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DAYC.

Developmental Assessment of

Youngi Children

PROFILE/EXA.MINER SU,MMARY SIHIEET

Section Ii. Identifying Informalion

Childs Name _

Ma Ie Femaile

Parent/Guardian

School/Daycare _

Respondent s Name _

Relationship to Child

Length of Time Respondent Has Known Child Examiner s Name and Titl'e

Month

Year

Day

Date of Testing Date of Birth A.ge

Age in Months

Sec.tion II. Record of D'AYC Seor,e.s

Sect,ion III. Summary of Other Test Results

Raw Score

Age Equiv.

Std. Some

Test SC.Qre

DAve Score Equivalent

%Ue

Cognitive Communication

Social-Emotional

Physical Development __ Adaptive Behavior

Sum of Standard Scores

General Development Quotient

Test Niilme

Oate

1. __

2 .. _

3. _

4. _

5. _

6. _

7. _

DAve Scores

Section !IV; PI~ofile' of Standa.rd Scores

Other Test Scores

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.91 "" -a
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150
145
1<10
135
130
125
120
115
110
105
100
95
90
85
80
75
70
65
60
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150 145 140 135 130 125 120 115 110 105 100 95

90 85 80 75 70 65 60 55

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Additional copies of this form (#8737) may be purchased from PRO· ED. 8700 Shoal Creek Boulevard, Austin, TX 7B757-6897. 5121451·3246, Fax 5121451·8542

Section V. Referrallnfo.rmatioll

Section VI. I'nterpretation and Recommendations

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by Judith ,K. Voress and Hils A. :Pearson

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0-3 Months - . . - 6-9 Months

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•. Sucking r·eflex: sucks nipple when pleced In mouth

• Rooting reflex: turns mouth toward hand rubbing· cheek

• Opens mouth lind sticks out tongue In entlctpatlon of feeding when seeing breest or bottle •. Expresses displeasure when clothes lire: purred over head

• Enjoys bathj keeps. eyes open !lnd Indicates pleesure when placed In wsrm water Sleeps at 4·· to to-bcur Intervals

• Looks toward noise

• Mouths. toys

• Bangs toys

• Repeats arm or leg movement to cause an action to recur

• Pulls cloth from face

• Reeches for and grasps toy

• Looks dlrect!yat speaker

• Vocalizes In response to speaker

• Vocali%es pleasure and pain

• Ll:!ughs out loud

• Self-Inl~ted vocel piIlY: coos, chuc!qes, gurgles, end laughs

• P.ltch and intonafionvery

• Smiles at own reflection in mirror

• Expresses desire to be picked up

• Smiles In response to speaker

• Drops toy without watohlng results

• Finds toy that 15 partially hidden

• Flnds toy thet 15 completely hidden (begins to understand thai: objects continue to exist even when they

cannot be seen)

• Shakes toy

• Moves to get toy

• Looks beck and forth between two objects

• Watches an object moved slowty through line: of sigh I

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• Startled by loud noises

• Tums head toward speaker

• Makes noises other than crying

• Differentiated cry lor fatigue, hunger, and pein

• Uses tongue to reject pureed foods

• Holdsor supports bottle during feeding

• Steeps through the night; t"kes5:HI naps durIng the day

• Holds toy 1 0-15 seconds

• Holds small object

• Opens hand In anticipation of contact

• When pulled to sitting, holds head in line with body

• Brings hands together When lying On back

• Bounces when standing and supported by adult

Imitates facial expreSSions, actions, and famili~r sounds

• Comprehends parental gestures

• Looks at objects, family members, and pictures

when named

• Babbles fmf, Inl, ftJ, fdf, IbI, IpI, and tu

• Vocalizes to another person

• Vocalizes differentty for hunger, anger, and contentment

• Expresses physicll1 states such as \!Inger; tiredness, excitement, and hunger

• Extends arms to familiar persons

• 'Responds differently· to c.aregiver lind

strangers

.• Interacts by smi'ling and c~jn9

• Infant·to-Infant Interllctlons increase

• Responds differently to children and ~dults

• Recognizes self In mirror

• Looks at adult face

• Stops crying· when talked to, picked up, or comforted

• Turns et will toward or away from person or sltu~tlon

• Closes lips when swallowing

• Sleeps. through the night; 1.-2 naps during the day

• Brings food to mouth with whole hand

• Shows definite lIk.es and dislikes for various fooos

• Rakes or scoops SI1l<lU, OI::!Je:cts With hand

• Transfers object from hand to he_nd

• PiCks up obJec:tseasily

• Rolls from back to stornecn

• Crawls tolWard on belly

• When sitting, extends arm If failing to the: side:

• Pulls self up to standln!!

• Holds smell oqJeds between thumb end Index ·finger

• Sits alone. brieflY Without

support

• Walking. reflex: When held upright With feet ~estlns onftat surface, lifts feet alternatelY in wlllking-lik.e motion

• Closes fingers when light pressure Is applled to open palm

•. Ufts and rotates heed

• Ufts head 45 degrees with support of elbows

• KIcks reciprocally when on back

• Extends both ,legs when on stomach

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by Judith It Voress and Nils A. Pearson

• Looks tow<!rd noise

• Mouths toys

• Bangs toys

• Repeats errn or leg movement to cause an action to recur

• Pulls cloth from face

• Reaches for and grasps toy

• 1001<5 directly lit speaker

• Vocalizes In response to speeker .' Vocalizes pleasure and pain

• li!IuS/lS out loud

• SeJf-inltiatl1:d vocel plc3Y: coos, chuckles, gurgles, lind laughs

• Pitch and intonation vary

• Smiles at own reflection in mirror

• Expresses desire to be picked up

• Smiles in response to speaker

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Second Edition

.' looks back and forth between two objects

• Wlltd1es an object moved slowly through line of sight

• Uses tongue to reject pureed foods

• Holds or supports bottle during feeding

• Sleeps through the night; takes 2-3 naps duro Ing the day

• Holds toy 10-15 seconds

• Holds small object

• Opens hand In entlclpetlon of contact

• When pulled to sitting, holds head in line with bocly

• Brings hends together when lying on back

• Bounces whenstsndlng lind supported by adult

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• Stllrtled by loud noises

• Turns head towerd speaker

• Makes noises other thlln crying

• Differentl!lted cry for flltlgue, hunger, lind pain

• Looks lit IIdult fllce

• Stops crying when talked to, picked up, or comforted

• Turns lit will toward or <'!WilY from person or srtuation

'. Sucking reflex: sucks nipple when placed In mouth

• Rooting reflex: turns mouth toward hand rubbing cheek

• Opens mouth lind stlcl<s out tongue In antlel· patlon of feeding when seeing breast or bottle

• Expresses displeasure when clothes are pulled over head

• Enjoys bath; keeps eyes open lind lndlcetes pleasure When placed in warm water

• Sleeps lit 4- to 1 O-hour intervols

• Walking reflex: when held upright with feet resting on !lilt surface, lifts feet altemately In wei king-like motion

• Closes fingers when light pressure Is epplled to open palm

• Lifts and rotates head

• Lifts head 4S degrees with support of elbows

• Kicks ~eclprocal1y when on badk

• Extends both legs when on stomach

ha

• Drops toy Without watching results

• Finds toy that Is pertlally hidden

• FInds toy that is completely hid\:kn (begins to understend that oQjects continue to exist even when they

cermet be seen)

