TEST QUESTIONNAIRES

Name*

First Last

Date*

Date of Birth*

Clinician*

Instructions

These are statements that many people have used to describe their voices and the effects of their voices on their lives. Circle the response that indicated how frequently you have the same experience.

I would rate my/my child’s talkativeness as the following*

My child’s voice makes it difficult for people to hear him/her*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

People have difficulty understanding my child in a noisy room*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

At home, we have difficulty hearing my child when he/she calls through the house*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child tends to avoid communicating because of his/her voice*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child speaks with friends, neighbours, or relatives less often because of his/her voice*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

People ask my child to repeat him/herself when speaking face-to-face*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child’s voice difficulties restrict personal, educational and social activities*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child runs out of air when talking*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

The sound of my child’s voice changes throughout the day*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

People ask, ‘What’s wrong with your child’s voice?’*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child’s voice sounds dry, raspy, and/or hoarse*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

The quality of my child’s voice is unpredictable*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child uses a great deal of effort to speak (e.g. straining)*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child’s voice is worse in the evening*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child’s voice ‘gives out’ when speaking*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child has to yell in order for others to hear him/her*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child appears tense when talking to others because of his or her voice*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

People seem irritated with my child’s voice*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

I find other people don’t understand my child’s voice problem*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child is frustrated with his/her voice problem*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child is less outgoing because of his/her voice problem*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child is annoyed when people ask him/her to repeat*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

My child is embarrassed when people ask him/her to repeat*

0 - Never
1 - Almost Never
2 - Sometimes
3 - Almost always
4 - Always

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