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This document is a questionnaire used to gather information about a child's speech, language, hearing, and swallowing history to assist in the assessment process at the Speech-Language & Hearing Clinic.

How to fill out childadolescent speech-language and hearing

How to fill out Child/Adolescent Speech-Language and Hearing History

1. Start with the child's name and date of birth at the top of the form.
2. Fill in the parent's or guardian's contact information including address, phone number, and email.
3. Provide details about the child's primary language and any additional languages spoken.
4. Indicate any specific speech or language concerns noted by parents or teachers.
5. Record the child's developmental milestones regarding speech and language.
6. Include any relevant medical history, including hearing issues or previous evaluations.
7. Note any therapy services the child has previously received or is currently receiving.
8. List any family history of speech, language, or hearing disorders.
9. Leave space for additional comments or observations from the parent or guardian.

Who needs Child/Adolescent Speech-Language and Hearing History?

1. Parents or guardians of children who have concerns about their speech or language development.
2. Teachers or educators who are noticing communication difficulties in students.
3. Speech-language pathologists conducting assessments for diagnostic or treatment purposes.
4. Medical professionals referring a child for speech and language evaluation.

People Also Ask about

What are the milestones in speech and language for a 4 and 5 year old?

Imitates reading and writing from left to right. Blends word parts, like cup + cake = cupcake. Identifies some rhyming words, like cat and hat. Produces most consonants correctly, and speech is understandable in conversation.

Why has my child been referred to speech and language?

Cognitive changes such as decreased memory or problem solving skills. Has difficulties communicating basic needs. Child not combining words by 18 months of age. Child stops saying sounds or words he or she had previously mastered.

What are the stages of language development in adolescence?

Communication Development (11-16 Years) Increasing skill with narrative and complex grammar. Growing vocabulary and a developing ability to infer meanings of words from context. Increasing understanding of figurative language.

Why are children referred to speech and language?

Infants: Speech and Language Therapists (SLT's) support premature babies and infants with conditions such as cerebral palsy, cleft palate and Down syndrome from very early in life as well as infants who have difficulties with drinking / swallowing and developing their early play and communication skills.

What happens after a speech and language assessment?

Following the assessment, the therapist will discuss your child's needs - which may be: no further appointments needed as continued progress is expected - your child will be discharged. no therapy needed at present - your child's progress will be reviewed in an agreed number of months.

What is speech and language therapy for hearing impaired children?

SLTs can identify if your child has any specific language and communication problems in addition to their deafness. SLTs also support children with eating and drinking, especially if they have difficulties with swallowing.

Is speech and language part of autism?

Communication and speech-related challenges vary from person to person. Some individuals on the autism spectrum are not able to speak. Others love to talk, but have difficulty holding a conversation or understanding body language and facial expressions when talking with others.

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What is Child/Adolescent Speech-Language and Hearing History?

Child/Adolescent Speech-Language and Hearing History is a document that collects relevant information about a child's or adolescent's speech, language, and hearing development, including any previous evaluations or services received.

Who is required to file Child/Adolescent Speech-Language and Hearing History?

Typically, parents or guardians of the child or adolescent are required to file the Child/Adolescent Speech-Language and Hearing History as part of the evaluation process for speech and language services.

How to fill out Child/Adolescent Speech-Language and Hearing History?

To fill out the Child/Adolescent Speech-Language and Hearing History, parents or guardians should complete the form by providing detailed information about the child's communication skills, medical history, developmental milestones, and any concerns regarding speech or hearing.

What is the purpose of Child/Adolescent Speech-Language and Hearing History?

The purpose of the Child/Adolescent Speech-Language and Hearing History is to gather pertinent information that assists speech-language pathologists in assessing and identifying the specific needs of the child or adolescent in terms of communication.

What information must be reported on Child/Adolescent Speech-Language and Hearing History?

Information that must be reported includes the child's age, speech and language development milestones, any past evaluations or therapies, family history of speech or hearing issues, and details about any current concerns regarding communication abilities.