• ShlIkes toy

• Moves to get toy

• lrnltstes fec.ial expressions, actions" and fmnillar sounds

• Comprehends parental gestures

• Looks lit objects, family members, and pictures

when named

• Babbles Im/, Inl, Itl, Idl, IbI, IpI, and Izl

• Vocalizes to another person

• Vocalizes differently for hunger, anger, lind contentment

• Expresses physical states such es anger, tiredness, excitement, and hunger

• Extends erms to femiDar persons

• Responds differently to caregiver and

strangers

• Interacts by smiling end cooing

• Inflmt-ta-Infant Interactions lnerease

• Responds differently to children end lldults

• Recognizes self In mirror

• Closes lips when swallowing

• Sleeps through the night; 1-2 MPS during the day

• Brings food to mouth wtth whole hand

• Shows definite likes and dislikes for various foods

• Rakes or scoops small objects with hend:

• Transfers object from hand to hllnd

• Picks up objects easily

• Rolls from back to stomach

• Crawls forward on belly

• When sitting, extends IInTl If falllns to It)e side

• Pulls self up to standing

• Holds smIlll objects between ltunb lind index fioger

• Sits alone brlefly without

Sllpport

• AdUlt starts end stops toy. After the toY's movement stops" the Infant touches the toy or eduit to re~ctJvate the tOY

• Turns over the blank side of' e card to view picture

• Intentlonelly drops toy and wetches it fall

• Briefly stops beha,vior when told "no· o Begins to relate names lind objects

• Turns When called by name

o Gives obJect upon request

• Claps hands ond weves on commend

• Articulates most speech sounds

• GestufesNocalizes wants and needs

• Directs others physlceUy; pats" pulls, pushes, and tugs

• Repeats actions that elicit la~terl attentlon from others

• Plays simple sames: pet-e-cake, peek-a-bee

• Often attached to favorite toy or blanket

• Exhibits fear or reluctance toward strangers

.. Expresses affection (e.g., hugSlnS, patting)

• Expresses two or more emotions (e.g., oleasure, feaf, sad_ness)

• Pulls off owen socks

• Closes mouth on rim of cup but loses liquid from comers of mouth

• Feeds self finger foods

• Picks up cup and takes 4~5 SWallows

• Begins to cooperate: when being dressed (e.g., helps put arms, in holes)

• Fusses when diaper needs to be changed

• Bowels move regulally

• Cruises holding on to furniture

• Gan poke wIth Index finger

• S~nds alone momentarily

• WlIlks with adult hOldlng"one hand

• C!~eeps weill

• Claps hands

• Corrals ball with arms IIIld ~nds when sitting with less spread apart

• Moves body to musl(;

• ~3-4 toys by se.ttlns 'one aside

when given a new tOY

• Pulls obJe.ct up from Hoor with string

• Gives toy to someone to wind up

• Activ~tes,toy after adult demonstration

• Rolls wheeled toys

• Places things In cup; dumps out contents

• Demonstrates use of everyday Items (e.g., pretends to drink from CUp)

• says 'MarM" or 'Dada" dlscrimlnl!tely '. Points to, Objects when n~med

• Responds vocally to "who Questions

'. Ackno¥lied'gesothers' speech by eye contact, speech, OJ repetition of 'the word said

• Uses sentence-like intonation (Jargon);.

Imitates SQme words

• Uses single words; says 3-20 words

'. Protests by saying "no," shaking head,

moving away, or frowning

• Points to wanted object

• sa~ 'all gone,' asks for 'more'

o Teases, scolds, werns using gestures and vocenzetions

• :Respondsto, the directions "In" lind 'on'

.' lookslltstor,lbook pictures with adult, naming or pointing to familiar objects on request

• Usesstlck 'to'get out-of-reech tOY

• Actll(!ltes toy Without a.dult demonstratlon

.' Looks For familiar person who has left

the room

• Spontaneously names objects

• Turns pages in book

• Inserts shapes Into matching slots

• Understands 'one,' "all' (e.g., Give me one block)

• seqcences related actions in play SUCih as preparing food for dol~ 'feeding it, Wiping its mouth

• Matches an object to its picture

• Uses pretend objects In play

• Repeats flnger play with words and actions

• Matches simple shapes such as circle, square, and triangle:

'. Says 50 words

• Names familiar objects • Understands appr·oxlmately 500 words

• Uses ritual words 'hl," "bye" • May omlt some fina' consonanlS 0( 'sub-

• Understands approximately 300 words stltute one consonant for another (e.g"

• listens as pictures ere nerned /WI for Ir/)

• Points to five body parts • sa,ys 200 words

• Responds to yeslno questJons by • Mean Sentence' length=3,1 words

shaking or nodding head • Knows, "big/little"

• Produces words with consonant-vowel- • Answers "what/where' questions (e,g"

consonant structure "What do you hear with?")

• Combines words to make I,\ovo-word phrases • uses some regular plurals (e.g., cats)

• Mean Sentence length .. 1 ,8 words • Asks tsasfc questions ("Daddy gone?")

• Uses commends (e.g., "move"), possessives ,. Asks. simple 'what/where" questlons

(e.g., "mine'), reactions (e,g., "ewee") (e.g" "Wh.!it's that?")

., Follows a series of two related commands • Whispers

(e.g., 'Pick up the ball and give It to me")

• Has temper tantrums when frustrated

'. \'!/hen taced with a novel sltuetlon, looks • Frequently does the opposite of what he

to parents for reassurance or she is, IlSked to do

• Shows emerging independence by • Curious" gets into everything

moving around a familiar room In a • Often ddlant; says "no" to many reCIIJests

playful, exploratory menner (stili may • Enjoys simple rnake-belleve

require some supervision and • Has difficulty sharing

encouragement) • Usually pl~ys alone even when other

• When playing on his or her own, may children are present

periodlcslly return to the parent for • Helps put things sway

reessurence and attentlon (likes to • Insists on trying to do many things

know adult is near) without help (e.g., eating with spoon,

• Plays alone for short: periods drinking from cup)

• Contacts with peers center on a tOY, • Engages in meke-beueve and pretend

<In adult,etc. ,play

• Brings toy to share w,lth caregiver • Plays well for bnef time In groups of two

or three children

• Chews textured foods

• Spoon-feeds and drinks from cup Independently-freQuent spills

• Sleeps through the nlsht; one nap during the: day

• Cooperates when dressing end undressing

• Stirs with spoon

• Sips, liquid from cup using II 'straw

• Squats to play

• Kicks stationary ball forward

• Drops objects Into smell contslner

• Stacks 2-4 objects on top of one another

• Starts Ilnd stops In walking

• Wlllks up lind down stairs with esststence, placing DOth feet: oneach step. '. Enjoys pushing or pulling toys while

walking

• Takes Independent steps

• Maintains ~Iance while kneeling

• Walks ~ckwl!rd

• Creeps backward down steps

• HoldS crayon With fingers, hand on top, forearm tumed 50 thumb is directed

• Begins using fork

• Squats, holds self, or verbalizes bowel

and bladder needs (50% of thetJme)

• Brushes teeth with assistance

• Tries to wash own hands and f~ce

• Removes loose dothlngsych as Jacket or shorts Without aSslstance

• Scribbles vigorously with crayons or

markers

• Imitates vertical strokes

• Walks on a straight line

• Stecks 4-6 objects

• Following eemenstrenen, throws smell ball overhand lit least 3 feet

• fO'llowing demonstratlon, throws small ball underhand at least 3 feet

' •. AsksfOr assistance When having difficulty

• Shy with strangers, especiaDy adults

• Claims certain articles as being his

or her own

• Attempts to comfort others in distress

• Sings familiar songs with adulis

• Shows pride In eccornpllshrnents

• Separates from parent In familiar surroundings without crying

• Takes off own shoes, socks, and some pants

• Independently eats enure meal with

spoon

• Tries to wash self

• less frequent eliminations

• Sits on tollet for at least 1 minute supervised

• Puts on socks, co~t, ,and shirt

• Opens door 'bytumlng handle

• Imitates Circular, vertical, end ho~zon~1

strokes

• Rolls, pounds, and .squeezes ci~

• Stacks 6-7 blocks

• Walks up steps, alternating feet In adult

fashion while holding on

• Jumps In plece with both 'feet to:gether

• Snips paper wlth,sclssors

• Catches ball from str~19ht arm position, trapping ball "galnst chest

• Uses one hand consistentlY In most l!!cti\litles

42-48 Months 48-54 Months

• OrollW'S '(<lice from model

• Mlrtches three colors

• M<lItches objects by colonshape, and size

• Understands epproximately 900 words

• Points to pictures of common objects described by their use (e.g., "Show me what you eat with.")

