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Home | Forms (to print-scroll to bottom of form) Supplemental Questionnaire Community Speech and Hearing Center How does your child communicate? 1. Requests:
How does he/she get attention? (show off, tease, flirt) _________________________________________________________________________ How does he/she initiate social exchange? _________________________________________ _________________________________________________________________________ How do you know when he/she wants to convey or receive affection? ____________________ _________________________________________________________________________ How does he/she request desired activities? (TV., bathroom)__________________________ ________________________________________________________________________ How does he/she ask for help? ________________________________________________ ________________________________________________________________________ How does he/she ask for information/clarification? __________________________________ ________________________________________________________________________ How does he/she ask for objects? ______________________________________________ ________________________________________________________________________ How does he/she ask for food? ________________________________________________ ________________________________________________________________________
2. Negations:
How does he/she express objection to a request? ___________________________________ ________________________________________________________________________ How does he/she express rejection of an event suggested by another? ___________________ ________________________________________________________________________ How does he/she express his/her desire to end an activity once it has begun? ______________ ________________________________________________________________________
3. Declarations/Comments:
How does he/she comment on an event or occurrence? (past, present or future)____________ ________________________________________________________________________ How does he/she comment on objects? (including food), or about people (complaints/comments)?______________________________________________________ ________________________________________________________________________ How does he/she acknowledge that another person has committed an error? ______________ ________________________________________________________________________ How does he/she convey agreement about or willingness to engage in an event or action?_____ ________________________________________________________________________ How does he/she greet a person or express recognition?_____________________________ _______________________________________________________________________ How does he/she express humor?______________________________________________
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