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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How old is your child?

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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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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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