• Knows third-person pronouns (e.g.,

he, She)

• Articulates IpI, Im/, In/, Iw/, end Ihl

• S"ys 500 words

• Mean Sentence Length:;3.4 words

• Refers to self by own name

• Uses pronouns (e.g., me, you, mine)

• Sa% 'please" end ·,thank you· When reminded

• Spends most group time In SOlitary activity, watching other children

• States whether he or she Is III boy or a girl

• Gets drink from fountain

• Stabs food wtth fork and brings to mOlJth

• Daytime control of tolleting needs with occasional accidents

i f

• Thread's four sman bead's on .string

• Copies dr_lng 0 circle

• Stands on one foot for 3 seconds

• (en Jump CNer a string 2 Inches off the noor

• Counts by rote to 5

Stacks !fngs on peg in order of size

• Understands "more" (e.g., more

dogs)

• Listens to simple stories

• Names primary colors

• Makes horizontal train of cubes in ,Imitation

• Builds bridge using three blocks

• Understands approximately 1,200 words

• Responds to two unrelated commends (e.g., 'Put your cup on the table and tum off U1e TV.")

• Uses finalconsonents most of

the time

• Says BOO words

• Mean Sentence Length .. 4.3 words

• Uses regular past tense fOIl11$

• Beginning of question-asking stage using "what: "who,· ·why,· and "howmony"

• Calls attention to own performance .' Shares toys

.' Uses complex speech in intereenens with other children m play and soclel situations

• Shows IIftection to younger children by husglng and kissing

• Hangs clothing on hook

• Takes responsibility for tolletlng

• Washes hands unassisted

• Cleans up spliis

• Uses vertJcal, horizontal, and circulllr

motions when drawing

• Hammers nails lind pegs

• Pedals lind steers srn<!lll tricycle

• Kicks a large b<!IlI

• Cuts on line ----.,

'"

• Organizes pretend gomes (e.g., tell

party, PIIIY house, etc.)

• Counts flve objects

• DrollW'S III human fllCe

.' Sorts by sh!lPes, colors

• Tells own IIge lind full name

• MlItches objects thllt h~e the same functJon (e.g., comb lind brush)

., Sorts objects Into cl!tegories-may not be <!Ible to label categories (e.g., animals, food)

• Understands concept of the number 3 (e.g., 'Give me 3")

• Knows ·In front of" and "behind"

• Understands approximately 1,500- 2,000 words

• Responds to three commands (e.g., "Pick. up the spoon, put it In the cup" lind bring It to me.")

• Articulate.5/b1, IdI, Ik/, IgI, Iff, and Iyl

• Mean Sentence length,,4A words

• Tells how common objects are used

• Does simple verbal analogies (e.g., '~addy Is II man, Mommy Is a !blank).")

• Uses contractions (e.g., I'll, can't)

• UsulIlly tekes tums

• Spontaneously greets tl!mllll!r person by hugging

• Shows empathy for others

• Separates from parents without

crying

• Begins cooperebve play

• Plays dress-up

• Shows off; repents rhymes, songs, or dances for others

• Asks to use other person's belongings

• Plays group gomes with simple rules

• Sleeps through the night; no naps during the day

• Can pour milk lind juice: wtth some

assistance

• Eats entire meal Independently

• Uses all eating utensils

• Puts on boots lind mittens

• Wipes nose; may need to be reminded

• Brushes teeth Independently

• Tells adult of toilet needs In time to get to toilet

• Manipulates l<lIrse buttons and snllPS

• Gets drink from fllucet without aSSistance

• Sets table with assistance

• WlIShes hands, fllCe without assistance

• Copies drawing a cross

• Walks down steps, altemating feet

• Holds crayon between first two fingers lind thumb, [)Ot with fist

• Forms simple shspes out of clay (e.g.,

b!l1I, srnlke, pancake)

• Runs eround obstacles, tums comers

• Climbs ladder of low ploy equipment

• Balances on one foot for 5-10 seconds without support

• Hops on one foot a, few steps

• Wolks on tiptoes for 3 seconds

• Builds pyrllmid of Six blocks

• Plays with words (e.g., creates own rhyming words)

• Stacks five objects lin order of size

• Sorts group of objects In morethlln one way te.s.. by shape end then by size)

• Copies own neme

• Retells story from picture book with reasonable accuracy

• Understands IIpproximately 2iOOO- 2,500 words

• Knows "between,· "!lbove,' "below," ·top," and "bottom"

.' Few consonant omissions and

substitutions

• s.,ys 1,500 worCis

• Mean Sentence Length = 4.6 words '. Uses possessives consfstently tes.

boy's, eat's)

• identifies first, last, and mIddle

• Shows pride in accomplishments

• Indicates (Mt he or she feels, sony

.' Usu~lty prefers, ploying 'with other

children to pl<llYing aJone .' Ielks about own feelings

• Understands rules of hllr play

• Accepts mild, frequent teasing without becoming too agitated

• Waits for tum when playing in group games (e.g., red rover, ste!li the bllCon, tag, relays)

• Selects own friends

• Has best friend of same gender

• Independently fllS!ens Steltbelt in

eutomoolle

• ZIppers efficientlY

• Laces shoes

• Takes cere of own toJleting needs; often wllnts prtvllCY in the bathroom

• Serves self at table (parent holds serving dish)

• Dresses lind undresses Independently, Including front fllSte:n'ings; requires II5$I$tance with ties lind b<!Ick fastenings

• Jumps over objects 5-6 Inches high; lands 'NIth feet together

• Cuts circle with scissors

• Welks, swinging erms "nd legs freely in cross pattern similllr to adult walk pattern

• Builds steps wtth six blocks

• DrIlWS II streight line to connect two dots that are <lIpproxlll'll!tety 5 Inches aPllrt

• Turns, II sornerseult

• Goltops, lelldlng with one toot lind trm'lSfemng weight srnooItlly and evenly

• Tells Whet Is going to h,,~!'1 next

• Prints first nome

• Recognizes III few printed words,

• UnderstMlds "tIIllest," "biggest," "same,' lind

'more"

• Counts 201 cl:ljects,

• CI_llies op)ects (e.g., to)l5, food', (lnimals)

• Dro-.vs stick figure

• Dravvs objects without models,

• NIlImes most letters,

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• Understands approximately 2,500-2,800 words

• Knows "heeYfflight: 'Ioudfsoit,' "like/unlike,"

and "long/short"

• May'mlsartic",late a few difficult blends

• Says 2,000 words,

,. Mean Sentence L,l!:lflgth",S,7 words

• ,Generlltes complex sentences (e.g., "We we,nt to the store lind bought mllk.")

