Referral Checklist
www.barnsleyspeechtherapy.co.uk
Name: ……………………………………
…………………………………………….
Date of Birth: …………………..............
NHS number: ……………………………
Please do this checklist before making a referral.
We do not provide a service for:
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Children with a lisp who are developmentally under 8 years. If they are over 8 years
we will only see them if they are concerned about the lisp and are keen to change it.
Children who change a ‘th’ or ‘the’ sound to ‘f’ or ‘v’ e.g. thin said as “fin” and this said
as “vis”.
Children with difficulties with ch, sh, j, r, l, r-clusters or l-clusters until they are
developmentally 8 years or older.
Children who reduce s-clusters e.g. spider to “pider”, stamp to “tamp” until they are
developmentally 7 years or older.
Children with voice difficulties
Does the child have a persistent hoarse / husky voice / regularly lose their voice?
If so, refer the child to an Ear, Nose and Throat (ENT) Service. The parent/carer may
need to ask their GP to do this on their behalf. If appropriate, the ENT Consultant will
make an onward referral to our service. We are unable to accept a referral before the
child has been seen by ENT.
Our website www.barnsleyspeechtherapy.co.uk provides general advice for the child,
family and school on looking after your voice.
What to Do
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Fill in this checklist with the child’s parent / legal guardian. You are considering the
child’s general level of development not their chronological age.
Select the appropriate age range below.
If you only tick boxes in the left column (no colour):
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You do not need to refer to Speech and Language Therapy at the current time.
If you tick any boxes in the right column (colour):
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You need to complete a referral form. Send this checklist with your referral.
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1
NO REFERRAL REQUIRED
TICK
18 MONTHS (Education Level P2-P3)
Some pretend play (feeding self,
brushing own hair)
Responds to simple commands and
questions as part of an everyday routine
Communicates through gesture rather
than words
Uses babble ‘nonsense’ words or words
which only close family understand
REFERRAL REQUIRED
18 MONTHS
Concerns regarding eating / drinking
No pretend play
No understanding of very familiar, often
used words
Little response to spoken language
No babble or words
2 YEARS (Education Level P4)
Enjoys pretend play
No concerns about understanding of
familiar language; can respond to simple
instructions
2 YEARS
Concerns regarding eating / drinking
Little pretend play
Uses a small number of real words (10),
possible ‘nonsense’ words
Understands less than 10 everyday objects
and action words (do not count family
names, yes / no)
Names less than 4 everyday objects (do
not include family names, yes / no); no
attempt to copy or imitate words
Child sounds nasal; speaks through their
nose; has a history of food coming down
their nose; has a cleft lip or palate
Child only uses the consonants m and n
Only close family understand speech
Repeats syllables in a word e.g. “fafa” for
flower or “tata” for tractor
Misses ends off words e.g. bike sounds
like “bye”
May only have the sounds p, b, m, n, w
2 ½ YEARS (Education Level P4)
Understands simple instructions including
2 key words e.g. show me mummy’s
shoes, show me daddy’s eyes
Vocabulary includes some action words
e.g. jump, run, clap
Has the sounds from previous section
plus t, d, g, k
Single word vocabulary of more than 12
single words and parents report progress
including imitation
k and g often said as t and d e.g. car
sounds like “tar” and go sounds like “doe”
Speech is often difficult for people
outside the close family to understand
Misses the end off words e.g. bike
sounds like “bye”
TICK
No words understood by close family
2 ½ YEARS
Concerns regarding eating / drinking
Does not follow simple instructions
involving 2 key words
Does not understand action words e.g.
jump, run, clap
Has less than 12 single words (do not
count family names, yes / no)
Has a stammer
Speech is often difficult for close family to
understand
Child sounds nasal; speaks through their
nose; has a history of food coming down
their nose; has a cleft lip or palate
Child only uses the consonants m and n
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2
3 YEARS (Education Level P5)
No concerns about understanding of
language
Understands simple instructions including
3 key words e.g. give the big truck to
mummy, give the little car to grandma
Close family usually understand what
child is saying but often unintelligible to
others
Uses appropriate sentences of 3+ words
Sounds developing in addition to those in
previous section are s, f, y
s and z are often said as t and d e.g.
sand said as “tand”
f and v often said as p and b
y often said as w or l
l often said as w or y
3 ½ - 4 YEARS (Education Level P6)
Understands instructions typically given
to a child of this age
Understands most of what is said to them
Utterances are 5 – 6 words long and
used appropriately
Speech is mainly understood by others
c/k and g often said as t and d e.g. car is
said as “tar” and go is said as “doe”
Sounds developing are sh, ch, v, z, j
sh often said as t
f and v often said as p and b
s and z often said as t and d
y often said as l or w
ch often said as t or s
j often said d or z
3 YEARS
Concerns regarding eating / drinking
Does not seem to understand what is said
to them
Uses only single or 2 word sentences and /
or the same phrases over and over again
and / or inappropriate short sentences
Has a stammer
Child sounds nasal; speaks through their
nose; has a history of food coming down
their nose; has a cleft lip or palate
Child only uses the consonants m and n
Speech is difficult for family to understand
most of the time
3 ½ - 4 YEARS
Concerns regarding eating / drinking
Does not seem to understand what is said
to them
Not using 5 – 6 word utterances
Repeats the same phrases over and over
and / or mimics others’ language frequently
Uses unusual word order
Has a stammer
Speech is difficult for others to understand
Does not use final consonants in words
e.g. bat → “ba”
Uses k and g for many other consonants
e.g. door → “goor”,
sun → “gun”, shoe → “goo”
Child sounds nasal; speaks through their
nose; has a history of food coming down
their nose; has a cleft lip or palate
Child only uses the consonants m and n
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3
4 ½ - 5 YEARS AND ABOVE
(Education Level P7-P8)
Responds appropriately to instructions
Utterances are long and appropriate but
some grammatical features are still
incorrect e.g. “breaked”
Speech is harder to understand when
utterances are longer and more complex
or when a child is excited or upset
Under 7 years: s-clusters not used
correctly e.g. sp is said as “p” and sm is
said as “m”
Under 8 years: l- and r-clusters not yet
used correctly e.g. pl said as “p” or “l”,
tr said as “t”
Under 8 years: sh said as “t” or “s”,
ch said as “t”, “s” or “sh”
j said as “d”, “z”
r said as “w”
y said as “w” or “l”
th said as “f”
the said as “v”
4 ½ - 5 YEARS
Concerns regarding eating / drinking
Uses unusual word order
Seems not to understand spoken
instructions when other skills are good
Has a stammer
Unintelligible to familiar adults much of
the time
Uses sounds not normally found in English
Child sounds nasal; speaks through their
nose; has a history of food coming down
their nose; has a cleft lip or palate
Child only uses the consonants m and n
This checklist has been adapted from the Bristol Surveillance of Children’s Communication (BRISC)
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