Ages and Stages Report Form

Child’s Name: K.C. Date of Birth: 12/11/13

Date of Examination: 9/21/17 Date of Report: 9/24/17

Chronological Age: 3 years 9 months 10 days

Examiner’s Name: Brenna Johnson

Name(s) of Assessment: ASQ-3

Name(s) of Other Assessment Procedures: None

Reason for Referral:

ECE 362 Class Assignment
Background Information:
K.C. is a three-year-old in SDSU’s Laboratory Preschool at Fishback Center for Early Childhood Education.
She lives in the town of Brookings, SD with her mom, dad, and little brother. Both of her parents are employed
at 3M Incorporations in Brookings. She also has grandparents, aunts, uncles, and other family members residing
in Michigan and Minnesota. Some of K.C.’s favorite things include Paw Patrol, books, and all kinds of arts and
crafts. She has a dog named Maddie, who is her best friend. She also has many friends at Peace Lutheran Early
Childhood Center, where she attends daycare. Peace Lutheran has been an educational experience for K.C.,
because they have stimulated creativity and encouraged emotional, physical, and social development.
Assessment Results:
K.C. is above the cutoff and her development appears to be on schedule in communication, gross motor, fine
motor, problem solving, and personal-social. K.C. can form sentences, follow multi-step directions, and
understand different actions. She alternates feet while walking upstairs, hops on one foot, jumps with two feet,
and can throw a ball overhand. K.C. understands how to draw a circle, a cross, and a line. She also has the skills
of using scissors and writing utensils. She is able to problem solve by putting blocks together, determining size
differences, and acting in dramatic play. She knows how to use self-help skills and can recognize characteristics
of herself.
Recommendations:
K.C. can continue to work on her skills in establishing her first and last name, continually using connector
words to form complete sentences, practicing catching a ball with both hands, and working on puzzles. Working
on these skills will help improve all areas of development, but also ensuring that she continues to practice the
skills she has mastered to maintain her current knowledge.
Self-Evaluation of Testing:
K.C. rides to BATA Bus to and from preschool each day. Knowing this, I contacted her mom via email to get
parent permission. She was super excited about the assessment to see what K.C. is learning and developing
during preschool. Through the process, I have learned each child is unique based on individual or group type
focus. The first day, I began the Ages and Stages Questionnaire with K.C., I pulled her away from small group
to begin the screening. She was very hesitant and wasn’t sure why she was the only one of her friends not in
small group and was curious to know what she was missing out on. The next day, another assistant teacher and I
did our assessment together. The girls seemed to be more relaxed and thought of the activities more as games
than stressful questions or tasks. This atmosphere made it easier on me, as the teacher, as well as on K.C.
Assessment is important in understanding what the child knows and what the child can do and with that
information, the teacher can develop individual goals for the individual for that year.