Preschool Communication Screen Form
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1
2Pre-school Communication Screen
Date __________
Name ____________________________
DOB __________
Age ___________
Examiner _________________________
Screening Site _____________________
Result
_____ PASS (Age-appropriate skills; no concern at this time)
_____ WATCH (A few errors; inconsistent; borderline performance; non-compliant)
_____ EVALUATE Skills in question: _____________________________________
Materials needed: (1) pen, (2) book, (3) box of 8 basic-colored crayons or markers, (4) articulation
pictures
Responding to Wh- Questions (repetitions are allowed) (Pass = 3 correct)
1.
a.
What's your name? _____________________
b.
How old are you? _____________________
c.
How many ears do you have? _____________________
___ Pass
d.
Who do you like to play with? _____________________
___ No
e.
What do you like to eat? _____________________
Following Commands
2.
Place pen, book, and crayons in front of child. (Pass = 2 correct in parts a & b)
Individual commands using prepositions (repetitions are allowed, but not for
a.
errors)
1.
Put the pen on the book. ____
___ Pass
2.
Now, put the pen under the book. ____
___ No
3.
Now, put it next to the book. ____
Two-level commands (repetitions are allowed, but not for errors)
b.
1.
Open the book, and then give it to me. ____
2.
Now, take the book back, and give me the crayons. ____
___ Pass
3.
Touch your nose, and then clap your hands. ____
___ No
Identifying Colors (repetitions are allowed, but not for errors)
3.
Present crayons or markers with the 8 basic colors. (Pass = 4 correct)
"Which one is..." (Child must point, not give, so number of choices remains same.)
___ Pass
a. red ___
b. blue ___
c. brown ___
d. green ___
___ No
e. yellow ___ f. black ___
g. orange ___ h. purple ___
Understanding Number Concepts (repetitions are allowed, but not for errors)
4.
Place all of the crayons or markers in front of the child. (Pass = 2 correct)
___ Pass
a.
Give me two of them. ____
___ No
b.
Now give me one and you take one. ____
Continued on other side...>>
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