Kathy and Calvin's Home Page

Sample Evaluation from an ESD

ESD

Early Intervention Program

I. NAME:

REPORT DATE: 6-9-98

PARENTS:

CHRONOLOG. AGE: 2 years 2 months

II. BACKGROUND & REFERRAL REASON

A. Referred By: KinderCare suggested that his parents call us.

Referral Reason:

CK is using less than ten words. He does not always respond to his name.

B. BackeroundAlistory:

Information for this report was obtained through parent report. CK's father was reporter on this day. CK lives at home with his mother and father.

Prenatal History:

Dad reported that CK's mother experienced no complications during her pregnancy. He was born one week late, weighting 9 lbs. 4 oz. There were no reported complications after his birth.

Medical History:

Dad remembered that CK has had a few ear infections in his life and one in the last six months. He is not sure how well CK seems to hear. He does not consistently respond to his name. Dad has no concerns about CK's vision.

Developmental Milestones:

CK reportedly crawled somewhere between 6 and 8 months of age. He walked around 14 months of age. He mostly finger feeds, but has recently been using a spoon at school. He is able to take his shoes and socks off. He does help put his jacket on, according to Dad. He is climbing the steps of the slide well at school. Dad says he is using very few words to indicate his wants. He is now able to separate more easily. It took him a couple months to adjust to leaving Mom or Dad.

C. Child Observation: This observation took place at KinderCare on May 11, 1998. I observed CK while in his class at KinderCare. He had two teachers and five peers with him. When I first walked in, they were having snack and CK ate crackers and drank juice. He did ask for more when he wanted something. He needed cueing to use more than a one word phrase most of the time. I did hear "more juice" on one occasion spontaneously. KinderCare teachers brought to my attention that he is drooling more than he used to. I had a difficult time gaining his attention by calling his name. I am not sure whether he does not hear or is too busy to respond. I used the Battelle Developmental Inventory Screening on CK. He passed the motor portion of the test but did not do as well on other areas of his development. His lack of language affected the outcome of these other area of his development.

111. EVALUATION PROCEDURES

IV. CURRENT LEVELS OF FUNCTIONING

CK showed appropriate stranger anxiety KinderCare. He was willing to come with the assistant who stayed for several minutes in the testing area until he began to interact with us. He had just spent some time with the Speech Therapist so he was surprisingly good-natured with another hour plus of testing. He is at preschool daily from 9am to 4pm, usually brought by his Dad. He is a fairly reserved youngster in demeanor and vocal utterances. Occasionally he broke into a smile and giggled but was not particularly interested in having praises or hugs. Staff and Mom reported that his responses and performance are typical (with the exception of dressing) so the assessment appears to approximate CK's current skill level in this testing environment.

Two tests of were used to assess CK's developmental skills; the Battelle Developmental Inventory, a standardized test of age appropriate skills in five areas, and a non standardized test, The AEPS for Birth to 3 Year Olds.

CK's scored -2.33 standard deviations in the Social, Adaptive, and Cognitive sections on the BDI meaning that he falls below the average for children his age. His score was -1.56 in Gross Motor, and -.92 in Fine Motor areas for a combined Motor score of -1.4, meaning he is slightly delayed in the gross motor area, and almost at age level in the fine motor area.

These scores may have been heavily influenced by his lack of understandable language and his social interactive skills.

A. Gross Motor Skills:

CK is a blond, well-proportioned youngster with no unusual reflex responses, or physical features who moves fairly easily between activities when you have his attention.

CK's movements are free of abnormal reflex activity, age level motor movement patterns were seen, and motor control was adequate for purposeful movement. Balance reactions were present in sitting, squatting and standing on both feet. His overall strength, endurance and range of motion was within age appropriate levels, with appropriate muscle tone.

CK is able to move easily on indoor play equipment, moving cautiously on the top of the large cubes, he runs well, squats for play and rises to standing easily, he can even walk up and down the small slide while carrying a toy in both hands. He throws and kicks a ball at age level and gets ready to catch the ball when it is tossed from about 3 feet away with verbal cues. He climbs small play structures, and can balance momentarily on his right foot. Staff report that he negotiates the outdoor play area well and that his safety awareness seems appropriate for his age and ability there. At home, Mom reports that they watch him closely because he has a tendency to run away.

He uses a tryke usually by walking it although he can pedal a few rounds when coaxed. He is not yet jumping up or forward.

B. Fine Motor Skills:

CK stacks a 5-block tower, knocks it down with a smile and builds it again. CK grasps small objects with a neat pincer grasp and is able to release appropriately and put a form puzzle together once. He uses either hand well, tending to use the right hand for activating toys and throwing the ball. After a demonstration, he was able to successfully string one bead. He was not interested in scribbling, making only 2 marks on the paper. School staff state he does not choose paper work often.

C. Adaptive Skills:

CK is at an age level for dressing at home, but he does not choose to put his coat on at school unless he knows they are going outside to play.

At lunch in the classroom after the testing session, he knew to sit down and wipe hands with verbal cues, a cursory wipe. He uses his sippee cup successfully here and at home, eats finger food as well as using a spoon. He asks for food with gestures and babble.

He tends to stuff his mouth, not chewing well. Mom reports this occurs at home as well and neither they nor the school staff have been able to change that habit. He helps brush his teeth at home and enjoys a variety of foods and textures.

He is able to distinguish non-edible foods during the testing session, but the school staff states that he does mouth items there.

CK does not fuss when he has wet or messy diapers, and is not yet notifying staff or parents when he needs changing.

