Paed AUD: S.I.F.T.E.R. MOBILE

S.I.F.T.E.R.
SCREENING INSTRUMENT FOR TARGETING EDUCATIONAL RISK
ID number:
This child is in:
This child is suspect for hearing problems which may affect his/her ability to listen, pay attention, develop language, follow teacher instruction and learn normally. This rating scale has been designed to sift out children who are at risk for educational delay and who may need further evaluation. Based on your knowledge of this child, circle the number that best represents his/her behavior. If the child is a member of a class that has students with special needs, comparisons should be made to normal learning classmates or normal developmental milestones.
The above child is suspect for hearing problems which may or may not be affecting his/her school performance. This rating scale has been designed to sift out students who are educationally at risk possibly as a result of hearing problems. Based on your knowledge from observations of this student, circle the number best representing his/her behavior.
This scale has been designed to screen for educational risk in secondary students that have hearing loss. The effects of hearing impairment are frequently invisible. Regular monitoring of performance can assist in determining if a student is successfully accessing verbal instruction in the typical classroom. Based on your observations and familiarity with this student, circle the number that best represents his or her behavior.
PRE-ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
1. How well does the child understand basic concepts when compared to classmates (e.g., colors, shapes, etc.)?
PRE-ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
2. How often is the child able to follow two-part directions?
PRE-ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
3. How well does the child participate in group activities when compared to classmates (e.g., calendar, sharing)?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = SELDOM 4 3 = OCCASIONAL 2 1 = FREQUENT
4. How distractible is the child in comparison to his/her classmates during large group activities?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = LONGER 4 3 = AVERAGE 2 1 = SHORTER
5. What is the child's attention span in comparison to classmates?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
6. How well does the child pay attention during a small group activity or story time?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
7. How does the child's vocabulary and word usage skills compare to classmates?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
8. How proficient is the child at relating an event when compared to classmates?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
9. How does the child's overall speech intelligibility compare to classmates (i.e., production of speech sounds)?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALMOST ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
10. How often does the child answer questions appropriately (verbal or signed)?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALMOST ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
11. How often does the child share information during group discussions?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALMOST ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
12. How often does the child participate with classmates in group activities or group play?
SOCIAL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALMOST ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
13. Does the child play in socially acceptable ways (i.e., turn taking, sharing)?

SOCIAL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALMOST ALWAYS 4 3 = FREQUENTLY 2 1 = SELDOM
15. How often does the child become frustrated, sometimes to the point of losing emotional control?
ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = UPPER 4 3 = MIDDLE 2 1 = LOWER
1. What is your estimate of the student's class standing in comparison of that of his/her classmates?
ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = EQUAL 4 3 = LOWER 2 1 = MUCH LOWER
2. How does the student's achievement compare to your estimation of her/her potential?

ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = NOT VERY 4 3 = AVERAGE 2 1 = VERY
4. How distractible is the student in comparison to his/her classmates?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = LONGER 4 3 = AVERAGE 2 1 = SHORTER
5. What is the student's attention span in comparison to that of his/her classmates?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = NEVER 4 3 = OCCASIONALLY 2 1 = FREQUENTLY
6. How often does the student hesitate or become confused when responding to oral directions (e.g., "Turn to page . . .")?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
7. How does the student's comprehension compare to the average understanding ability of her/her classmates?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
8. How does the student's vocabulary and word usage skills compare with those of other student s in his/her age group?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE AVERAGE 4 3 = AVERAGE 2 1 = BELOW AVERAGE
9. How proficient is the student at telling a story or relating happenings from home when compared to classmates?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = FREQUENTLY 4 3 = OCCASIONALLY 2 1 = NEVER
10. How often does the student volunteer information to class discussions or in answer to teacher questions?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = USUALLY 2 1 = SELDOM
11. With what frequency does the student complete his/her class and homework assignments within the time allocated?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = NEVER 4 3 = OCCASIONALLY 2 1 = FREQUENTLY
12. After instruction, does the student have difficulty starting to work (looks at other students working or asks for help)?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = NEVER 4 3 = OCCASIONALLY 2 1 = FREQUENTLY
13. Does the student demonstrate any behaviors that seem unusual or inappropriate when compared to other students?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = NEVER 4 3 = OCCASIONALLY 2 1 = FREQUENTLY
14. Does the student become frustrated easily, sometimes to the point of losing emotional control?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = GOOD 4 3 = AVERAGE 2 1 = POOR
15. In general, how would you rank the student's relationship with peers (ability to get along with others)?
ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
1. How does the student’s general foundation skills (i.e., reading level) compare to the difficulty of work expected in class?
ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
2. How does the student’s ability to summarize and draw conclusions about information presented in class compare to his/her class peers?
ACADEMICS - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
3. How does the student’s demonstration of academic skill growth compare to class peers/expectations?

ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = OFTEN 2 1 = RARELY
5. How successful is the student at avoiding distraction by noises, visual distractions, personal items, or activities unrelated to class instruction?
ATTENTION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = OFTEN 2 1 = RARELY
6. How does the student’s attention to detail compare to class peers/expectations (avoiding careless mistakes)?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
7. How well does the student communicate his/her needs to the teacher in comparison to class peers/expectations?
COMMUNICATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
8. How does the student’s word usage skills compare to class peers/expectations (i.e., written, verbal, signed vocabulary)?

CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
10. In comparison to class peers, what is the student’s present level of meaningful contribution to classroom discussions?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ABOVE 4 3 = AVERAGE 2 1 = BELOW
11. To what level does the student demonstrate a recognition that participation is an integral part of the learning process?
CLASS PARTICIPATION - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = OFTEN 2 1 = RARELY
12. During cooperative group activities, how often does the student interact with others to achieve the goals of group work?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = FREQUENTLY 2 1 = OCCASIONALLY
13. How often does the student demonstrate respectful behavior toward others in class (peers and teacher)?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour.
Rows 5 = ALWAYS 4 3 = FREQUENTLY 2 1 = OCCASIONALLY
14. How often does the student follow classroom rules compared to class peers/expectations?
SCHOOL BEHAVIOUR - please use the rating scale to indicate the number that best represents their behaviour
Rows 5 = POPULAR 4 3 = AVERAGE 2 1 = ISOLATED
15. To what level does the student appear to be accepted by his/her peers?
Please provide any additional comments:
PRE-SCHOOL Expressive Communication (AT risk = 6-13; PASS = 14-30)
PRE-SCHOOL Socially appropriate behaviour (AT RISK = 4-11; PASS = 12-20)
SIFTER - ACADEMICS (PASS 10-15)
SIFTER - ATTENTION (PASS 9-15)
SIFTER - COMMUNICATION (PASS 11-15)
SIFTER - CLASS PARTICIPATION (PASS 9-15)
SIFTER - SCHOOL BEHAVIOUR (PASS 10-15)
SECONDARY SIFTER - ACADEMICS (PASS 10-15)
SECONDARY SIFTER - ATTENTION (PASS 10-15)
SECONDARY SIFTER - COMMUNICATION (PASS 10-15)
SECONDARY SIFTER - CLASS PARTICIPATION (PASS 9-15)
SECONDARY SIFTER - SCHOOL BEHAVIOUR (PASS 11-15)
Should be Empty:

Rows	5 = ABOVE AVERAGE	4	3 = AVERAGE	2	1 = BELOW AVERAGE
1. How well does the child understand basic concepts when compared to classmates (e.g., colors, shapes, etc.)?

Rows	5 = ALWAYS	4	3 = FREQUENTLY	2	1 = SELDOM
2. How often is the child able to follow two-part directions?

Rows	5 = SELDOM	4	3 = OCCASIONAL	2	1 = FREQUENT
4. How distractible is the child in comparison to his/her classmates during large group activities?

Rows	5 = LONGER	4	3 = AVERAGE	2	1 = SHORTER
5. What is the child's attention span in comparison to classmates?

Rows	5 = ALMOST ALWAYS	4	3 = FREQUENTLY	2	1 = SELDOM
10. How often does the child answer questions appropriately (verbal or signed)?

Rows	5 = UPPER	4	3 = MIDDLE	2	1 = LOWER
1. What is your estimate of the student's class standing in comparison of that of his/her classmates?

Rows	5 = EQUAL	4	3 = LOWER	2	1 = MUCH LOWER
2. How does the student's achievement compare to your estimation of her/her potential?

Rows	5 = NOT VERY	4	3 = AVERAGE	2	1 = VERY
4. How distractible is the student in comparison to his/her classmates?

Rows	5 = NEVER	4	3 = OCCASIONALLY	2	1 = FREQUENTLY
6. How often does the student hesitate or become confused when responding to oral directions (e.g., "Turn to page . . .")?

Rows	5 = FREQUENTLY	4	3 = OCCASIONALLY	2	1 = NEVER
10. How often does the student volunteer information to class discussions or in answer to teacher questions?

Rows	5 = ALMOST ALWAYS	4	3 = FREQUENTLY	2	1 = SELDOM
13. Does the child play in socially acceptable ways (i.e., turn taking, sharing)?

Rows	5 = ALMOST ALWAYS	4	3 = FREQUENTLY	2	1 = SELDOM
14. How proficient is the child at using verbal language or sign language to communicate effectively with classmates (e.g., asking to play with another child's toy)?

Rows	5 = UPPER	4	3 = MIDDLE	2	1 = LOWER
3. What is the student's reading level, reading ability group or reading readiness group in the classroom (e.g., a student with average reading ability performs in the middle group)?

Rows	5 = ALWAYS	4	3 = USUALLY	2	1 = SELDOM
11. With what frequency does the student complete his/her class and homework assignments within the time allocated?

Rows	5 = GOOD	4	3 = AVERAGE	2	1 = POOR
15. In general, how would you rank the student's relationship with peers (ability to get along with others)?

Rows	5 = ABOVE	4	3 = AVERAGE	2	1 = BELOW
1. How does the student’s general foundation skills (i.e., reading level) compare to the difficulty of work expected in class?

Rows	5 = ALWAYS	4	3 = OFTEN	2	1 = RARELY
4. When called upon and asked a question, how often does the student appear to have been attending to teacher instruction? (he/she appears to understand the basis of the question)

Rows	5 = POPULAR	4	3 = AVERAGE	2	1 = ISOLATED
15. To what level does the student appear to be accepted by his/her peers?