Speech Play Evaluation Check List

Date of Evaluation:

Caregiver’s name:

Child’s Name:

DOB:

Questionnaire for the caregiver about the child:

• Pregnancy History
• Medical History
• Vision
• Hearing
• Allergies
• Referral
• Milestone
• Lateralization
• Bilingualism
• Eye contact 

PLS-5 (Preschool Language Scale Fifth Edition), age range birth - 7:11

• Receptive
• Expressive
• Articulation Screener

Goldman Fristoe-3 Test of Articulation, age range 2:0 - 21:11

Play skills assessment after Westby’s Symbolic Play Scale through the first 5 years

Feeding:

• Biting/chewing (get some healthy, crunchy, and  chewy snacks)
• Drinking from a cup (cup, water, nectar juice)
• Drinking through a straw (straw)

Oral-motor skills:

• Lips: pa-pa-pa
• Tongue: ta-ta-ta
• Palate: ka-ka-ka
• Overall: pa-ta-ka

Voice/fluency 

Materials:

Preschool Language Scales PLS-5 Evaluation, age range birth - 7:11

To buy https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Speech-%26-Language/Preschool-Language-Scales-%7C-Fifth-Edition/p/100000233.html?gclid=CjwKCAiAgvKQBhBbEiwAaPQw3L0l5NssM6LltS-On0HTgrGn_QMuoxhdrcZBa8zO0wnKlBX2rq9k9xoCDOcQAvD_BwE

Goldman Fristoe-3 Test of Articulation, age range 2:0 - 21:11

To buy https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Developmental-Early-Childhood/Goldman-Fristoe-Test-of-Articulation-3/p/100001202.html#

Westby’s Symbolic Play Scale, through the first 5 years

https://www.smartspeechtherapy.com/wp-content/uploads/2017/07/Revised-Concise-Symbolic-Play-Scale.pdf

https://www.hpcswf.com/wp-content/uploads/2019/10/Paul_Westby_Play_Scale.pdf