4 YEAR OLD - INFORMAL LANGUAGE SAMPLE CHECKLIST
Student: ____________________________
Examiner: ____________________________
Birthdate:
______________________ CA:____
Date of Sample: ______________________
THIS CHILD DEMONSTRATED THE FOLLOWING SKILLS DURING THE SAMPLE:
(Leave ‘Not Observed’ skills unchecked)
CONCEPTS, PROCESSING, AUDITORY COMPREHENSION
 Y  N – Identifies colors
 Y  N – Identifies body parts
 Y  N - Sequences an event
 Y  N - Gives descriptions
 Y  N – Gives functions
 Y  N - Problem solves events
 Y  N – Understands
comparative/superlatives
 Y  N – Repeats 4 digits if given
slowly
MORPHOLOGY/ GRAMMAR
 Y  N – Answers Yes/No questions
 Y  N – Answers who, what, why, where, when how
many(up to #4) questions
 Y  N – Asks questions
 Y  N – Repeat sentences containing 4-5 words.
 Y  N – Follow simple directions (2-3 part)
 Y  N – Prepositions
 Y  N – Number concepts
 Y  N – Time concepts (today, yesterday, etc.)
 Y  N – Categorizing: selects items that are the same
 Y  N – Categorizing: selects items that are the different
NOTES:
Pronouns:
(circle)
 Y  N – Singular & Plural Subjective
I/ you/ he/ she/ we / they/ it
 Y  N – Singular & Plural Objective
me / you/ him/ her/ us/ them
 Y  N – Singular & Plural Possessive
my/ mine/ your/ yours/ his/ hers/ theirs/
its/ ours
 Y  N – Present prog. –“ ing”
 Y  N – plural marker –s, -es
 Y  N – Semiauxiliaries (gonna, gotta,
wanna)
 Y  N – Possessive –s (girl’s hat)
 Y  N – Present tense auxiliary (can,
will, be, do)
 Y  N – “BE” verb + pres. prog. “-ing”
 Y  N – Uses “be” verb (is / are/ am)
 Y  N – Regular past tense “-ed”
 Y  N – Irregular past tense
 Y  N – Articles “a” “the” etc.
MEAN LENGTH OF UTTERANCE & SENTENCE STRUCTURE
 Y  N - 3.75-4.5
 Y  N - Uses 3-5 words in a sentence
LITERACY & NARRATIVE SKILLS
 Y  N – Told personal narratives
 Y  N – Told with adult prompting
 Y  N – Told independently
 Y  N – Stories sequenced
 Y  N – Points & labels pictures
YN–
YN–
YN–
YN–
YN–
Stories included people
Stories included setting
Stories included outcomes
Turns pages
Retells a story in sequence
YN–
YN–
YN–
YN–
YN–
Retells stories/TV shows/procedure
Stories told in random order
Listens to short books/ stories
Holds a book correctly
Listens to simple nursery rhymes, songs
PRAGMATICS- (Use of language in communicative interactions)
SPEECH INTELLIGIBILITY -  75-95%
 Y  N – Appropriate turn taking
 Y  N – Associative play
 Y  N – “Conversation” with dolls
 Y  N – Engages in simple, make
believe activities
YN–
YN–
YN–
YN–
YN–
Terminate topics in conversation
Maintain topics in conversation
Looks for missing toys
Holds up fingers to tell age
Helps put away toys
 Y  N – Were utterances
sequenced?
 Y  N – Were utterances told in
random order?
 Y  N – Makes conversational repairs