the stuttering been going on?
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Do you notice any of the following secondary behaviors?
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Is there a family history of stuttering?
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Does stuttering occur often?
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Is the stuttering more frequent in certain situations?
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Does your child have siblings?
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Would you describe the household environment as busy?
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Would you describe your child as being a perfectionist or being hard on himself or herself?
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About what percent of your child’s speech do you and other family members understand?
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About what percent of your child’s speech do unfamiliar listeners understand?
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Do you notice a pattern to the stuttering?
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Are there certain speech sounds your child seems to “get stuck on"?
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How long have you been concerned about your child’s feeding behaviors?
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Will your child try any new foods?
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Is your child okay with a new food or non-preferred food being on his or her plate?
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Did your child have any trouble taking a bottle?
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Did your child have trouble moving from liquids to solid foods?
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Do you notice excessive drooling when eating and throughout the day?
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Does your child regularly gag or vomit when eating?
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Does your child regularly cough when eating?
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Does your child have trouble chewing?
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Was your child born premature?
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Does your child have any known allergies?
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Is your child’s height typical for his or her age?
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Does your child have a history of gerd or reflux?
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Does your child arch or stiffen his or her body during feeding?
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How long is your child’s typical meal time?
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Does your child have challenges with certain textures or tastes?
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Is there anything remarkable to note about your child’s medical history and overall health?
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How many words does your child use unconfidently?
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