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Handout 8a: Parent/guardian questionnaire

Please download the Word document and complete

The Word document includes the following questions:

Your concerns:

  • What concerns do you have about your child?
  • How long have you had these concerns?
  • Which of these are you most concerned about?

Home and family

  • Who lives at home at the moment?
  • Any other family members who are important to your child?
  • What languages are spoken at home? What other languages does your child hear regularly? Which language are they most confident with?
  • Is there any family history of speech and language difficulties? Who and what difficulties?
  • Is there any family history of anxiety or shyness? Please describe.

Speaking habits

  • How much is your child able to speak to close family members at home? Are you concerned about their language skills at home?
  • Who does your child speak to freely and easily?
  • Is there anyone they talk to a little bit?
  • Anyone they cannot talk to at all?
  • Are they aware that they have a problem?

How concerned are you about your child’s confidence in speaking on a scale from 0-10 (where 10 is most concerned)                                0   1   2   3   4   5   6   7   8   9   10

Is there anything else you want to add?

Please note this form must be submitted alongside the standard referral form and the staff questionnaire if the child is in a setting OR if there are other SLCN concerns presented at school advice session