RESOURCE PACKET Assessment of Language Impairment

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NAME ________________________________
RATING SCALE
Never – 1 Rarely – 2 Sometimes – 3 Usually – 4 Consistently – 5
3. Please rate communication functions (CONTINUED):
Date Date Date
• Expresses “finished” or “all gone” or “gone”
• Provides greetings/farewells
• Expresses comments (i.e., “I like it”. “It’s soft”.)
• Expresses feelings
• Expresses physical conditions
• Answers basic questions
• Asks questions
4. Please rate expressive language skills:
A. Phonology: Sound Production Patterns
Check the phonemes or speech sounds produced by the student—
include sound/word inventory:
• Speech sounds ______________________________________
__________________________________________________
• Babbling—consonant-vowel combinations _________________
__________________________________________________
• Jargon-speech sounds combined into patterns with intonations
__________________________________________________
B. Echolalia:
Check if student demonstrates echolalia in communication.
Timing: Immediate ________________________________
Delayed __________________________________
Echolalia: Exact ____________________________________
Function:
Mitigated (changed) _________________________
To continue interaction _______________________
To demonstrate comprehension _______________
Comments _________________________________________
_________________________________________
_________________________________________
ED –4072 / Rev. 07.09
Department of Education
Language Impairment Resource Packet