General Information
Current Treatments & Services
| Type of Treatment/Service | Service Provider | Hours per Week | Start Date |
|---|---|---|---|
Communication Skills Assessment
Instructions: This assessment evaluates receptive language skills by checking response to auditory and cognitive stimuli. Score each task 1-5.
Scoring Scale:
1 = No response or significant difficulty
2 = Some response with assistance
3 = Adequate response with moderate difficulty
4 = Proficient response with minimal difficulty
5 = Excellent response, performs independently
| # | Task Description | Resources Needed | Instruction/Task | Score (1-5) | Comments |
|---|---|---|---|---|---|
| 1 | Responds to caregiver's voice by looking | None | Call the participant's name softly or speak in a calm tone to see if they look at you. | ||
| 2 | Responds upon hearing name called | None | Call the participant's name in a normal tone of voice and observe their response. | ||
| 3 | Understands at least 10 words | List of 10 common words | Ask the participant to point to, or act on, 10 familiar words (e.g., "ball", "cat"). | ||
| 4 | Understands the word "no" | None | Say "no" and observe whether the individual stops an action or responds accordingly. | ||
| 5 | Understands the word "yes" | None | Ask a question requiring a yes response (e.g., "Do you want to play?"). | ||
| 6 | Follows instructions requiring only one action | Simple instructions list | Give simple one-step instructions (e.g., "Pick up the toy"). | ||
| 7 | Understands at least 50 words | List of 50 common words | Ask the participant to point to or act on a selection of 50 familiar words. | ||
| 8 | Responds to questions that use the word "what" | Simple questions | Ask questions using "what" (e.g., "What is this?") and observe their response. | ||
| 9 | Responds to questions that use the word "who" | Simple questions | Ask questions using "who" (e.g., "Who is this person?") and observe their response. | ||
| 10 | Responds to questions that use the word "where" | Simple questions | Ask questions using "where" (e.g., "Where is the ball?") and observe their response. | ||
| 11 | Responds to questions that use the word "why" | Simple questions | Ask questions using "why" (e.g., "Why is the sky blue?") and observe their response. | ||
| 12 | Responds to questions that use the word "when" | Simple questions | Ask questions using "when" (e.g., "When is your birthday?") and observe their response. | ||
| 13 | Follows "if-then" instructions | "If-then" instruction list | Provide "if-then" instructions (e.g., "If you finish your work, then you can play"). | ||
| 14 | Pays attention to a show for at least 30 minutes | TV Show or video | Observe if the participant watches a show or video for a full 30 minutes. | ||
| 15 | Follows instructions involving right and left | Simple directional cues | Give directional instructions (e.g., "Turn to your right" or "Go to the left"). | ||
| 16 | Remembers to do something up to an hour later | Reminder cue | Ask the participant to remember to do something in one hour and check if they do it. | ||
| 17 | Remembers to do something several hours later | Reminder cue | Ask the participant to remember something to do several hours later and check if they do it. |
Instructions: This assessment evaluates expressive language skills by checking ability to communicate needs, preferences, and ideas. Score each task 1-5.
Scoring Scale:
1 = No response or significant difficulty
2 = Some response with assistance
3 = Adequate response with moderate difficulty
4 = Proficient response with minimal difficulty
5 = Excellent response, performs independently
| # | Task Description | Resources Needed | Instruction/Task | Score (1-5) | Comments |
|---|---|---|---|---|---|
| 1 | Indicates when uncomfortable | None | Observe if the participant signals discomfort, such as moving away, facial expressions, etc. | ||
| 2 | Vocalizes or gestures to get attention | None | Observe if the participant uses vocalizations or gestures (e.g., waving) to attract attention. | ||
| 3 | Vocalizes or gestures to continue or stop an activity | None | Observe if the participant uses vocalizations or gestures (e.g., "stop," "more") to indicate preferences in activities. | ||
| 4 | Says caregiver name to obtain attention | None | Ask the participant if they can say the caregiver's name when they want attention. | ||
| 5 | Uses at least three basic gestures (ex. more, thumbs up, all done) | None | Observe the participant for gestures like "more," "all done," or "thumbs up." | ||
| 6 | Repeats or tries to repeat common words | Common words list | Ask the participant to repeat a few simple words (e.g., "ball," "dog," "cat"). | ||
| 7 | Says "no" to indicate preference | None | Ask the participant if they say "no" to express preference (e.g., "Do you want this?"). | ||
| 8 | Says one-word requests | None | Observe the participant making one-word requests (e.g., "juice," "play"). | ||
| 9 | Says "yes" to indicate preference | None | Ask the participant if they say "yes" to express preference (e.g., "Do you want this?"). | ||
| 10 | Says at least 50 words | Vocabulary list | Ask the participant to say a list of words and count how many they can say. | ||
| 11 | Says what he is doing using simple sentences | None | Ask the participant to describe what they are doing using simple sentences (e.g., "I am eating"). | ||
