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THE AUTISM CHECKLIST

Gylnis Hanneli. BA (Hons). MSc Registered Psychologist


Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Difficulties with nonverbal communication
Has limited use of eye contact to express feelings
Has limited understanding of or response to eye contacts
Has limited use gesture or physical touching to express
feelings or wishes
Does not seem to understand gestures or physical touching
from others
Does not show much facial expression
Does not find it easy to read facial expression in others
Does not readily exchange social smiles
Does not often enjoy physical contact (e.g. cuddles, hugs,
or tickles)
Is a poor judge of social distance: stands too close or too
far away

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Difficulties with social and emotional empathy


Does not seem to understand or connect with other
peoples feelings
Does not often bring or point our objects of interest for
others to see
Does not really relate to anyone, even close family members
Only relates to one or two close family members
Does not show much affection
Does not readily learn appropriate behavior from role models
Often does not understand abstract social concepts such as
be kind
Misunderstands other peoples behavior or feelings

Difficulties with friendships


Seems to be unaware of the presence of other
Does not attempt to make friends with others
Tries but is unsuccessful in developing friendships with peers
Does not join in play activities, games, etc.
Is very wary of strangers
Is inhibited with strangers
Does not understand sharing
Doe not understand turn taking

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Difficulties understanding socially appropriated behavior


Says or does socially inappropriate things
Does not get embarrassed by social gaffes
Asks for explicit feedback such as Am I giggling too much?
Communication difficulties
Has no spoken language
Has a significant delay in spoken language
Uses language repetitively: repeats what other person has
just said
Uses language repetitively: repeats himself or herself over
and over
Uses odd, meaningless words or phrases repeatedly
Hears but does not respond appropriately when spoken to
Has significant difficulties with turn taking in conversation
Repeats same conversational pattern over and over
Has great difficulties understanding or using mime
Has difficulties deliberately imitating speech or action
Does not play imaginatively
Takes things very literally
Unusual physical mannerisms
Engages in repetitive movements (e.g. hand clapping or
body rocking)
Flickers own fingers close to face and watches them intently
Is poorly coordinated
Has a stiff or tiptoe walk, unusual arm movements when walking
Is very sensitive to some smells, textures, tastes
Has an unusually high threshold for pain or high/low temperature
Causes self-injury, engages in biting

Unusual physical mannerisms


Engages in repetitive movements (e.g. hand clapping or
body rocking
Flickers own fingers close to face and watches them intently
Is poorly coordinated
Has a stiff or tiptoe walk, unusual arm movements when walking
Is very sensitive to some smells, textures, tastes
Has an unusually high threshold for pain or high/low temperature
Causes self-injury, engages in biting, picking, head banging

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Inflexible interest and adherence to routines


Has intense preoccupation with a specific object or topic
(e.g.., keys, fires, ambulances)
Is distressed by small changes in routine
Adheres to unnecessary, meaningless routine
Is preoccupied with parts of objects
Is fascinated by spinning or flickering items
Engages in repetitive activities such as lining up toys in
certain order over and over
Exceptional islands of memory or skill
Has extraordinary memory for some specific information
(e.g. train timetables)
Has exceptional technical skill (e.g., in music), but creative
Expression is lacking

THE CONDUCT DISORDER CHECKLIST


Gylnis Hanneli. BA (Hons). MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Socially inappropriate behavior
Has little empathy or concern for other people
Bullies or intimidates others
Associates with other antisocial youngsters
Is intolerant of minority groups
Is outspoken and rude
Does not respect others rights (e.g. to learn, to enjoy
peace and quiet)
Is a poor judge of other people, mistakenly thinks they
are hostile or threatening
Engage in sexually promiscuous behavior
Shows little guilt or remorse for wrongdoing

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Destructive
Deliberately spoils or destroy other peoples possessions
Sets fires, deliberately knowing that this will cause serious
damage
Vandalize public property (graffiti, smashing glass)
Disrespectful of adult authority
Ignores parental rules or request
Ignores school rules
Breaks the law
Runs away from home
Is truant from school
Does not comply with punishments
Is frequently suspended or expelled from school
Ignores request by persons in authority (e.g. bus drivers,
traffic warden. etc.)

