A UDITORY SENSATION (Sammy Page 3)

YES NO COMMENTS

Does your child:

Seem overly sensitive to sound? __yes___ _____ coffee grinder, blender and vacuum

Miss some sounds or poorly discriminate sounds? __yes___ _____ ____________________________

Seem confused about the direction of sounds? _____ __no___ ___________________________

Like to make loud or high pitched noises?___yes__ _____ _Humming with fingers in his ears_

Have a diagnosed hearing loss? _____ __no___ ___________________________

Hear things before you hear them? __yes___ _____ If you turn on his favorite video come running

Easily distract by noise? __yes__ _____ At times, ignores at others

Frighten by the sound of certain machinery or toys? __yes___ _____ ___________________________

Have you or others ever thought your child was deaf? __yes___ _____ ___________________________

SPEECH AND LANGUAGE DEVELOPMENT

1. How would describe your child's speech and language?Has a few words but not level appropriately.

3. Articulation: Serious but some intelligible speech ****He used to speak clearer than he does now!

5. Please describe your child's voice: ***Sometimes when he say's a word he will almost whisper it and his voice almost has a sing song quality to it.

Never Sometimes Often Always

Do you have to repeat instructions? ______ __________ ______ ____Often____

Pay little attention when spoken to? ______ __________ ______ ___Often_____

Have difficulty remembering what is said? ______ __________ _______ ___Often_____

Enjoy music? ______ __________ _______ ___Often_____

Loses his/her concentration ______ __________ ___Often___ ________

Easily distracted? ______ __________ ___Often____ ________