| 12 | Uses negatives in sentences | None | Observe the participant using negative sentences (e.g., "I don't like that"). | ||
| 13 | Uses the word "and" in phrases or sentences | None | Observe the participant using "and" in phrases or sentences (e.g., "I want a cookie and juice"). | ||
| 14 | Asks questions using the word "who" | None | Ask the participant questions using "who" (e.g., "Who is your friend?") and observe their response. | ||
| 15 | Uses plural nouns | None | Ask the participant to say things like "two dogs" or "many books." | ||
| 16 | Uses the words "in," "on," and "under" | None | Ask the participant to describe locations using the words "in," "on," and "under." | ||
| 17 | Asks questions using the word "why" | None | Ask the participant questions using "why" (e.g., "Why is the sky blue?") and observe their response. | ||
| 18 | Asks questions using the word "when" | None | Ask the participant questions using "when" (e.g., "When is your birthday?") and observe their response. | ||
| 19 | Uses the word "because" in phrases or sentences | None | Observe the participant using "because" in phrases (e.g., "I like it because it's fun"). | ||
| 20 | Tells the basic parts of a familiar story or plot | Storybook or picture prompts | Ask the participant to tell you parts of a familiar story (e.g., "What happens next?"). | ||
| 21 | Uses "behind," "in front of," and "between" | None | Ask the participant to describe locations using "behind," "in front of," and "between." | ||
| 22 | Gives simple directions involving one or two steps | None | Ask the participant to give simple instructions (e.g., "Put the toy on the table"). | ||
| 23 | Uses compound sentences joined by "and" or "but" | None | Observe the participant using compound sentences with "and" or "but" (e.g., "I want cake and ice cream"). | ||
| 24 | Uses own knowledge or opinions to comment | None | Ask the participant to share their thoughts or opinions (e.g., "What do you think about this?"). | ||
| 25 | Talks about everyday experiences in detail | None | Ask the participant to describe a recent experience (e.g., "Tell me about your day"). | ||
| 26 | Clarifies by restating differently when needed | None | Observe if the participant rephrases or clarifies their statement when asked. | ||
| 27 | Gives complex directions with three or more steps | None | Ask the participant to give directions with three or more steps (e.g., "Go to the store, buy milk, and come back."). |
Instructions: This assessment evaluates written skills including ability to hold a book, recognize letters, write from memory, and read aloud. Score each task 1-5.
Scoring Scale:
1 = No response or significant difficulty
2 = Some response with assistance
3 = Adequate response with moderate difficulty
4 = Proficient response with minimal difficulty
5 = Excellent response, performs independently
| # | Task Description | Resources Needed | Instruction/Task | Score (1-5) | Comments |
|---|---|---|---|---|---|
| 1 | Holds a book and turns pages correctly for reading | A book | Observe if the participant holds a book properly and turns the pages correctly. | ||
| 2 | Identifies one or more alphabet letters | Alphabet chart or flashcards | Ask the participant to identify one or more letters from an alphabet chart. | ||
| 3 | Recognizes own name in printed form | Printed name | Show the participant their name in written form and observe if they can recognize it. | ||
| 4 | Identifies at least 10 alphabet letters | Alphabet chart or flashcards | Ask the participant to identify at least 10 letters. | ||
| 5 | Writes in the correct direction for his/her language | Writing materials | Observe if the participant writes from left to right (or from right to left in languages that follow this pattern). | ||
| 6 | Copies his/her own first name correctly | Writing materials | Ask the participant to copy their first name exactly as shown. | ||
| 7 | Copies simple words from an example correctly | Example words | Provide an example word (e.g., "cat") and ask the participant to copy it. | ||
| 8 | Reads at least 10 words | List of simple words | Ask the participant to read a list of at least 10 simple words aloud. | ||
| 9 | Writes both first and last name from memory | Writing materials | Ask the participant to write their full name (first and last) from memory. | ||
| 10 | Reads sentences of three or more words out loud | Short sentences | Ask the participant to read a sentence of at least 3 words aloud (e.g., "The dog runs"). | ||
| 11 | Copies phrases of four or more words correctly | Example phrases | Provide a short phrase (e.g., "The ball is red") and ask the participant to copy it. | ||
| 12 | Writes at least 10 simple words from memory | Writing materials | Ask the participant to write 10 words from memory. | ||
| 13 | Reads simple stories out loud | Simple storybook or passage | Ask the participant to read aloud a short story or passage (e.g., a 2-3 sentence story). | ||
| 14 | Writes simple sentences of three or more words | Writing materials | Ask the participant to write a simple sentence (e.g., "I like ice cream"). | ||
| 15 | Writes at least 20 words from memory | Writing materials | Ask the participant to write 20 words from memory. | ||
| 16 | Writes simple correspondence of three sentences | Writing materials | Ask the participant to write a simple note or letter (e.g., "Dear Mom, I am doing well..."). |
Evaluator's Summary
Assessment Code
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