Ages and Stages Report Form

Child’s Name: M. H. Date of Birth: 9/24/12

Date of Examination: 2/20/18 Date of Report: 2/20/18

Chronological Age: 5 years 4 months 29 days

Examiner’s Name: Paige Feist

Name(s) of Assessment: ASQ-3

Name(s) of Other Assessment Procedures: None

Reason for Referral:

ECE 362 Class Assignment

Background Information:
M. is a sweet, outgoing 65 month old in my lab group. M. lives in Brookings with her family whose
parents are together and two sisters. Her sister’s names are M. (7) and M. (infant). M.’s parents are considered
to be in middle class for their socio-economic status. This child’s home life is stationed in a positive setting.
M.’s father, J., works at the SDSU campus as a facilities and services employee from Sunday through Thursday.
M.’s mother, J., also works on the SDSU campus. M. attends home daycare during the week when she is not at
preschool. M. is also involved in gymnastics and ballet/tap once a week. She has interests in animals (esp.
horses), being outside, gymnastics, and her dolls that she brings to class.

Assessment Results:
Communication: 45
Gross Motor: 50
Fine Motor: 50
Problem Solving: 60
Personal-Social: 60

Recommendations:
From gathering information from M.’s scores on the ages and stages questionnaire, she is on track. Her
lowest score on this assessment was a score of 45/60 on communication. I feel that this score will rise after she
gets to know the students and teachers in the lab. There are new faces for these children to meet and remember.
Something that I observed when asking M. to repeat the sentence after me is that she couldn’t remember the
names that I read. I read this statement three times and gave her time to repeat it. I even told her I would say it
with her. I asked her, “Can you repeat this after me this time?” She said slowly, “I maybe can try.” She was not
confident in that portion of the assessment. A way to assess this further is to give her shorter sentences to repeat.
I feel as if the sentences that were given to me were a little too long for her to comprehend. A way that the
family can help her with forming sentences is to read books or even talking to one another. The parents could
ask questions that push M. to answer the questions with longer sentences. Continuing M.’s gross and fine
motor, problem solving, communication, and personal skills in lab will only benefit her by getting her ready for
kindergarten and kindergarten ready for her.

Self-Evaluation of Testing:
The ages and stages questionnaire is very valuable to me as a future teacher because it tells me what my
students can and can’t do yet. This will benefit me when I make my lesson plans. I can incorporate the items
that my students can’t do yet into my plans. Asking M.’s mother, J., for permission to assess her daughter made
me nervous. I introduced myself and reminded J. that the scores wouldn’t be shared. My nerves went away after
she started asking questions about myself and my time with M. I explained to J. that I chose Maddix to do this
assessment because she was in my small group so we had spent time together and because M. has an awesome
personality. She was very happy to hear this information. For me, the questionnaire went very good with the
child that I chose. She was very cooperative and loved doing the exercises. She had a great attitude with
whatever I asked her to do. The only downfall that I had was doing the exercises naturally. Since the children
want to play with all of the new areas that the student teachers set up, it made it hard for me to get my
questionnaire done. Thankfully, I chose a very mature child who is also in my small group. I recognized during
my observations that she was comfortable with me since we have spent so much time together. She listened to
me and enjoyed doing the activities. I learned that the assessment process was quicker than I thought it would
be. M. made the screening quick by paying attention to my questions and requests. At the end of the process I
gave M. a high five and thanked her for helping me.