Ridicules adults in authority (e.g., public figures)

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Physically aggressive or cruel


Often starts fights
Uses physical force or a weapon to intimidate victim
Physically aggressive if upset or annoyed
Cruel to animals
Cruel to people younger or weaker than himself or herself
Enjoys cruel, sadistic, or violent films or games
Talks aggressively or threatens violence
Drives in an aggressive and dangerous manner
Deceitful and dishonest
Lies to adults
Lies to peers
Invents or exaggerates stories about himself, herself, or others
Breaks promise
Steals from family or friends
Steals from shops, school or other organization
Steals cars and drives them recklessly
Breaks into premises and steals or vandalizes
Forges parents signature
Destroys documents that incriminate him or her (e.g. letter
from school to parent)
Blames others and does not accept responsibility
Incriminates other for his or her own advantage, makes false
accusations
Feigns ignorance when asked for the truth
Covers up for friends who are behaving inappropriately
Drugs and Alcohol Abuse
Use illegal drugs
Deals in illegal drugs
Drinks alcohol or smokes cigarettes while underage
Drinks excessive alcohol

Difficult at home
Often angry and uncooperative
Secretive and often absent from home
Particularly aggressive to a specific person (e.g. mother or
younger sibling)
Demanding and intimidating, must have needs met
Does not communicate positively
Does not fulfill responsibilities
Lacks warmth and empathy for family members
Acts tough but is emotionally immature

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THE OPPOSITIONAL DEFIANT DISORDER CHECKLIST


Gylnis Hanneli. BA (Hons). MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Difficult to discipline
Refuses to comply with reasonable requests
Deliberately disobey states
Finds loopholes in rules
Does not seem to care if privileges or favorite things are removed
Does not like to reveal that punishment are hurting
Does not like to show that they are pleased with rewards
Becomes defiant and disobedient when criticized or punished
Makes threats to try to stop adults disciplining him or her
Blames others for his or her own wrongdoing
Very persistent if ignored, well escalate behavior until adults
respond
Justifies behavior by saying rules, requests, etc., were
unreasonable

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Difficult to please
Is unwilling to show pleasure in gifts or outings
Spoils family trips by constant complaining
Is reluctant to say what he or she wants
Does not want what is offered, wants something different
Rejects what adults thought would be a treat
Changes preferences (asks for one thing and then rejects it
when it is given
Argues with adults
Often say the opposite of what adults say
Argues endlessly, even obviously wrong
Tries to make adult look at fault
Says or does something and then denies it

Argues with adults


Often says the opposite of what adults say
Argues endlessly, even when obviously wrong
Tries to make adult look at fault
Says or does something and then denies it

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Lack of respect for adults


Uses body language and facial expression to defy adults
Scoffs at what adults say
Talks about adults in a disrespectful way
Will not accept adult authority
Plays adults off against one another
Is very demanding of adults: expects them to accept orders
Tries to manipulate others to undermine adults
Often deliberately annoys peoples
Deliberately annoys siblings or peers
Openly defies rules when adults are watching
Often tests limits
Easily annoyed
Is very touchy and easily annoyed
Views simple accidents as deliberate provocations
Gets very angry if sibling or peers retaliate to his or her
provocation
It easily irritated if things do not work properly
Is very sensitive (e.g. hates an everyday noise such as a
Siblings sniffing)
Angry or resentful
Loses temper very quickly over minor matters
Takes general criticism very personality
Sees personal accusations where none were intended
Holds grudges for a long time
Sulks for a long time after an upset
Spiteful or vindictive
Will deliberately spoil others fun
Will retaliate in a spiteful or vindictive way
Ridicules success or popularity in others

Spoils surprises or secrets

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Yes

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Dont know

Yes

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Dont know

Associated problems
Has Attention-Deficit/Hyperactivity Disorder
Has learning difficulties
Has communication
Family history
Other family members have a history of Oppositional
Defiant Disorder
Other family members have had behavioral or mental
Health problems

