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Mock Referral Report

Mock Referral Report

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Published by Zach Selnes
Standard B - Artifact 1
Standard B - Artifact 1

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Categories:Types, Resumes & CVs
Published by: Zach Selnes on Nov 27, 2010
Copyright:Attribution Non-commercial


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Evaluation Team Summary ReportStudent: Sebastian Stump Date of Report: Apr 15, 2010Date of Birth: Feb 26, 2006Parent: Bo Stump Address: 715 N. 54
Ave WBackground Information / Information Reported by Family:
Sebastian was referred for evaluation by the Early Childhood Special EducationDepartment at Rochester Public School District after falling into the refer range whengiven the ESI-P. Sebastian was screened in Jan 2010 during a routine screening withRochester Public School District. Sebastian was reticent to participate and cried soscreening was repeated at home where he received a score of 40 on the Ages andStages. Cutoff for his age is 70. Sebastian passes the hearing and wears glasses.Sebastian is 4 years 1 month. He was born 6 weeks early and had frequent ear infectionsuntil the age of 3, which are now being resolved. Sebastian received glasses at 24months due to near-sightedness. Sebastians father Bo, along with Bos preschoolteacher are concerned with what they think could be delayed gross and fine motorskills. Sebastians teacher reports that he does not have a dominant hand, mature graspand cannot copy letters or simple shapes. His teacher also reports that he is hesitant to join peers in active play. Bo reports that Sebastians mother passed away 2 years agoand that he has lots of support from nearby family members. Bo is concerned thatSebastian is sometimes withdrawn and seems overly sad and shows little interest.Sebastian has no siblings and is not potty trained.
 Health and Medical:
Sebastian was born 6 weeks premature. He had frequent ear infections from birth to 3years of age that are now being resolved. Bo reports that Sebastian has not been sickfrequently, has had no illnesses, hospitalizations or serious injuries.
Hearing and Vision:
Sebastian passed his hearing screening. He received glasses at 24 months due to near-sightedness.
No intelligence testing was done as part of this evaluation.
 Cognitive / Preacademics
:The Battelle Developmental Inventory-2 (BDI-2) was administered to assess Sebastiansfunctional abilities in five areas of development. The BDI-2 is a standardized,
individually administered assessment battery of key developmental skills for childrenfrom birth  age 7 years, 11 months and is considered effective in measuring thefunctional abilities of young children. On this measure Sebastian received an overalldevelopmental quotient (mean of 100; standard deviation of 15) of 78, which is belowage expectations. This reflects performance in all of the five developmental areas on thetest.The cognitive domain of the BDI-2 measures those skills and abilities most commonlythought of as mental or intellectual with the exception of language andcommunication skills. This includes the three subdomains of attention and memory,reasoning and academic skills and perception and concepts. On this measure Sebastianreceived a score of 93; which is in the average range. He was able to complete all tasksin his age range.On the Child Development Inventory (CDI), completed by Sebastians father Bo,Sebastian was at age equivalent for letter acquisition and at below 2 standard deviationsfor number knowledge.During an observation Sebastian was able to follow directions 25 out of 30 times andreferred to the picture classroom schedule twice without prompting.
:There are no needs at this time.
:The communication domain of the BDI-2 measures how effectively a child receives andexpresses information and ideas through verbal and nonverbal means. On this measureSebastian received a score of 112; which is in the high average expectations for his agerange. His receptive and expressive skills were evenly matched. On this measure he wasable to follow the conventional rules of communication, complete opposite analogies,identify missing parts of objects, sequence familiar events in logical order, recall eventsfrom a story presented orally and respond to where and when question. He haddifficulty with understanding the superlatives biggest and longest.On the Child Development Inventory (CDI), completed by Sebastians father Bo,Sebastian was at age equivalent for expressive language and more than 1.3 standarddeviations below the norm for language comprehension.During an observation Sebastian was observed using 1 to 2 word responses and onlyused words when he needed to ask for help or answer direct questions from adults.
There are no needs at this time.
:The Motor domain of the BDI-2 assesses a child's ability to control and use the large andsmall muscles of the body. This includes gross and fine motor and perceptual motorskills. On this measure Sebastian received a score of 79; which is below ageexpectations. His skills in perceptual motor were more developed than his gross and finemotor skills, which were in the below age expectations. He was able to walk backwardfor 5 feet, jump forward with both feet together, remove forms from a form board,string 4 large beads, stack 8 cubes vertically and copy a circle. He had difficulty walkingdown stairs without assistant, alternating feet, use pads of fingertips to grasp a penciland copy a cross. He was not able to copy the letters V, H, L, draw a person with 6 partstrace designs with curved part or walk in a straight line, heel-to-toe for 4 or more steps.Sebastians teacher reports that he cannot copy letters or simple shapes, does not havea dominant hand and does not have a mature grasp.On the Child Development Inventory (CDI), completed by Sebastians father Bo,Sebastian was well below 2 standard deviations below the norm for gross motor andmore than 1 standard deviations below for fine motor.
Sebastian needs to improve his gross and fine motor skills, including being able to walkdown stairs without assistance, to copy simple letters and shapes and developing amature grasp.
Self-Help / Adaptive
:The adaptive domain of the BDI-2 measures the child's ability to use the informationand skills acquired in the other two domains. The subdomains in this area are self care,which assesses a child's ability to perform the tasks associated with daily routines andincreasing autonomy, and personal responsibility which assess a child's ability toperform simple chores, initiate and carry out play, carry out tasks with minimalprompting and avoid common dangers. On this measure Sebastian received a score of 78; which is in the below age expectations. His skills in personal responsibility weremuch more developed than his self care skills; which fell in the low range. He was ableto feed himself, remove his own clothing, unassisted, show care when handling aninfant or a small animal and demonstrates caution and avoids common dangers. He haddifficulty initiating and organizing his own activities and responding yes or no whenasked if he needed to use the toilet. He was not able to control his bowel movements,express a need to use the toilet and answer what to do if questions involving personalresponsibility.

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