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Fisher’s Auditory Problem Checklist

Student's Name(Required)
MM slash DD slash YYYY

Please choose, YES or NO before each item that is/isn’t considered to be a concern by the observer:

Has a history of hearing loss?(Required)
Has a history of ear infection(s)?(Required)
Does not pay attention (listen) to instruction 50% or more of the time?(Required)
Does not listen carefully to direction — often necessary to repeat instructions?(Required)
Says "Huh?" and "What?" at least five or more times per day?(Required)
Cannot attend to auditory stimuli for more than a few seconds?(Required)
Has a short attention span?(Required)
If you chose YES for 'short attention span,' please check the most appropriate time frame(Required)
Daydreams — attention drifts — not with it at times?(Required)
Is easily distracted by background sound(s)?(Required)
Has difficulty with phonics?(Required)
Experiences problems with sound discrimination?(Required)
Forgets what is said in a few minutes?(Required)
Does not remember simple routine things from day-to-day?(Required)
Displays problems recalling what was heard last week, month, year?(Required)
Has difficulty recalling sequence that has been heard?(Required)
Experiences difficulty following auditory directions?(Required)
Frequently misunderstands what is said?(Required)
Does not comprehend many words/verbal concepts for age/grade level?(Required)
Learns poorly through the auditory channel?(Required)
Has a language problem, (morphology, syntax, vocabulary, phonology)?(Required)
Has an articulation (phonology) problem?(Required)
Cannot always relate what is heard to what is seen?(Required)
Lacks motivation to learn?(Required)
Displays slow or delayed responses to verbal stimuli?(Required)
Demonstrates below average performance in one or more academic areas?(Required)

Scoring: Four percent credit for each numbered item checked ‘No’?

Number of items checked ‘No’___ x 4 = ___

This field is for validation purposes and should be left unchanged.