INTELLECTUAL DISABILITY CHECKLIST


Glynis Hannell, BA (Hons,) MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Early developmental delay
Was slow to learn to talk
Was delayed in achieving physical milestones (walking, sitting)
Was later than usual in achieving toilet training

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Needs more help than usual for a child or adolescent of


same age
Needs more help than usual with personal hygiene
Needs more adult guidance with regard to organization
Needs more adult supervision with basic chores such as
bed making
Needs more adult supervision with the regard to safety
Needs more adult supervision with managing money
Needs adult guidance with regard to sexually explicit behavior
Social difficulties
Finds it difficult to make friends of own age group
Often gets teased or bullied
Is socially nave
Is often too trusting of others, very gullible, and easily duped
Is easily led or set up by others
Is uninhibited: does not realize when it is important to hold back
Makes inappropriate friends
Thinks someone is a friend when he or she is only and
acquaintance
Believes in Santa, tooth fairy, etc., much later than peers
Immature play and recreation
Often plays with younger age group

Often likes toys, books, TV program or activities suitable for


younger age group
Gets frustrated and confused by age-appropriate toys or games
Is physically rough or silly in organized games

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Dont know

Assessments indicate well below average abilities


JQ score less than 70
Scores two or more standard deviations below the mean on
tests of intelligence
Additional difficulties or disorders
Speech and language less well developed than peers
Physically clumsy
Has additional difficulties or impairments, such as hearing
or visual difficulties
Classroom difficulties
Restless and inattentive in group activities
Avoids schoolwork
Depends very much on others
Needs a lot of teacher attention
Gets distressed and uncooperative when tasks assigned
Does not ask for help (may not realize that he or she is on the
wrong track)
Learning difficulties
Makes very slow academic progress in comparison to peers
Is significantly below standard in all curriculum areas
Needs learning broken into small stages
Needs a lot of repetition to master new learning
Needs concrete, hands-on learning experiences
Needs explicit teaching
Reading comprehension is poor even accuracy is reasonable
Finds abstract concepts difficult
Drawing and bookwork is immature
A high level of effort does not produce expected outcomes
Seems to be falling further and further behind as time goes by
Family History
Siblings or other family members have Mental Retardation

THE ATTENTION-DEFICIT DISORDER


(INATTENTIVE TYPE) CHECKLIST)
Glynis Hannell, BA (Hons.) MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Inattentiveness
Often seems to be daydreaming or in a world of his or her own
Sometimes says things out of the blue that are not relevant
Often starts things but gets distracted before he or she is finished
Often makes careless mistakes
Is sometimes suspected of having hearing problems
Often takes a very long time with everyday tasks such as dressing
or eating
Often slow to respond when spoken to or asked to do something
Seems vague and unaware of what is going on

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Poor organization
Often loses things that are needed for tasks or activities
Cannot organize a piece of schoolwork: does not know where
to start
Does not plan ahead, leaves everything until last minute
Seems to be unaware of urgent matters
Forgets important things
If messy: desk, locker, school bag, etc., are always a mess
Loses important items and does not remember where they
were left
Impatience
Gets easily frustrated with games or activities that need
patience
Has a poor sense of time; thinks tings take too long
Loses interest if things take too long

Easily distractible
Finds it hard to pay attention for long
Is easily side tracked
Starts things but does not finish them

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No

Dont know

Poor memory
Forgets instructions
Has difficulty learning by role (e.g., times tables)
Specific learning disabilities
Has difficulties with reading or spelling
Has difficulties with writing or neatness
Is underachieving in school
Family history
Adults or other children in the family have similar traits

Yes

THE ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER CHECKLIST
Glynis Hannell, BA (Hons.), MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Inattentiveness
Often seems to be in a world of his or her own
Sometimes says things out of the blue that are not relevant
Often starts things but gets distracted before he or she is finished
Often makes careless mistakes
Is sometimes suspected of having hearing problems
Takes a long time with everyday tasks such as dressing or eating
Does not seem to listen when spoken to
Seems agitated and distracted