D. Cognitive Skills:

School staff indicates that CK initially was adamant about putting toys away in the exact same place they were found. He has made progress in becoming less concerned about that. He appears to understand the routine of the classroom and is able to follow simple requests, once his attention is gained. He followed about half of the testing instructions well and completes some activities without visual cues.

It was difficult to obtain CK's attention, unless he was sitting in front of the tester or unless your voice was raised. The staff demonstrated this in the classroom as well and Mom reports this as true at home.

CK let me know he was finished by pushing objects back to me or putting them in the baggie and trying to close the ziplock. He is able to find hidden toys when he did not watch them being hidden and found his classroom at the end of the testing session.

Several unfamiliar actions were imitated - kicking the ball, and stringing a bead and several were not - drawing shapes, vocalizing, or copy a 4 block train.

He does not differentiate colors or sizes, fits a circle and square into the form board once but then could not repeat the task when the forms were placed differently on the table.

He does not appear to have the concept of one or one more.

E. Social Skills:

Staff indicates that he is not interested in sitting in their laps or being comforted with hugging when he falls outside. However, Mom reports that he is very loving at home and will give them bear hugs and kisses, and give his stuffed animals kisses.

CK did not often watch people around him or look directly at the tester when he was engaged with toys. He looked at several of his peers engaged in play, took a similar toy along side one to imitate his play and verbally and physically protested when someone bumped into him. He did not attempt to engage another youngster during our observation.

I was able to understand two words - ba for ball and bye for bye. Mom reports that in the last several weeks, he seems to be picking up several words a week - recently he looked at the sky and said sky, when asked if it was a blue sky he said blue sky. They do not know where he picked up those words although they have put more emphasis on verbalizing requests and greeting in these last few weeks.

F. Language:

CK's ability to understand and use verbal language was tested with the Preschool Language Scale - 3 (PLS-3). He was asked to respond to verbal questions and/or directions by pointing to objects or pictures, by carrying out actions which showed his understanding of what was said to him or asked of him, and by giving verbal answers which indicated his ability to use a variety of language concepts. These were the results:

auditory comprehension subtest

standard score: 79

standard deviations from the mean: -1.40

expressive communication subtest

standard score: 83

standard deviations from the mean: -1. 13

In the area of understanding, CK identified a variety of body parts and showed understanding of action words within the context of a pretend play activity. He showed recognition of action in pictures. He did not point to pictures of common objects on request, show understanding of a variety of pronouns, or identify pictures of objects by their use. In the area of expression, CK was observed to say at least one pronoun, produce a succession of single word utterances to express a single thought, and he named common objects. He did not use a question inflection, combine three or four words into sentences, or name a variety of pictures on request.

In order to corroborate the results of the PLS-3, the communication portion of the Battelle Developmental Inventory was also administered. This assessment also measures understanding and use of verbal language. These were the results: receptive subdomain percentile: First standard deviations from the mean: -2.33 expressive subdomain percentile: First standard deviations from the mean: -2.33

In the area of understanding, CK responded to directions when they involved both verbal and gestural components, associated spoken words with familiar objects or actions, and responded to the location words "in" and "out." He did not show understanding of possessive forms, follow three or more verbal commands when there were no visual cues, or respond to location words such as "on ... .. in front," or "behind." In the area of expression, he used variations in his voice some of the time, initiated communicative interaction with objects in the immediate environment, and used at least ten different words. He did not use a variety of pronouns or combine words into twoword phrases.

An informal language sample was also taken. What CK said during the assessment session was written down and analyzed for content. Information was somewhat limited, because many of his utterances could not be understood. Those that could were one word in length. Most of them were names for objects or pictures. He also used the pronoun "mine" once and said "yeah" once. This information indicates that CK's ability to express his wants, needs and ideas is delayed for his age. The results of this sample agree with the results of the Battelle Developmental Inventory.

Based on this information, CK demonstrates a significant delay in the area of language skills.

G. Speech:

CK's ability to pronounce the consonant and vowel sounds was observed during the assessment. It was noted that he says most of the sounds, though one is often substituted for another. As a result, what he says is difficult to understand. Those words that were understood were usually based on the context of the activity. This would indicate that those who are listening to him do not accurately interpret much of what CK tries to communicate.

H. Hearing

CK's hearing was tested by Mid-Valley Speech and Hearing Center on June 2, 1998. The results indicated that his hearing is adequate for normal development of speech and language.

V. SUMMARY

CK exhibits nice foundational skills in gross and fine motor areas and is near age level, He is slightly delayed in the adaptive area only because he has not begun toilet training. The personalsocial and cognitive areas show significant developmental delay. It is difficult to assess during this one testing session if these are valid concerns or whether this documented delay is due to his lack of vocalization and understandable speech. He is not able to demonstrate attending to conversations around him, respond to directions and tasks, socializing with peers, nor imitating manipulative tasks at age level.

VI. RECOMMENDATIONS

1. CK would benefit from a setting with exposure to age level direction, play activities and expectations which could be observed by several members of the team over time such as in a Toddler Group. Intervention strategies could be targeted to all areas of delay. This might provide a more useful picture of whether the lack of understandable speech was a factor in the test results.
2. A Toddler Group would provide an opportunity for CK to continue to gain gross motor and fine motor skills, as well as further assess his chewing and swallowing ability.

EARLY CHILDHOOD SPECIAL EDUCATION MULTIDISCIPLINARY ASSESSMENT TEAM

Intake and referral

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Speech-Language Pathologist

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BCEI Physical Therapist

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