• Tells 1_lIIllr stories without picture cues

• LJ~rstIlnds the seasons of the veerend what you do In each

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• 'Shows, concern I!Ind sympathy for others

• Exploins rules of 91l1mes to others

• IUkes competitiVe Slimes

• Gains attention from peers In~r9PrlIlIte ways

.' Toilets, wI~ se'lf;flushes toilet, lind redresses iJfldependently

• Combs, or brushes hair

• Uses ~ble knlfefbr spreading soft butter,

jelly, and peanut butter

• Crosses the street safei)'

• ~tIi.!re, grasp on pencil; 'fine movements, present in, hand

• Cqples drllwlngll squlITe

• Completes elght-piece pllZile: without trio!lll lind error

• Wlliks 'balance beam that Is 4 Inches wide

• 'Swings on sv.ing, maln~inlng ow", momentum;

uses le,g'S to propel:

• Skips on altemallngteet.maintalhing balance

• Cuts slmple, 'Shapes

• Colors within the lines

'. Hops in II stmlgl'lt line: on one foot

R.eferences

Allen, K. E., 8. Mo,ol"l;, I. (1999), Developmenlal profiles.

Albany; NY: Delmar.

Dunst. C. J. (1980). A clinica! end educe/iono! mClnuol for use with the Uzgirls and Hunt Scoles aF' Infont Psych%gical Development Austin, TX: PROED.

Dykes, M. K. (1980). Developmen,o' a.sessmenl for Ihe ,eve,ely handicapped. Austi n, TX: PROED

• Matches letters

• Reads out foud numbers, 1-10

• Understends '0' (zero) Is the: absence of

quantity

• Names the: weekdll)l5 In order

• Tells month and day of birth

• Iells own street end town

• Manges numbered tiles or cards In proper sequence

• Draws person with 6 recognlz » able parts

• Uses Irregular plUfo!lls conSistently (e.g., child! dllldre.f1)

• Understo!lnds appro-xlmo!lt.ely 13,000 words

• Understands 'Yesterday/tomorrow," "more/less,' "some/many," "SI!!veral,/lew,' "most/,Ieast,' "before/llfter,· and "now/later'"

• ArtIculliles It/, Iln.gl, Irl, lind III

• Mean Sent.ence ,~ength=6.6 words

• Understllnds "the opposite or (e.g'., "The

opposite of "hot"ls [bl~nkl.·)

• States similarities lind differences between objects

• Uses: superlative, "-est"

• Uses 1111 pronouns consistently

• Tells slrnple Jokes,

• Comfort5mends In distr'ess

• Confidently visits neighbors end their children

• Works ilIlone ~t chore for 20 to 30 minutes

• 'Expresses, anger with nonaggresslve words rather th~n with ph)l5lcal actions

• States g~t for him or herself and carries

outactMty

• Makes simple breakfast and lunch

• Sets end cleers the table Without asslstanoe

• Iles Initial, knot In shoel'lIce Out may not complete knot

• Selects ciothJng spproprtete for temperatureend occeslon

• Plens ahead to meet tolletlng needs befoTe beginning an activity

• HIlS complete Independence In bathing

• Skips onaltematlng feet, maln~lnln9 balence

• Skates

• Places paper clip on paper

• Hand domlmsnce Is well esto!lbllshed

• Po!Istes and glues appropriately

'. When gl,ven II, simple: meze on paper, can complete the maze by drawing II line with 0 pencil from the beginning to the end

'. Jumps rope by self

'. Bounces and catches ~ennls 'ball

• Drops ball and kicks It torward before It hits the' ground

Folio, M. R., &. fewell, R. R. 12000). Peabody Developmenial Malor Scales-Second Edi/ian. Austin, IX:

PROED.

Gord, A., Gillman. L., & Gorman, J. (l993). Speech Ion· guage de"",lopmenl chorl12nd ed). Austin, TX: PRO.fD.

Johnson-Morlin, N., len •. K. G. &. Attermeler, S M. (1986).

The Coroiinc curriculum for handicapped inlonts and inFanls 01 risk. Bollimore: Brook,s,.

• Points to coins when named (l.e., pennY,. nickel, dime, dnd quarter)

• Calcuilites sln.gle·dlglt addition and

subtrllctlon problems

• Writes first end last name from memory

• Writes, .nlJl'f1e/a1s 1-19 without model

• Reads 10 printed words

• States preceding lind follOWing dll~ and numbers

• Understands ,lIpproxlmo!ltely '20,000-26,000 words

• Is awere of mistakes In other people's speech

• Unders~nds roughly the difference In time

Intervels (e.'S" minute, hour, day)

• Articulates voiceless Ith/, Ish/, Ich/, and 1)/

• Meo!ln Sentence 'Length: 7'.3 words

• Uses mUd slang and mild profenlty

• Uses Irregular comparatives correctly (e,g., good, better, best)

.' Uses pessive voice

• Accepts valid criticism without crying, pouting, or refuSing to continue

• Answers the, phone, remembers o!I. simple mesSo!Ige, end delivers It to the correct person

• Reallzestno!lt other people ho!lve Ildeo!lS and feel· Ings: !flat mill' be dlfferenth'om his or her own

• Accepts soclel rules but sees them as change· able (eo'g., rules of a' !fllme can be changed If those playing asree)

• Often 'follows gender-specific stereotypes (e.g., bo)l5should.n't plllY with dolls'

• Chosen pl!!y groups ere usually gender segrego!lt· ed (l.e., bo~ play with boys, girls pllllY with girls)

linder. T. W.11993). TranHii.ciplinary play·ba.~d ossessment. Bahimore: Brook" s,

Vern, J. J., Serwatko, T. S .. & Anthony; R. A. (1980). Scale of social development. Tulsa. OK: Modern Education Corporation.

Voress, J. K., & Maddox, T. 11998). Developmental Assess. ment of Young Children AU$tin, TX: PROm

Cf

UJ

6

"'" "-

Developm~ental Assessment of

Young Chilldren

ADAPTIVIE B,EHAVIOR SUIBT,EST SCORIING FORM

Section I. Identlifyingl Infofmation

Child's Name _

Male Female __

Parent/Guardian

School/lDaycare _

Respondent's Name _

Relationship to Child

length of Time Respondent Has Known Child Examiner's Name and Titlle

Month

Year

iDay

[late of Testing Date of Bi rth Age

• Age in Months

Section II. IRecord of 'Scores

Section III. Summary of Other Test Results

Raw Score

Age Equivalent PerQentile Standard Score Rating

Test 'S(Ofe

DAyt Sc,ore Equivalent

Ten. Name

Date

1. _

2. ___

1. _

4. _

5. ___

Section IV. Administration Conditions

A. Testingi conducted in: one session

Administration time Administratiion time

two sessions three or more

Administration time

B. Testing Location _

C. Describe administration (individual, arena, observation, interview" andlor direct) in detail.

D., :Environmental Characteristics

Iinterfering N'oninterfering'

Noise level tnterruptlcns Distractions Lighting Temperature

other _

E. Personal or physical characteristics thai! may affect the child's test results.

Section V. Interpretation and Recomme.ndations

e 1998 by PRO·ED, Inc.

12 1:3 14, 1S 11 10 .09 08

Additional copies of this form (#8732) may be purchased from PRo·m, B700 Shoal creekalvd. Austin, TX 7875.7·6897 8001897·3202. Fax 8001397·7633, www.proedinc.com

Section VI. Adaptive Behavi'or Subtest

Instructions: Starting points are determined by the child's age. Score 1 for those items that the chlld can do right now, is, beginning to do, or did when he or she was younger but has outgrown. Score 0 for those' items that the child cannot do.