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Poor organization
Often loses things that are needed for tasks or activities
Cannot organize a piece of schoolwork; does not know where
to start
Does not plan ahead, leaves everything until the last minute
It messy; desk, locker, school bag, etc., are always a mess
Always seems to be in a muddle
Impatience
Finds it hard to wait
Is nearly always in a rush
Gets easily frustrated with games or activities that need patience
Has a poor sense of time; thinks things take tool long
Impulsive
Often touches things when told not to
Acts or speaks before thinking
Repeats the same mistake over and over

Calls out in class when asked to listen or wait until asked


to speak
Works too quickly and makes silly mistakes
Interrupts when others are speaking
Seems sorry for wrongdoing but does the same thing again a
few minutes later

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Excitable
Often gets over-excited and silly when out of routine
Does not know when to stoop (e.g., with play fight or joke)
Is more excitable when tired
Loses control quickly (e.g., has tantrums over a small upset)
Easily distractible
Finds it hard to pay attention for long
Is easily side tracked
Starts things but does not finish them
Physically restless
Nearly always on the go; seems to have far more
than others
Often fiddles aimlessly with small objects
Finds it hard to keep still (has to move, touch, talk)
Sometimes noisy and boisterous; sometimes disruptive in school
Finds it hard to wind down and go to sleep
Is clumsy and poorly coordinated
Social difficulties
Causes parents friends and relatives to avoid contact because of
students active behavior
is too difficult for babysitters to handle
Other students are cautious because of boisterous, impulsive play
Causes parents to avoid shopping trips because of difficulties
managing the student
Is a poor team player; cannot wait turn: has to win: loses temper
quickly
Poor memory
Forgets instructions
Has difficulty learning by rote (e.g., times table)

Specific learning difficulties


Has difficulties with reading or spelling
Has difficulties with writing or neatness
Is underachieving in school

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Yes

No

Dont Know

Early history
Was restless or overactive as a young student
Family history
Adults or other children in the family have similar traits

THE SPECIFIC LEARNING DISABILTIY CHECKLIST


Glynis Hannel, BA (Hons)., MSc Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Underachievement
Had difficulties in learning to read, spell or write
Produces schoolwork that does not reflect his or her true ability
School reports say Could do better
Teachers think that the student is underperforming
Puts in effort not reflected in results
Only makes small improvements in response to a lot of good
teaching input

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1

2
2
2
2

3
3
3
3

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

Memory difficulties
Has difficulties remembering instructions
Has difficulties learning basics (e.g., letters and their sounds)
Has problems remembering words from one page to the next
Has problems learning sequences (e.g., multiplication tables)
Can learn spelling for a test but forget the words very rapidly
Gets the sequences of letters or numbers wrong
(e.g., 13 for 31, on for no)
Has difficulties with arithmetic, uses fingers to count
Copies things down incorrectly
Makes the same error over and over (e.g., whent for went)
Speech, phonological, and language difficulties
Has problems with word finding when speaking
Has problems pronouncing long words (e.g., hostipal for
hospital)
Has problems breaking words into sounds
Has difficulties blending sounds together
Has difficulties recognizing or producing rhymes
Has difficulties recognizing or producing alliteration
Has difficulties learning phonics

Was later that average in learning to talk


Has history of early ear infections
Is poor in structuring written language

0
0
0

1
1
1

2
2
2

3
3
3

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

0
1
0
0
0
0
0
0

1
2
1
1
1
1
1
1

2
3
2
2
2
2
2
2

0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

0
0

1
1

2
2

3
3

Difficulties combining spoken and written language


Was or is slow to learn the link between sounds and letters
Can spell a word verbally but cannot write it down
Has difficult getting thoughts on paper
Has words missing (or extra words) in written language
Reads words that are not there
Lacks fluency and speed in reading
Visual motor difficulties
Was or is slow to learn how to write
Does poor bookwork; is untidy, slow, messy
0
Mixes upper-and lowercase letters
Has difficulties working as fast as other students
Has poor coordination: is clumsy
Loses place when reading: uses finger to keep track
Reverses letters and numbers after the age of 7
Disliked puzzles and drawing as a younger child
Has difficulties with sustained writing; hand gets tired very
quickly
Has poor posture: slumps on desk when working: fidgets
sitting on the floor

