Teacher Checklist-Fluency

 

The following form contains a checklist and questionnaire which is designed to increase awareness of the teacher of a child who stutters.


THIS FORM IS TO BE COMPLETED BY SCHOOL PERSONNEL BASED UPON OBSERVATIONS IN THE CLASSROOM

Student’s Name _______________________________________________

B. D. ________________ Age _________ Date ______________________

Teacher/Support Staff___________________________________________

School ____________________________ Grade______________________

Your observations of this student’s ORAL COMMUNICATION SKILLS will help determine if there is a fluency problem which adversely affects the student’s ability to communicate effectively in school learning and/or social situations.

Fluency refers to the typical rate and rhythm of connected speech. When disruption occurs, this is known as disfluency and/or stuttering.

  1. Check any of the following behaviors that you have noticed in this student’s speech:

    • Revisions (starting and stopping and starting over again
    ( )

    • Frequent interjections (um, like, you know)
    ( )

    • Phrase repetitions (and then, and then)
    ( )

    • Pauses or hesitate while speaking (“He … went away.”
    ( )

    • Word repetitions (we-we-we)
    ( )

    • Part word repetitions (t-t-t-take; mo-mo-mom)
    ( )

    • Prolongations (no____body)
    ( )

    • Blocks (noticeable tension/no speech comes out)
    ( )

    • Unusual face or body movements (head nods, eye movement) 
    ( )

    • Abnormal breathing patterns
    ( )

    Other _______________________________________________________

    _______________________________________________________



  2. Answer the following questions with YES or NO.


  3. Information questions


Thank you for taking time to share this helpful information.

Source: Judith Eckardt, SLP, Board Recognized Fluency Specialist, USA, 8/03

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