Basal and Ceiling: Begin at the suggested starting point. Continue to administer items (by observation, interview, or direct administration) until 3 of 5 items receive a score of 0 (i.e .• a ceitinq). If the chlld does not receive a score of 7 on 3 consecutive items, administer (by observation,interview, or direct administration) the items in reverse' unti:l a, basal of 3 scores of t is reached.

litem ##

Score 1 or 0

Item

Start Age: BIrth

enjoys bath; keeps 'eyes open and indicates pleasure when placed in warm water

2

opens mouth and sticks out tongue in anticipation of feeding (sight of breast or bottle)

3

expresses displeasure when clothes are pulled over head

4

sleeps for 4- to 10-hour intervals

5

sleeps through the night; takes 2 to 3, naps. during the clay

6

uses tongue to reject pureed foods

7

holds or supports, a bottle to feed self

9

doses lips when swallowing

brings food to mouth with whole hand

Start Age: 12 months

drinks from cup held by adult

10

11

12

13

14

15

16

17

18

19

20

21

22

shows definite likes and dislikes of various foods

pulls off own socks

feeds self finger foods

fusses when diaper needs to be changed

sleeps through the night; takes one nap during the day

cooperatesin dressing and undressing (e .. g ..•. helps put arms in holes)

chews textured foods

wil'lingly allows caregiver to wipe nose

brushes teeth with assistance

Start Age: 24 months

tries to wash own hands and face

sips liquid from glass or cup using a straw

helps with simple household tasks (e.g., helps put things away)

Page 2 Total,

2

I

,Item #

Item

Score 1 or 0

23

removes loose clothinq such as a jacket, shorts,or a shirt without assistance

24

puts on simple clothing (e.g., hat, pants" shoes, socks)

25

squats, holds self, or verbalizes bowel and bladder needs most of the time

26

opens door by turning handle

27

independently eats entire meal with spoon

28

29

sits on toitet for at least 1 minute supervised

wipes own nose; may need to be reminded

Start Age: 36 months

30

hangs clothing, on hook

31

32

sleeps through the night; no naps during the day

tells adult of toifet needs, in time' to get to toilet

33

washes and dries hands and face without assistance

34

pours milk and juice with some assistance

,

3.5

drinks from water fountain independently

36

gets drink of water from tap unassisted (may need help getting cup from cupboard)

37

takes responsibility for tOi,let'ing; may require assistance in wiping

38

39

deans up spills, getting own cloth

manipulates large buttons and snaps

Start Age: 48 months

40

sets table with assistance (plates, ,glasses, silverware); direction may be provided

41

uses all eating utensils

42

sleeps through the night without wetting

43

brushes teeth independently

44

dresses self completely, except for tying shoelaces (includes underwear; clothes must be on correctly, including all fasteners)

45

covers mouth and nose when couqhing and sneezing (hand, tissue, or handkerchief may be used)

46

serves self at the table (adult may need to hold serving dish)

47

zippefsefficiently

48

puts shoes on correct feet without assistance

t

49

often wants privacy in bathroom

50

51

I,

t

fastens seat belt in automobile independently

uses table knife for spreading soft: butter, jelly, and peanut butter

II

J

Page 3 Total

I

J

3

Item Score
# 1 or 0 Item
52 crosses street safely
53 plans ahead to meet toileting needs before beginning an activity
54 blows nose independently; no reminder needed
55 selects clothing appropriate for temperature and occasion
S6 hangs up clothes on a hanger
57 brushes and combs hair with neat results without assistance
58 makes own bed; may need to be reminded
59 makes simple breakfast and lunch
60 sets and dears table without assistance I
61 ties shoelaces into a bow without assistance
62 adjust water temperature for shower or bath
Page 4 Total
Page 3 Total
Page 2 Total
Total Subtest Raw Score (Page 2 + 3 ... 4) 4

DAYC

Developmental Assessment of

Young Children

COGNITIVE SUBTEST SCORING FORM

Section I. Identifying Information

Child's Name _

Male Female

Parent/Guardian

School/Daycare _

Respondent's Name _

Relationship to Child

Length of Time Respondent Has Known Child Examiner's Name and Title

Month

Day

Year

Date of Testing Date of Birth Age

Age in Months

Seetio,n II. Record of Scores

Section III. Summary of Other Test Results

Raw Score

Age Equivalent Percentile

Standard Score Rating

Date

Test Score

DAye Score Equivalent

Test Name

1. _

2. ___

3. _

4. __

5. _

, .~

Section IV. Administration Conditions

A. Testing conducted in: one session

Administration time

two sessions three or more

Administration time

Administration time

B. Testing Location _

C. Describe administration (individual, arena, observation, interview, and/or direct) in detail.

D. Environmental Characteristics Interfering

Noninterfering

Noise level

I nterru ptions D istr acti ons

Lighting Temperature

Other _

E. Personal or physical characteristics that may affect the child's test results.

Section V. Interpretation and Recommendations

e 1998 by PRO-ED, Inc.

13 14 15 11 10 09 08

Additional copies of this form (#8733) may be purchased from PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6897 800/897-3202, Fax 800/397-7633, www.proedinc.com

Section VI. Cogn.itive Subtest

tnstructions: Starting points are determined by the child's age. Scoret for those items that the child can do right now, is beginning to do, or did when he or she was younger but has outgrown. Score 0 for those items that the child cannot do.

Basal and Ceiling: Begin at the suggested starting point. Continue items (by observation, interview, or direct administration) until 3 of 5 'items receive a score of 0 (i.e., a c.eil,ing). If the child does not receive a score of 1 on 3 consecutive items, administer (by observation, interview, Of direct administration) the items in reverse until a basal of 3 scores of 1is reached.

Item #

Score 1 or 0

Item

Start Age: Birth

moves hand to mouth

2

3

watches an object moved slowly through his or her line of sight

looks back and forth between 2 objects

4

holds toy placed in hand for 10 to 15 seconds

5

alternatively g'lances from hand to an object or from one hand to another

6

repeats arm or leg movements to cause an action to occur a.ga.in (e.g'., shakes arm with rattle attached to wrist; kicks leg to move mobile attached to crib)

I I

7

I

8

II

9

l

10

I

,

11

I

I

12

mouths toys

explores objects in a variety of ways; visually; turning it around; feeling all surfaces; banging and shaking

pulls cloth from face

imitates familiar actions after observing caregiver doing that action (e.g.,. claps hands)

finds an object that is partially hidden

intentionally drops all object and watches it fall

I

13

retrieves an object seen hidden under or behind a singl'e barrier

14

touches adult to have that person start or continue interesting game or action

Start Age:. 12 months

15

transfers an object from one hand to the other to pick up second object

16

hands an object to an adult to have that person repeat or start a desired action (e.g .• start windup toy)

17

imitates scribbling

~I 18

demonstrates understanding of functional relationships (e.g., puts person in car and pushes car; combs hair

with brush) .

19

attempts to start toy if he or she has seen someone else make it work (e .. g., a windup toy)

I Start. Age: 24 months

,I

21

I 20 demonstrates use of everyday items (e.g., pretends to drink from a cup)

places a small object into small container (e.g' .. , a raisin into a small bottle)

22

l

rolls wheeled toys

Page 2 Total

2

Item #

Score 1 er 0

Item

23

manages 3 to 4 toys by setting one aside when given a new toy

24

looks at storybook pictures with adult, naming or poi!nting to simpl'e objects 'upon request

25

spontaneously names object

26

matches an object to its picture

27

sequences related action in play (e.g., feeds doll with bottle, pats it on the back, puts it to bed)

28

uses pretend objects in play

29

understands concept of "one" (e.g., "Give me' one block.") and "all" (e.g., "Give me al! the blocks.")

