3 YEAR OLD - INFORMAL LANGUAGE SAMPLE CHECKLIST
Student: ____________________________
Birthdate:
______________________ CA:____
Examiner: ____________________________
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 - Sequencing an event
 Y  N - Gives descriptions
 Y  N – Gives functions
 Y  N - Problem solving events
 Y  N – Demonstrates knowledge
of verbs by selecting correct picture
MORPHOLOGY/ GRAMMAR
 Y  N – Answers Yes/No questions
 Y  N – Answers who, what, why, where questions
 Y  N – Asks questions
 Y  N – Repeat sentences containing ____ words.
 Y  N – Follow simple directions (1-2-part)
 Y  N – Prepositions: (circle) in/off, on/under, out of,
together, away from, up/down
 Y  N – Number concepts
 Y  N – Time concepts
 Y  N – Categorizing: selects items that are the same
 Y  N – Categorizing: selects items that are the different
Pronouns:
(circle)
 Y  N – Singular & Plural Subjective
I/ you/ he/ she/ we / it
 Y  N – Singular & Plural Objective
me / you/ us/ them
 Y  N – Singular & Plural Possessive
my/ mine/ your/ yours
 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)
NOTES:
MEAN LENGTH OF UTTERANCE & SENTENCE STRUCTURE
 Y  N - 2.5-3.0 – Increasing length due to use of axiliaries. Increases use of wh-questions and uses interrogative reversals. Should already be:
using 1-2 & 3 word utterances, intonation to answer yes/no questions
 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–
Stories included people
Stories included setting
Stories included outcomes
Turns book pages
YN–
YN–
YN–
YN–
YN–
Retells stories/TV shows/procedure
Stories told in random order
Listens to books/ stories (at least 3 minutes)
Holds a book correctly
Listens to simple nursery rhymes, songs
PRAGMATICS- (Use of language in communicative interactions)
SPEECH INTELLIGIBILITY -  50-75%
 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