3
3
3
3
3
3

Concentration difficulties
Is inattentive, in a daydream
Is easily distracted
Has been diagnosed as having Attention-Deficit Disorder
Is often restless and fidgety
Is often impulsive; does not stop and think; calls out in class
Makes many careless errors
Cannot read for more than a short period of home
Is poorly organized: often forgets books, equipment
Social and emotional difficulties
Has low self-esteem with regard to schoolwork
Avoids learning tasks; loses books: waste time; forgets
homework
Does not expect to succeed, so does not try

Gets frustrated and upset when effort does not produce good
results
Is reluctant to accept help; does not like to be different
Is often told to try harder even when working very hard

0
0
0

1
1
1

2
2
2

3
3
3

Yes

No

Dont know

Family history
Other family members have Dyslexia or similar learning
difficulties

THE SPEECH OR LANGUAGE IMPARIMENT CHECKLIST


Glynis Hannell, BA (Hons.) MSc. Registered Psychologist
Each item that applies to the child or adolescent should be checked off using the following rating
scale.
0 Not at all, does not apply
1 Mild, sometimes observed, applies to some extent
2 Moderate, Often observed, certainly applies
3 Severe, frequently observed, strongly applies
Please use O to indicate that an item has been considered and does not apply. If the O is not
checked, it is not clear if the item has been overlooked.
Late in learning to talk
Was late in learning to talk
Has needed speech therapy
Was or is slower than average to use correct grammar
(e.g., me wants, we wented)
Was or is low learning to count and recite the alphabet
Gets lost in the middle of a sentence

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

0
0
0

1
1
1

2
2
2

3
3
3

0
0
0
0

1
1
1
1

2
2
2
2

3
3
3
3

Word-finding difficulties
Often struggles to find the word that is needed
Uses word substitutes such as thingy, stuff, bit
Forgets names or words that are familiar
Puts up hand in class and then cannot remember the answer
Was or is slow to learn names of colors
Has difficulties learning names of letters or numbers
Finds it difficult to read words by sights
Is stilled and lacks fluency in reading
Not a confident talker
Is reluctant to talk to unfamiliar people
Does not usually volunteer to speak in class
Does not to talk on the telephone
Difficulties with expressive language
Gets words mixed up (e.g. confuses yesterday and tomorrow)
Gets words muddled (e.g., I was set up instead of I was upset)
Has difficulties saying what he or she means
Gives up trying to explain: says It doesnt matter

Uses gesture, facial expression, and mime more than others

0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3

0
0

1
1

2
2

3
3

0
0

1
1

2
2

3
3

0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3

0
0
0

1
1
1

2
2
2

3
3
3

Difficulties with receptive language


Has been suspected of having hearing difficulties even
though hearing is fine
Sometimes gets the wrong end of the stick when listening
Does not enjoy listening to stories; prefers pictures or action
Forgets a list of instructions
Seems to be in a world of his or her own a lot of the time
Often does the wrong thing when instructions are given
Watches others for cues as to what to do in school
Often asks teacher to repeat or clarify instruction
Gets tired and tunes out if listening for a long time
Phonological difficulties
Had early articulation difficulties
Is poor at producing rhyming words
Is poor at producing alliteration (words with the same
initial sounds)
Finds reading with phonics difficult (cannot remember sounds,
cannot blends sounds)
Mixes up words with similar sounds
Difficulties with social language
Does not use language to solve social problems; may use
physical force instead
Does not seem to understand tone of voice
Very literal: does not understand jokes pans or metaphors, etc.
Does not use facial expression or eye contact appropriately
Is not good at turn taking in conversation
Is poor at taking the listeners needs into consideration
Talks too loudly, too, softly, or too fast
Gets frustrated and upset when cannot make self understood
When upset or in trouble, cannot explain what is wrong
Forgets to use common courtesies and greetings
(e.g., Thank you, Hello)
Problems with auditory processing
Finds it hard to hear against background noise
Is very sensitive to loud noises
Is easily distracted by noises