Start Age: 36 months

30

stacks 6 to 7 blocks

31
32
33
I 34
;1 3S
36
37
38
39
40
41
42
43
44 matches simple shapes, such as circle, square. triangle

responds to "one" and "one more" (e.g., "Give me one block.""Give me one more .. ")

puts graduated sizes in order (e.g., nests four boxes or stacks rings on peg in order of size)

matches objects by color, shape', and size

repeats finger plays with words and actions

counts by rate to' 5

matches objects that have the same function (e.g., comb and brush)

tells if an object is "heavy" or "light"

counts up to 5 objects

builds bridge using 3 blocks; adult models 00

understands "same'tand "different" (e.g., "Are these two colors the same or different?")

sottsobjects by one criterion (Give child pictures or objects across at least two categories--e.g., shape, color-and state, "Put these intoqroups that are alike .. ")

understands concept off the number 3 (e.g., "Give me three blocks.")

understands "more," "less," "same" (e.g., "Which pile has more?")

Start Age:' 48 months

4S

imitates drawing of a face

46

sorts objects into categories (Give ch:ild pictures or objects-e.g .. , toys .. animals-and state, "Put these into qroups that are alike."); may not be able to label the categories

47

identifies objects that do not belong in a gTOUp (e .. g .. recognizes that dog does not belong with food items)

48

knows sequence of reading a book, from left to right; top to bottom

49

sorts groups of objects in more than one way (Give child pictures or objects across at least two categories=e.q.icolor, size, shape-and state .• "Put these into groups tha,t are alike. Now sort them in another wav.")

50

bui'lds pyramid of 6 blocks; adult models ~

51

identifies "first," "last," "middle" (e.g., "Point to the child who is first in line.")

Page 3 Total

3

Item #

Score II 10r 0

Item

52

,I

retells story from picture book with reasonable accuracy

53

identifies the larger of two numbers (e .. g., "Which is more, 2 or 31")

54

draws a stick figure

55

identifies abstract characteristics (e.g., real and make-believe: living and nonliving;. e.g., "Is the truck. a.live?")

56

copies own name; may use I'arge, irregular letters

57

predicts what may happen next (e.g., child predicts what willi happen next in a story)

58

points to "half" or "whole" objects

59

names most letters

60

puts three pictures in a sequence to tell a story

61

matches the number of items in a set to the correct numeral

62

understands concept of "zero" (e.g .• "Which cup has zero cubes?")

63

draws person with 6 recognizable parts

64

prints first name legibly without a model

65

draws identifiable objects without a model

66

counts up to 20 objects

67

tells month and day of birth

68

arranges numbered tiles or cards in proper sequence

69

I tells own street name and town

70

names the days of the week in order

71

states preceding and foHowi;ng days of the week (e.g -r "What day comes after Sunday?")

72

points to coins when named (i.e .• penny. nickel, dime, quarter)

73

states preceding and following numbers (e.g .• "What number comes before 197")

74

writes first and last name from memory

75

calculates single-digit addition and subtraction problems

76

counts by rate from 1 to 100

77

writes numerals l' to 19 without model

78

reads 10 printed words

Page 4 Total

Page 3 Total

Page 2. Total

Total Subtest iRa.w Score (Page 2 ... 3 + 4)

4

---

DAYC

Developmental Assessment of

Young Children

COMIMUNICATION SUBTEST SCORINGI FORM

Sedion t Identifyingl Ilnfcnmation

Child's Name _

Male Female

Parent/Guardian

SchoollDaycare' _

Respondent's Name _

Relationship to Child

Length of Time Respondent Has Known Child Examiner'S Name and Title

Month

Day

Year

Date of Testing Date of Birth Age

Ag.e in Months

Section II. Recorctof Scores

Section III. Summary of Other 1'est. Results

Raw Score

Age Equivalent Percentile Standard Score Ratiing

Date

fest Score

DAye Score Equivalent

Test :Name

1. _

2. ___

3. __

4. _

5. _

Sedion IV. Administration Conditions

A .. Testiing conducted in: one session

Adiministration time Administration time

two sessions three Or more

Administration time

B. Testing Location _

C. Describe administration (individual, arena, observation, interview, and/or direct) in detail.

D. Environmental Characteristics

Interfering Noninterfering

Noise level Interruptions Distractions

Lighting Temperature

Other _

E. Personal or physica'i characteristics that may affect the chlld's test results.

Section V. Interpre'tation and Recommendation5

e 1998 by PRO·ED, Inc.

u 12 13 14 15 12 11 10 09 08

Additional copies of this form (#8734) may be purchased from PRO·ED. 8700 Shoal Creek Boulevard. Austin, TX 78757-6897. 5121451-32.46, Fax 51.2J451·8542

Se.c;tiOIl VI. 'Commullication Subt.est

Instructions: Starting points are determined by the child's age. Score 1 for those items that the child can do right now, is beginning to do, or did when he or she was younger but has outgrown. Score 0 for those items that the child cannot do.

Basal and Ceiling; Begin at the sug:gested starting point. Continue to administer items (by observation, interview; or direct administration) until 3 of 5 items receive a score of 0 (i.e .• a ceiling). tf the child does not receive a score of 1 on 3 consecutive items, administer (by observation, interview, or direct administration) the items in reverse until a basal of 3 scores of 1 is reached.

,I: Item

! #

Item

Score 10r 0

Start Ag.e: Birth

reacts to loud noise by blinking, moving arms or legs, or stopping movement

2

turns head toward voice when someone speaks to him or her

3

makes noises other than crying (e.g., cooing,. gurgling)

smiles at person who is talking or gesturing

4

5

produces vocal gurgle in response to soothing voice

6

has different cries for pain, hunger, and discomfort

produces single vowel sounds (e.g .. , ah, eh, uh)

7

laughs out loud

8

produces some consonants such as Ikl, Igl, or Ihl

9

turns, and looks toward noise

110

produces twc-syllab:le, one-consonant sound strings repetitively (e.g .. , a-ba)

1'1

12

stops activity when name is called

produces consonants such as fbI, Iml, Iwl, Idl, Inl, Irl

responds with appropriate gestures to "up," "bye-bye," or other routines

15

Start Age: 12 months

briefly stops activity when told "no"

16

produces string of consonants and word-like double consonants (e.g., ba-ba, da-da)

uses inflection patterns when vocaHzing (e.g., raises pi,tch as if asking a question)

17

moves body to musk

18

says "Mama" or "Dada" discriminately

19

locates familiar objects on request (e.q., "Where is your blanket?")

20

21

follows simple spoken commands (e.g., "Give Mommy the cup. ")

,I

22

when asked, will polnt to familiar persons, animals, and toys

I I

23

responds, to "where" questions (e.g., "Where is the bail?")

Page 2 Total

2

Score

11 or 0 Item

follows directions about placing one item "in" or "on" another

has a word or sound for drink

spontaneously says familiar greetings and farewells

carries out 2-step directions that are related (e,g" "Go to the table and bring me the toy,")

points to .3 body parts when asked

2.9

says one word: that conveys entire thought; meaning depends on context (e,g., "cookie" may mean "wants more" or "the cookie broke")

Start Age: 2.4 months

30

uses at least 5 words (vocebularly is similar to age peers)

31

identi.fies familiar characters or items seen on TV (e .. g., Big Bird)

refuses by sa,ying "no"

32'

33

indicates "yes" or "no" (or appropriate head movement) in response to questions

34

knows names of playmates

understands possessives ("mine," "yours," and "his"; e.q, "Where is your ball?" "Whose ball is this?")

