Downey Unified School District

Adapted Physical Education Assessment Report

INFORMATION CONFIDENTIAL

Sebastian Romero Date of

Name Rodriguez Gender Male Evaluation April 2021
Birthdate 02/26/05 Age 16.2 Evaluator Elsie Gutierrez
Grade 10th Parent/Guardian Peggy Martinez
Ethnicity Hispanic Address 9245 Elm Vista Dr. #1
Primary Language English Downey, CA 90240
Attending School Warren High School Contact Number (562) 500-3892
Case Manager Amanda Peck Current Placement: Adapted Physical Education
Purpose Triannual

Relevant Background Information/Reason for Referral

Sebastian is a 15-year-old boy currently receiving Adapted Physical Education services at Warren High
School. An Adapted Physical Education Assessment is bring conducted for his IEP meeting to review
services. Sebastian is currently receiving special education services under the primary eligibility of
Other Health Impairment (OHI).

The purpose of this assessment is to evaluate Sebastian’s sports skills, gymnastics skills and fitness
skills. This assessment will guide and assist the IEP team in the process of determining Adapted PE
eligibility and appropriate placement.

Medical History
Sebastian had surgery for a tumor in the brain on May 7, 2015. He displayed double vision, tracking,
and left side weakness due to ataxia.

Assessment Results:
Assessment Instruments:
The Competency Testing for Adapted Physical Education (CTAPE) is a standardized assessment. It is not
biased against a racial or gender group, and is, in fact, fairly well balanced with regard to its being
challenging without being frustrating. CTAPE discriminates between children who have average motor
skills and children who have significantly below average motor skills. In this case significantly below is
defined as different from 90% or more of the population. Children with motor skills that differ to this extent
clearly need special help. The CTAPE assess sports skills, gymnastics skills, and fitness skills.

Assessment Observations
Testing Behavior:
Sebastian is a friendly 10th grader who enjoying participating in adapted physical education. He is an
active participant during in-person and distance learning lessons. He has expressed interest in joining a
weight training class that is offered as an elective. During the assessment, Sebastian attempted each test
item to the best of his ability. The assessment was administered over two class periods. Sebastian came
prepared to PE with proper attire and a positive attitude. He was provided with verbal prompts and a
demonstration prior to attempting each skill.

Testing Observations:
Sports Skills
Sebastian attempted each test item to the best of his ability. He is emerging an overhead volley pass.
Sebastian can contact the ball using his fingertips, but had difficulty getting the ball 10 feet high.
Sebastian can dribble a basketball using his right hand (dominant hand) by keeping it at waist level. He
struggled to transfer the ball to his left hand and was unable to dribble with proper form. Sebastian’s
strengths are in fitness skill in which he passed most of the test items. Sebastian strengths are in
throwing a football at a distance of 20 feet with proper form for five trials. Also, Sebastian
demonstrated mastery level using a basketball to bounce pass to a receiver 10 feet away. He can use
two hand, takes a step toward the target, and follows through when passing the ball.

Gymnastics Skills:
Sebastian strengths were in performing five consecutive walk outs with proper form. He was able to
walk forward to a pushups position and hand walk backwards to a starting position. Sebastian is
emerging in being able to execute a jump with a full turn. He can do a full turn but has loses his
balance when landing. Additionally, Sebastian is emerging in a V-sit. He can elevatedhis legs in a “V”
form, but struggled to keep his arms extended for a period of three seconds.

Fitness Skills:
In the fitness skills section, Sebastian had the most passed test items. His strengths are in several test
items such as crunches, jumping jacks, and arm/leg lifts, in which he demonstrated mature form.
Sebastian was able to complete 6 push-ups by maintaining proper form. Sebastian can hop on his right
foot but struggled to hop on his left. Sebastian can improve on walking/jogging half a mile. He
completed the half mile in 9 minutes and 58 seconds. Sebastian was able to run a 50-yard dash in 12.3
seconds, but his running was not in mature form.

Test Results:
Items found in blue represent a passing score.
Please note that some test items were not administered due to COVID-19 restrictions.
Skill Item Test item Passing score Student Score
Overhead Volley 12 5
Forearm Pass 18 17
Sports Skills Soccer Dribble 9 3
Soccer Kick 8 14
Overhand Throw 3 5
Bounce Pass 3 5

Jump Turn 3 2
Gymnastics Skills Walk-Outs 7 7
V-Sits 10 9

Long Jump 12 16
50- Yard Dash 9.4 second 12.33 seconds
Fitness Skills
Hop 2 1
Arm/Leg Lifts 9 18
 Push-ups 8 16
Crunches 20 25
Jumping Jacks 11 14
½ Miles Jog/Walk 6 minutes 9 minutes 58 seconds

Scoring: According to the data, Sebastian scored a 64%. This score indicated a MILD motor deficit.
Please note certain test items were not administered due to COVID-19 restrictions.

Deficits:
70% - 100% Indicates motor skills are in the average range. The student does not qualify for adapted
physical education services.
69% - 45% Indicates a mild motor deficit; the student is eligible for adapted physical education
services. Full time or part time services may be considered.
44% - 20% Indicates a moderate motor deficit; adapted physical education on a full time basis should
be considered.
19% - 0% Indicates a severe motor deficit; adapted physical education in small instructional groups on
a full-time basis should be considered.

Summary of Assessments and Recommendations

Adapted PE services are delivered in different forms including direct service, consultation, and
collaboration. Proposed eligibility criteria for Adapted Physical Education instruction includes the
following:
-Significantly reduced performance level of two or more years or 1.5 standard deviations below the
mean (less than 7.5 percentile)
-There is significantly reduced performance level because of severe medical disability or impairment,
which requires significant modification of activities and precludes safe or successful participation in
the general physical education or special physical education program.
-Physical disabilities shall not include temporary physical disabilities.

According to the Competency Testing for Adapted Physical Education (CTAPE), Sebastian is
functioning at a mild motor deficit on norm referenced and criterion referenced assessments. The
degree of severity of these motoric delays results in limited strength and vitality, which adversely
affects performance in general physical education. Referencing the testing observations, Sebastian has
shown specific needs in balance, coordination, and sports skills that require crossing his midline.
Currently, he is receiving Adapted PE for 200/100 minutes a week. Based on the assessment results and
observations, Adapted Physical Education services are recommended to continue at this time. Test
scores will be shared at the IEP meeting and the IEP team will review placement options and the
appropriate level of services.

__________________________________ ______________________________
Amanda Peck Date:
Adapted Physical Education Specialist