| Parental Assessment and Observation of Child while in Early Intervention Program |
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9. Parental Assessment and Observation of Child while in Early Intervention Program
Tools for Early Identification and Intervention- 0-5 years
By James J. Messina, Ph.D
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Parental Assessment and Observation of Child while in Early Intervention Program
CHILD'S NAME:
DATE:
PARENT(S) REPORTING:
I. Child's Capacity to Regulate Routine Sensations:
RATING SCALE: 1 = Over reactive 2 = Typical 3 = Under reactive (circle rating)
1. Sensitivity to Sound
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1 2 3 Soft Sound
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1 2 3 Loud Sounds
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1 2 3 Motorized Sounds
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2. Sensitivity to Touch
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1 2 3 Light Touch
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1 2 3 Soothing Touch
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1 2 3 Painful Touch
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3. Sensitivity to Visual Stimuli
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1 2 3 Far away
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1 2 3 Close up
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1 2 3 Bright
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4. Sensitivity of Movement
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1 2 3 Fast-Intrusive
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1 2 3 Normal-Assertive
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1 2 3 Slow-Cautious
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5. Sensitivity to Smell
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1 2 3 Sweet Smell
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1 2 3 Acrid (sour) Smell
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6. Sensitivity to Taste
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1 2 3 Sweet Taste
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1 2 3 Sour Taste
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II. Description of Child's Processing of Sensations:
- Auditory Processing:
- Cognitive Processing:
- Emotional Processing:
- Visual & Spatial Processing:
III. Description of Child's Motor Functioning
- Muscle Tone:
- Fine Motor Abilities:
- Motor Planning:
IV. Child's Social Behavior
- Sequencing of actions, behaviors and thoughts:
- Sequencing of social behavior e.g. turn taking, cooperative play:
- Connecting desires, emotions and intentions:
V. Child's Functioning at:
- Home:
- School:
- Religious Congregation's Services and School:
- Public Places in Community:
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