Teacher Speech and Language Concerns
Student: _________________________
Teacher: ________________________
Date form completed: ______________
Check all areas of concern. Please return this form to Lauren or Megan when
completed. Thank you!
Speech Production Concerns
 Student has difficulty producing individual speech sounds, and this significantly
interferes with communication. Sounds in words may be omitted, distorted, or substituted
with other sounds.
 Student has conversational speech that is not understandable (intelligible) all or some of
the time and that significantly interferes with communication.
 Other (please specify):
On average, I understand about X % of the student’s speech when he/she talks to me in
the classroom (circle one):
0-30%
40-50%
60-70%
80-90%
90+%
Expressive Language Concerns
 Student does not talk in complete sentences and this significantly interferes with
communication. Instead, the student talks mostly in incomplete phrases and sentences.
 Student’s sentences contain numerous grammar errors that are not typical for students
of the same age and that significantly interfere with communication (e.g., plurals,
negatives, verb tenses, pronouns). This may NOT apply to students who are English
Language Learners or who are known to speak a dialect of English.
 Student has difficulty providing explanations or directions that make sense to the
listener.
 Student retells stories or personal narratives that are disorganized, incomplete, or hard
to follow.
 Student has difficulty in conversation that significantly interferes with communication
(e.g., does not take turns, switches topics inappropriately).
 Other (please specify):
Teacher Concerns Checklist, p. 2
Student: _________________________
Teacher: ________________________
Date form completed: ______________
Receptive Language/Comprehension Concerns
 Student does not appear to understand/follow an age-appropriate direction that contains
multiple parts.
 Student does not appear to understand teacher questions presented in class that are
age-appropriate.
 Student does not appear to understand vocabulary words used in class that are at the
student’s independent/instructional reading level.
 Student does not request clarification when it appears the student does not understand a
teacher’s verbal direction.
 Student does not appear to understand comprehension questions about a short story
that is at the student’s independent/instructional reading level.
 Other (please specify):
Speech Fluency Concerns
 Student’s speech contains disfluencies that significantly interfere with communication.
 Sound, syllable, or word repetitions with obvious tension in face or neck muscles
 Sound prolongations
 Blocks (no sound or airflow)
 Student appears frustrated or upset about his/her dysfluent speech pattern.
 Other (please specify):
Voice Quality Concerns
 Student’s voice quality significantly interferes with communication
 Harsh or hoarse voice quality
 No voice
 Excessively nasal voice quality
 Other (please specify):