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LISTENING CHECKLIST
The ability to listen cannot be seen.  The only way to gauge listening is indirectly -- through evaluation of related skills. This checklist offers a catalog of skills which can be related to auditory ability.  There is no score and no "right" or "wrong" answers.  Check as many boxes as you feel are appropriate.  If you would like feedback for the Checklist, mail or fax to Rocky Mountain Learning Systems or take it to another professional.

RECEPTIVE LISTENING AND LANGUAGE 

This is listening which focuses outside of the self, relative to what others are saying, or what is going on in the environment. 

_X_  Check the most appropriate line.  

Difficulty staying focused at school.  
__ rarely  __ sometimes  __ often  __ always  

Short attention span.  
__ rarely  __ sometimes  __ often  __ always  

Easily distractible, especially by noise.  
__ rarely  __ sometimes  __ often  __ always  

Oversensitivity to certain sounds.  
__ rarely  __ sometimes  __ often  __ always  

Misinterprets questions or requests.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty in sound discrimination.  
__ rarely  __ sometimes  __ often  __ always  

Confuses similar sounding words.  
__ rarely  __ sometimes  __ often  __ always  

Needs repetition and clarification more than usual.  
__ rarely  __ sometimes  __ often  __ always  

Able to follow only one or two instructions in a sequence.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty understanding discussions.  
__ rarely  __ sometimes  __ often  __ always  

Poor short-term memory.  
__ rarely  __ sometimes  __ often  __ always  

Poor long-term memory.  
__ rarely  __ sometimes  __ often  __ always  

Must read material several times to absorb content.  
__ rarely  __ sometimes  __ often  __ always      
  

Tires easily 
__ rarely  __ sometimes  __ often  __ always  

Becomes sleepy when listening to speakers or reading.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty hearing low male voices.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty hearing high female voices.  
__ rarely  __ sometimes  __ often  __ always  

Seems that most people speak too fast.  
__ rarely  __ sometimes  __ often  __ always  

EXPRESSIVE  LISTENING AND LANGUAGE  

This listening focuses inside the self, including checking, monitoring and reproducing correctly what one hears, especially one's own voice and speech.   

Flat and monotonous voice quality.  
__ rarely  __ sometimes  __ often  __ always  

Speech lacks fluency and rhythm is hesitant.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty recalling exact word usage.  
__ rarely  __ sometimes  __ often  __ always  

Sings out of tune.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty with reading, especially out loud.  
__ rarely  __ sometimes  __ often  __ always  

Poor spelling.   
__ rarely  __ sometimes  __ often  __ always  

Difficulty summarizing a story.  
__ rarely  __ sometimes  __ often  __ always  

Difficulty relating isolated facts.  
__ rarely  __ sometimes  __ often  __ always  

Stumbles over words.  
__ rarely  __ sometimes  __ often  __ always

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MOTOR SKILLS 

This is listening to the body.  These skills are related to the vestibular system of the ear and affect balance, coordination, body image, and spatial orientation.  
__ Poor posture, including slouching and slumping.  
__ Uncoordinated body movement and fidgeting.  
__ Clumsiness, including tripping and stumbling.  
__ Confusion of right and left.  
__ Poor sense of rhythm.   
__ Messy handwriting.   
__ Difficulty with organization and structure.  
__ Often confused about location and direction.  
__ Poor athletic skills.   

BEHAVIORAL AND SOCIAL ADJUSTMENT  

These behaviors and attitudes may accompany an auditory problem.  
__ Low frustration tolerance.   
__ Poor self-image or low self-confidence.  
__ Difficulty in making and keeping friends.  
__ Withdraws from or avoids social interactions.  
__ Inordinately tired at end of school day.  
__ Low motivation, minimal interest in school, little desire to participate.  
__ Tense and anxious.   
__ Limited sense of aliveness.   
__ Difficulty setting goals and priorities.  
__ Difficulty in beginning and completing projects.  
__ Difficulty with time concepts and punctuality.  
__ Difficulty making judgments and generalizing to new situations.  
__ Hesitant to accept responsibility.  
__ Does not complete assignments.   
__ Lack of tactfulness.   
__ Tendency to act immaturely.   
__ Does not tolerate stress well. 


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LEVEL OF ENERGY 

The ear acts as a dynamo, providing us with electrical energy that stimulates the brain and nervous system.  This energy is necessary for our survival and for us to achieve fulfilling lives.  
__ Difficulty getting up.  
__ Tiredness at the end of the day.  
__ Habit of procrastinating.   
__ Hyperactivity.   
__ Tendency toward depression.   
__ Feels overburdened with everyday tasks.  

DEVELOPMENTAL HISTORY  

Listening difficulties often develop early in life.  Please note if any of the following apply.    
__ Delayed motor development.   
__ Delayed speech development.   
__ Delayed language development.   
__ Recurring ear infections.   
__ Experienced emotional trauma.  
__ Had dangerous experiences.   
__ Had frightening experiences.   
__ Mother had stressful pregnancy.  
__ Mother had difficult delivery.  
__ Experienced early separation from mother.  
  (i.e. hospitalization, incubation or mother ill) 

ENVIRONMENTAL HISTORY  

__ Exposure to loud sounds such as gunfire or loud concerts.  
__ Ringing in one or both ears.  
__ Suffered from concussion or head trauma.  
__ Suffers from headaches. (Please describe)  



FOREIGN LANGUAGES   

List the languages (other than English) spoken in your home.   



TELEPHONE #:   


DATE:  

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Parker, CO  80134
303-840-8806
Toll Free:  1-877-444-8808
Fax:  877-496-1968
 
Email:  info@rmlearning.com