35

I; I

36

produces some 2-word phrases (e'.g., more cookie)

38

11-_3_7_-+ I---_p_o_in_t_s _to_6_b_0_d_y_p_a_rt_s_w_h_e_n_a_s_k_ed -1

II

points to 15 or more pictures. of common objects when they are named

39

uses 10 to 1'5 words spontaneously (vocabulary is similarto age peers)

whispers

40

names 8 or more pictures of familiar objects

41

points to common objects described by their use (e.g .. , "Show me what you eat with.")

42

knows "big" and "little" (e.g .• "Throw the big ball to me.")

43

44

carries out 2.-step unrelated commands (e.g:., "Put the ball on the shelf and then clap your hands.")

Start .Age; 36 months

J

45 follows directions about placing one item "beside" or "under" another

I: 46 uses at least 50 different words in spontaneous speech (vocabulary is similar to age peers)

,I

uses 3-word sentences

48

49 describes what he or she is doing (e.g., responds to "What are you doing?")

Start Age: 48 months !I

50 asks "what" or "where" questions (e.g., "Where is my bail?")

demonstrates understanding of passive sentences (e.g.,"Show me the train was pushed by the car.")

,

J

51 'uses some plurals

Page 3 Total

3

,
Item Score
# 11 or 0 Item I
52 tells whether two words rhyme
53 responds to "who" and "whose" questions (e.g., "Who has on a red shirt today?")
54 gives full name on request (e.g., "What is your name?")
55 asks questions beginning with "When," "Who,"liWhy/' "How many" (e.g., "When will we eat?")
56 understands "in front of" and "behind" (e .. g., "What is behind the screen?")
57 changes speech depending on listener (e.g., talks differently to babies than to adults)
58 uses 3000 to 1,00000 words in spontaneous speech (vocabulary is similar to aqe peers)
59 uses contractions (e.g., "['Il," "can't")
600 carries out 3-step commands that are not related (e.g., "Put the ball on the table, shut the door, and tum
around.")
61 completes simple verbal analogies (e .. g., "Daddy is a man; Mommy is a .")
62 uses comparatives (e.g., "big,." "bigger," "biggest"; "Which one is bigger?")
63 defines 2 simple words (e.g., "What is a cat?")
, 64 makes statements about cause and effect (e.g., "It won't roll because the wheel is off .. ")
I 65 answers question, "What happens if ... " (e.g., "you drop an egg.,")
66 defines 5 simple words (e.g., "What is a block?")
67 tells familiar stories without picture cues
68 answers comprehension questions when told a short story
69 defines 100 simple words (e.q., "What is a ?")

700 understands seasons of the year and what you do in each (e .. g., "What do we do in the summer?")
71 uses irregular plurals (e.g., footffeet)
72 responds to questions involving time concepts (e.g., "When do we eat lunch?")
73 states similarities (i.e., "How are shoes and boots alike?") and differences (e.g., "How are milk and water
different?") between obiects
74 responds to "Tell me the opposite of "
7S tells simple jokes
76 identifies I.eft and right on own body (e.g., "Raise your right hand.")
77 uses irregular comparatives correctly (e.g., "good," "better," "best")
78 uses "yesterday" and "tomorrow" meaningfully
Page 4 Total
Page 3 Total
Page 2 Total
Total Subtest Raw Score (Page 2 + 3 + 4) , 4

- -- ---

DAYC

Developmenta'l Assessment of

Young, ChUdren

PHYSIICAL D'EVELOPMENT SUBTEST SCORING FORM

Section Ii. Identifying Information

Child's Name _

Male Female

'Parent/Guard ian

School/Daycare _

'Respondent's Name _

Relationship to Child

Length of Time Respondent Has Known Child I Examiner's Name and Title

Year

Month

Da,y

Date of Testing Date of Birth Age

Age in Months

1-

Section n. Recon::l of Scores

Section III. Summary of Other Test Results

Raw Score

Age Equivalent Percentile

Standard Score Rating

,PAye Score Equivalent

Date

Test Score

Test Name

1. _

2. _

3. _

4. _

5. _

Section IV. Administration Conditions

A. Testing conducted in: one session

Administration time

two sessions three or more

Administration time Administration time

B. Testing 'location _

C. Describe administration (indiividual.arena, observetlon, interview, and/or direct) in detail.

D .. Environmental Characteristics

Interfering Noninterferin9

Noise level Interruptions Distractions Lighting Temperature

Other _

E. 'Personal or physical characteristics that may affect the child's test results.

Section V. Interpretation and Recommendations

11:11998 by PRO·ED, Inc.

12. 1'3 14 15 11 10 09 08

Additional copies of' this form (118735) may be purchased from PRO-ED, 8700 Shoal Creek Boulevard. Austin. TX 78757·6897. 5121451·3246, Fax 512145l·8542

Section VI. Physical Development Subtest

Instructions: Starting points are determined by the child's age. Score 1 for those items that the child can do right now, is beginning to do, or did when he or she was younger but has outgrown. Score 0 for those items that the child cannot do ..

Basal and Ceiling: Begin at the suggested starting point. Continue to administer items (by observation, interview, or direct administration) until 3 of 5 items receive a score of 0 (l.e., a ceiling). If the child does not receive a score of 1 on 3 consecutive items, administer (by observation, interview, or direct administration) the items in reverse until a basal of 3 scores of 1 is reached.

Item Score
# 1 or 0 Item
Start Age: Birth
1 extends both legs when lying on stomach
I
2 closes fingers when light pressure is, applied on open palm ,I
I
3 kicks reciprocally (e.g., one leg, then the other) when lying on back
4 rolls from side to back
5 when held upright, will bear some weight on legs
6 when lying on stomach, lifts head with support of forearms
7 when pulled to sitting, holds. head in line with body (l.e., no head lag)
8 reaches for, but may not actually touch, an object
9 holds objects between fingers and palm of hand
10 brings hands together when lying on back
11 sits with support
12 rolls from back to side
13 holds a small object in each hand at one time
14 reaches for and grasps an object
1,5 opens hand in anticipation of contact
I 16 rolls from back to stomach
,
17 when on stomach, extends arms and legs off mattress
18 when on stomach, reaches with one hand while bearing weight on other forearm
19 when on back, brings feet to mouth
20 transfers an object from one hand to the other
21 holds an object between fingers and opposed thumb and palm of hand
22 bounces in standing when supported by adult
23 sits alone for 30 seconds while playing with toy
24 pulls self to sitting while grasping adult fingers
25 moves body forward to get an object
26 uses raking or scooping motion to pick up a small object
'Page 2 Total 2

II,tem #

Item

Score 1 or 0

27

uses arms to move forward on belly

28

sits alone steadily iniitially with wide base of support

29

stands alone by holding on to something

30

from sitting position, turns 90 degrees to retrieve an object

31

walks 3 or more steps with assistance

32

pulls self to standing position

33

34

when falling forward, extends arms to catch self

bangs 2 objects tog.ether

Start. Age: 12. months

moves from back to sitting without assistance

36

37

38

39

40

41

42

43

44

35

picks up a small object using thumb and forefinger

walks sideways while holding on to furniture

scoots toward an object while maintaining sitting position

moves from standing to sitting in controlled fashion

pokes with index finger

wa,l'ks. with one' hand held

pushes or pulls toys while walking

walks without holding on, may fa.1I easily

starts and stops. in walking

45

Start Age: 24 months

when standing, stoops, then stands again without losing balance

46

holds crayon, pencil, and so on, in fist with thumb up

47

creeps backward down steps

48

squats during play

49

runs (may be a hurried walk)

