Assessment Form & Evaluation

1. Child Development Assessment Childs Name: Child B Childs Age: 5 Date: 5 / 5 / 2011 Developmental Characteristics: Can child brush their own teeth? Can child dress themselves? Can child feed themselves? Can child tie their own shoes? Can child wash their own hands? yes yes yes yes yes 2. Language Skills Does the child speak English, Or other language? Spanish? Arabic? Can child say imitate speech? yes Can child use single syllables? yes Can child use more than one Word to make a sentence? Can the child uses receptive And expressive language? yes yes

Does the child use Holophrastic Speech. yes Does the child use Telegraphic Speech? Does the child use Private Speech? yes

Does child talk at all? yes Does child talk to fast? 3. Cognitive Development Can child identify the color red, Blue, black, green, yellow, white, Brown, and orange? yes yes

Can child identify the ABCs? Can child identify shapes,

yes

such as; square, circle, triangle, Heart, or rectangle? yes

Can child identify things That are large, medium, Or small? yes

Can child sort or group things By color, shape, or size? yes

4. Social Skills Does child play parallel Of other children? yes Does child play With other children? Does child cooperative With other children? yes 5. Fine Motor Skills Can child stack Cubes? yes yes yes

Can child scribble?

Can child draw shapes? yes Can child draw body parts? yes 6. Gross Motor Skills Can child hop on one leg? Can child stand on one leg? Can child skip? yes yes yes

Can child crawl? yes Can child jump? yes Can child climb? yes

7. Attention Span Is child able to focus on a task For a short time? yes

Is child able to sit for a long time? yes Does the child fidget? Yes sometimes

Does the child finish a task Before starting a new one? yes

8. Behavior Test Typical Yes Compliance Always Usually x Rarely Fearfulness None Mild Extreme 9. Recognition Does the child know what are animals? yes Does the child know what people are? yes Does the child know what the difference from a straight line from a wiggly line? yes

Summary

Is childs development within normal range for he/she age? Yes Is childs development delayed? How is childs development delayed? Is childs development advanced? No No No

Your childs development maybe within normal range and there is no need for intervention. No

Your childs development is delayed and may need evaluated. No Your child may have global delays and needs interventions set in place. No Your childs development is advanced and needs to be evaluated for an accelerated program. No