Free Self Screening Tool - Creative Speech Therapy NYC

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The Social Jam
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Services
The Social Jam
About
- Our Story
- Our Team
- Location
- FAQ
Resources
Book an Appointment

Risk factors to keep in mind

Family history of speech, language, or feeding delay
Prematurity
Tongue Tie
Hearing Problems
Missing developmental milestones
Being male (2-3x more likely than girls)
Being a quiet baby
Sleep apnea
Snoring
Difficulty latching to breast or bottle

Speech & Language Self-Screener

Please fill out the questions that apply to your child and we will be in touch with you within 24 hours.

How old is your child?

I think my child needs help with:

Speech sounds
Social language
Following directions
Apraxia
Stuttering
Tongue-tie (tethered oral tissue)
Open mouth posture at rest
Cooing and babbling

How much of your child's language do you understand?

My child is non-verbal or almost always non-verbal
About 25%
About 50%
About 75%
I can almost always understand them

How much of your child's language do others understand?

My child is non-verbal or almost always non-verbal
About 25%
About 50%
About 75%
People almost always understand them

If your child is verbal, have you noticed them struggling with a specific sound (or multiple sounds) like R, S, W, or Z?

Yes, they can speak in words and sentences but struggle with a certain sound(s)
No, there doesn't seem to be a particular sound they struggle with

Is your child able to answer yes/no questions?

Yes
No
Sometimes

Is your child able to follow directions and complete routines?

Yes
No
Sometimes

Is your child able to answer "Wh" (who, what, when, where) questions?

Yes
No
Sometimes

Is your child able to communicate using topic specific vocabulary and combine words into phrases and sentences?

Yes
No
Sometimes

Does your child have an autism diagnosis or another disorder or syndrome?

Yes, autism
Yes, a syndrome/disorder
Yes, autism + another syndrome/disorder
No

Does your child feel frustrated with their level of communication skills?

Yes
No

vocabulary combine at

Does your child your child act out or tantrum because they are unable to express their needs?

Yes
No
Sometimes

Does your child seem to be at the same level of communication skills as their peers?

Yes
No, they seem a little behind
No, they seem quite far behind

Do you notice your child's jaw hanging open when they're resting or that they often breathe through their mouth?

Yes
No
Sometimes

When your child smiles, do you see a significant amount of their gums and not just teeth?

Yes
No

Does your child exhibit any of the following:

Messy eating
Dental problems
Fatigue from chewing
Inefficient chewing (bites that are too big)
Difficulty swallowing pills
Excessive drooling
Digestive problems
Sleep apnea
Snoring
Asthma
Chronic stuffy nose/cold
Food texture aversion
Tooth grinding
Pocketing food in the cheeks when eating
Asymmetric smile
Headaches or TMJ

Name *

Email *

Phone Number

How you heard about us

Notice of Privacy Practices

No Surprises Act
You have the right to receive a "Good Faith Estimate" of what your services may cost

313 East 95th Street
New York, NY 10128
Main Office Line: +1 (646) 476 - 4599
Mobile Line: (347) 926 - 3631
office@cst-nyc.com

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