50

scribbles spontaneously

51

throws a ball overhand with relative accuracy

52

walks up and down stairs pl'acing both feet on each step, without assistance

53

54

holds crayon with fingers, hand on top, forearm turned 50 thumb is directed downward

uses hand to hold paper in place when drawing

Start .Age: 36 months

walks backward

56

57

I 55

uses one hand consistently in most activities

walks up stairs, alternating feet, in adult fashion while holding on

iPage 3 Tbtal

Item. Score
I # 1 or 0 Item.
,
58 climbs low play equipment
, 59 imitates circular, vertical, and horizontal strokes
60 holds pencil between first 2 fingers and thumb (i.e., adult grasp)
61 uses vertical, horizontal, and circular motions when drawing
62 walks swinging arms and legs freely in cross pattern similar to adult walk pattern
63 catches ball from straight arm position, trapping ball against chest
64 mak.es several snips on paper using scissors
Start Age; 48 months
65 hops on 1 foot a few steps
66 turns somersault.
67 walks forward heel to toe without losing balance
i 68 copies a cross
,
I
69 balances on one foot for 5 to 10 seconds without support
70 jumps over objects up to 6 inches high; lands with both feet together
71 cuts with scissors following a line
,
72 copies a square
73 copies a rectangle
, 74 gallops, leading with one foot and transferring weight smoothly and evenly
75 swings on swing maintaining own momentum: uses legs to propel
76 bounces and catches tennis ball (or any ball of similar size)
77 colors within lines
78 cuts out simple geometric shapes with scissors
I
79 skips, alternating feet, maintaining balance
80 rapidly touches each finger to thumb
81 hops in straight line on one foot without losing balance
82 places paper clips on paper
83 turns 3 consecutive somersaults
84 pastes or glues neatly
85 copies a diamond with straight, connected lines
86 drops a ball and kicks it forward before it hits the floor
87 jumps rope by self
Page 4 Total
Page 3 Total
Page 2 Total
Total Subtest Raw Score (Page 2 + 3 + 4) 4

Developmental Assessment of

Young Children

SOCIAL-EMOTIONAL SUBTEST SCO!RING FORM

Sec.tion I.. Identifying Information

Chilid's Name _

Male Female

Parent/Guardian

School/Daycare _

Respondent's Name ~

Relationship to Child

Length of Time Respondent Has Known Child Examiner's Name and Title

Month

Year

Day

Date of Testing Date of Birth Age

Age in Months

Section II. R.ecord of Scores

Section III. Summary of Ot.her Test Results

Raw Score

Age Equivalent Percentile Sta.ndard Score Rating

Date

Test Score

DAye Score Equivalent

Test: Name

1. __

2 .. _

3. _

4. _

5. __

Section lV. Administration Conditions

A. Testing conducted in: one session

Administration time Administration time

two sessions

three or more

Administration time

B. Testing Location _

C. Describe administration (individuaL arena, observation, interview, and/or direct) in detail

D. Environmental Characteristics

Interfering Noninterfering

Noise level Interruptions D istracti ons Lighting Temperature

Other _

E. Personal or physical characteristics that may affect the child's test results.

Section V •. lnte,rpretation and Rec.ommendations

© 199B by PRO·ED, Inc.

13 14 15 11 10 09 08

Additional copies of this form (#8736) may be purchased from PRO·ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6B97 800/891-3202. Fax 800/397-7633, www.proedlnc.com

Section VI. Social-Emotional Sub~est

Instructions: Starting points are determined by the child's age. Score 1 for those items that the child can do right now, is beginning to do, or did when he or she was younger but has outgrown. Score 0 for those items that the chi'ld cannot do.

Basal and Ceiling: Begin at the suggested starting point. Continue to administer items (by observation, interview, or direct administration) until 3 of 5 items receive a score of 0 (i.e., a ceiljnq). If the child does not receive a score of 1 on .3 consecutive items, administer (by observation, interview, or directadministration) the items in reverse until a basal of 3 scores of 1 is reached.

Item Score
# 1 or 0 Item
Start Age: Birth
1 stops crying when talked to, picked up, or comforted
2 looks at adult face for several seconds
3 interacts by smiling and cooing
4 recognizes familiar faces and objects (e.g., parent, bottle); reacts by waving arms and legs or squealing with
excitement
5 expresses feelings such as anger, tiredness, excitement, or hunger
6 comforts. self (i.e., quits fussing by himself or herself)
7 knows the difference between caregivers and strangers (e.g., smiles at loved ones; stares, quiets, or refuses
to smile with stranger)
8 plays alone for short periods (l.e., 5 to 10 seconds)
9 when someone calls the child's name, he or she looks at the person and vocalizes
Start Age: 12 months
10 extends arms to familiar persons
1'1 responds differently to children and adults
12 imitates facial expressions, actions, and sounds
13 recognizes self in the mirror
14 plays simple games (e.g., peek-a-boo, pat-a-cake)
15 shows anxiety at separation from caregiver (e.g., refusal to explore the environment. crying, searching)
16 expresses affection (e.g., hugging, patting, special looks, resting head)
17 shows special dependence on primary caregiver (e.g., wants only that person to feed, dress, change, and
comfort him or her)
18 lauqhs at incongruous events (e.g., wearing a bowl as a hat) I
19 purposefully refuses to comply with requests (e.g., says "no," shaking head)
Start Age: 24 months
20 beginning to function on his or her own; may periodically return to the parent for reassurance and attention
,
21 brings toys to share with caregiver
22 has difficulty sharing with other children
I
Page 2 Total 2

Item
#I
II 23
Ii 24
I 25
26
27 Score

11 or 0 Item

has temper tantrums when frustrated

insists on trying to do many things without help (e.g., eating with spoon, putting on a coat)

shows .independence (e.g., rum ahead of parent outdoors, refuses to have hand held)

28 enjoys simple make-believe II,

r---29---+--------r--sa-y-s- .. -p-le-a-s-e- .. -a-n-d-'-'t-h-a-n-k-y-o-u-"-;-m-a-y-n-e-e-d-t-o-,b-e- .. -re-m-"-in-d-e-d-· --------------------------------------111

plays well for brief time' in groups of two or three children

attempts to comfort others in dist,ress (e.g., comforts a child who, is hurt or distressed)

j

30

Start Age; 36 month,s

separates from parent in familiar surroundings without crying

31

sings familiar sonqs with adult

32

spontaneously greets familiar person by hugging

33

usually takes turns

spends most group time in solitary activity, wa,tchin.g other children

34

laughs at combinations of incongruous events and use of words (e.q., milking a dog)

3.5

36

asks for assistance when having difflculty

37

states whether he or she is a boyar a girl

38

shows pride in accomplishments

39

plays group games with simple rules

Start Age:. 48 months

40

plays dress-up

41

shows off by repaatlnq rhymes, songs, or dances for others

talks about own feelings

42

43

changes from one activity to another when required by teacher or parent

44

selects own friends

waits for turn when playing in group games (e.g., red rover, steal the bacon)

45

knows and fo'llows classroom rules

46

gains attention from peers in appropriate' ways

47

understands rules of fair play

48

likes competi,tive games

49

50

has best friend of same sex

51

explains rules of a game to others

IPage 3 Total

3

52

Score 1 or 0

Item

Item #

asks before usinqanother's belong,ings

53

accepts mild, friendly teasing without becoming too agitated

S4

works aleneat chore for 20 to 30 minutes

55

expressess anger with nonaggressive words rather than with physical action

56

states goal for himself or herself and carries out activity

57

accepts val.id critlclsrn without crying, pouting, or refusing to continue

58

answers, the :phone .. remembers a simpl'e message, and delivers it to the correct person

Page' 4 Total

Page' 3 Tota'i

Page 2 Total

I Total Subitest Raw Score (Page 2 + 3 + 4)

4