Speech and Language Screener Quick Take Along® Response Form II.

II. Early Skills (Colors, Shapes, Parts of the Body, and Number Concepts)
(For use with the Speech and Language Screener Quick Take Along Mini-Book #TA-160)

Name: _____________________________ Date of Screening:____________________ Colors: R E Shapes: R E Body: R E

purple   triangle   head  
School: ____________________________ DOB:_________________________________
red   diamond   eyes  
Examiner: __________________________ Age:_________________________________ orange   star   foot  
Reason for Screening: ____________________________________________________ black   oval   arm  
green   heart   fingers  
Primary Area(s) of Concern:  Articulation  Receptive Language
blue   circle   elbow  
 Voice  Fluency  Expressive Language  Other ____________________
brown   square   stomach  
Action to Take: None (age appropriate) Recheck in ____ months yellow   rectangle   chin  
Consider RTI Refer for evaluation Continue S/L therapy
Number Concepts:
Change/add goals Consider dismissal Other ____________________
Count 1–10  3 apples  6 pennies 
I. Articulation
III. Simple Directions (Basic Concepts and Functions)
( is correct; - is an omission; X is a distortion; use the phonetic symbol for a substitution)
Basic Concepts: Functions:
mud m d hay h  biggest  smallest  one we eat  one used with paper
AGE 3
 bottom  right  one in the kitchen  one we eat with
foot f t U j web w b  same  middle  one that grows  one that is a pet
 top  different  one in the sky  one we draw with
pen p n knife n f tape t p  below  beside  one found outside  one used with soup

bag b g gum g m day d IV. Complex Directions

 the big car, then the little car  the big car after the little car
king k ŋ book k  the hat, then the dog  If you are a boy, the dog
AGE 4  the tree, then the book, then the chair  If you are a girl, the hat
 the chair before the book  both cars before the chair
cheese T z smooth D  either the dog or the hat  the book and the tree after the hat
AGE 5
S V. Questions
shave v this D s zoo z
Personal: General: Factual:
itch T leash l S seal s l  What  Where  Y/N  What  Where  Who
 When  Who  Who  When  When  What
V v judge D D  Y/N  Why  Where  Why  Y/N  Why

V. Vocabulary (Synonyms, Antonyms, and Homonyms)

fur 2 rose r Give another word for ... Give the opposite of ... Give two meanings for ...
AGE 6
 ill  hot   bark
 large  up   tie
teeth T thumb T
AGE 7  pretty  asleep   bat
 quick  dark   rock
 VII. Categories (Attributes and Comparisons) XI. Story Retell and Sequencing
Show me all the ... Name the category ... Name three ...  Setting  initiating event  flow  solution
 food  dog, pig, bear    sports  Characters  sequence  problem  conclusion
 tools  table, bed, sofa    jobs
XII. Listening Comprehension and Inferencing
Describe a ... Compare and Contrast ...
 flower pants and shorts  same  different  Who was having a birthday party?
 bike drum and piano  same  different  Why do you think Megan wasn’t going?
 Where did Peyton live?
VIII. Grammar
 Why did Amy wake up early on the morning of the party?
Adjectives: Plurals: Pronouns: Verbs: Past Tense:  What kind of decorations did Amy have?
 knife  cats  they/them  was/were  went  What did Amy ask her dad to help her with?
 joke  books  I/me  is/are  finished  When was the party supposed to begin?
 pillow  children  us/we  were/was  talked  How long did Amy wait for her friends to arrive?
 ice  blocks  she/her  do/does  built  Why do you think Peyton didn’t answer the phone?
 elephant  teeth  him/he  are/is  broke  Why do you think Amy’s friends were at Peyton’s house?
 rock  men  me/my  have/has  watched
XIII. Speech Sample
 race car  feet  her/she  does/do  baked
 glue  toys  them/their  are/am  taught  voice  intelligibility  relevant information
 fluency  sentence structure  topic maintenance
IX. Phonological Awareness
XIV. Social Skills
Add the syllables: Clap the syllables: Give a rhyming word:
 flash + light  yesterday  cat  Student responds appropriately to greetings.
 ru + ler  pencil  mail  Student works and plays cooperatively with others.
 ham + bur + ger  television  nap  Student initiates conversations with others.
 cer + ti + fi + cate  fantastic  fan  Student stays on topic during conversations.
 Student maintains eye contact with others.
Identify the first sound: Add the sounds: Take away the sound:
 Student understands and responds to feelings appropriately .
 mouse c + u + p  nice - n
 talk  ph + o + ne  tape - t XV. Notes and Observations
 goat n + e + s + t  stop - s
 car  c + l + ou + d  drain - d ____________________________________________________________________________

____________________________________________________________________________
X. Auditory Memory
____________________________________________________________________________
Numbers: Words: Sentences:
 4, 9  corn, paint  Button your coat. ____________________________________________________________________________
 6, 2, 1  rabbit, pencil  She ate the banana.
 5, 7, 4, 3  grass, chalk, ring  The cat chased the mouse. www.superduperinc.com
1-800-277-8737
 6, 9, 5, 8, 1  folder, apple, camel  My brother went to the store.
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