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Mock Referral Report

Sebastian is a 4-year-old boy who was referred for an evaluation due to concerns about his development. He has a history of ear infections and wears glasses. Testing showed Sebastian's overall development to be below expectations, especially in the areas of motor skills, self-help, and social/emotional development. He needs to improve his gross and fine motor skills, self-help skills like toilet training, and developing age-appropriate social skills through language and interaction.

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Zach Selnes
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100% found this document useful (1 vote)
3K views7 pages

Mock Referral Report

Sebastian is a 4-year-old boy who was referred for an evaluation due to concerns about his development. He has a history of ear infections and wears glasses. Testing showed Sebastian's overall development to be below expectations, especially in the areas of motor skills, self-help, and social/emotional development. He needs to improve his gross and fine motor skills, self-help skills like toilet training, and developing age-appropriate social skills through language and interaction.

Uploaded by

Zach Selnes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Evaluation Team Summary Report

Student: Sebastian Stump Date of Report: Apr 15, 2010

Date of Birth: Feb 26, 2006

Parent: Bo Stump Address: 715 N. 54th Ave W

Background Information / Information Reported by Family:

Sebastian was referred for evaluation by the Early Childhood Special Education
Department at Rochester Public School District after falling into the refer range when
given the ESI-P. Sebastian was screened in Jan 2010 during a routine screening with
Rochester Public School District. Sebastian was reticent to participate and cried so
screening was repeated at home where he received a score of 40 on the Ages and
Stages. Cutoff for his age is 70. Sebastian passes the hearing and wears glasses.
Sebastian is 4 years 1 month. He was born 6 weeks early and had frequent ear infections
until the age of 3, which are now being resolved. Sebastian received glasses at 24
months due to near-sightedness. Sebastian’s father Bo, along with Bo’s preschool
teacher are concerned with what they think could be delayed gross and fine motor
skills. Sebastian’s teacher reports that he does not have a dominant hand, mature grasp
and cannot copy letters or simple shapes. His teacher also reports that he is hesitant to
join peers in active play. Bo reports that Sebastian’s mother passed away 2 years ago
and that he has lots of support from nearby family members. Bo is concerned that
Sebastian is sometimes withdrawn and seems overly sad and shows little interest.
Sebastian has no siblings and is not potty trained.

Health and Medical:

Sebastian was born 6 weeks premature. He had frequent ear infections from birth to 3
years of age that are now being resolved. Bo reports that Sebastian has not been sick
frequently, has had no illnesses, hospitalizations or serious injuries.

Hearing and Vision:

Sebastian passed his hearing screening. He received glasses at 24 months due to near-
sightedness.

Intellectual: No intelligence testing was done as part of this evaluation.

Cognitive / Preacademics:

The Battelle Developmental Inventory-2 (BDI-2) was administered to assess Sebastian’s


functional abilities in five areas of development. The BDI-2 is a standardized,
individually administered assessment battery of key developmental skills for children
from birth – age 7 years, 11 months and is considered effective in measuring the
functional abilities of young children. On this measure Sebastian received an overall
developmental quotient (mean of 100; standard deviation of 15) of 78, which is below
age expectations. This reflects performance in all of the five developmental areas on the
test.

The cognitive domain of the BDI-2 measures those skills and abilities most commonly
thought of as “mental” or “intellectual” with the exception of language and
communication skills. This includes the three subdomains of attention and memory,
reasoning and academic skills and perception and concepts. On this measure Sebastian
received a score of 93; which is in the average range. He was able to complete all tasks
in his age range.

On the Child Development Inventory (CDI), completed by Sebastian’s father Bo,


Sebastian was at age equivalent for letter acquisition and at below 2 standard deviations
for number knowledge.

During an observation Sebastian was able to follow directions 25 out of 30 times and
referred to the picture classroom schedule twice without prompting.

Needs:
There are no needs at this time.

Communication:

The communication domain of the BDI-2 measures how effectively a child receives and
expresses information and ideas through verbal and nonverbal means. On this measure
Sebastian received a score of 112; which is in the high average expectations for his age
range. His receptive and expressive skills were evenly matched. On this measure he was
able to follow the conventional rules of communication, complete opposite analogies,
identify missing parts of objects, sequence familiar events in logical order, recall events
from a story presented orally and respond to where and when question. He had
difficulty with understanding the superlatives biggest and longest.

On the Child Development Inventory (CDI), completed by Sebastian‘s father Bo,


Sebastian was at age equivalent for expressive language and more than 1.3 standard
deviations below the norm for language comprehension.

During an observation Sebastian was observed using 1 to 2 word responses and only
used words when he needed to ask for help or answer direct questions from adults.

Needs:
There are no needs at this time.

Motor:

The Motor domain of the BDI-2 assesses a child's ability to control and use the large and
small muscles of the body. This includes gross and fine motor and perceptual motor
skills. On this measure Sebastian received a score of 79; which is below age
expectations. His skills in perceptual motor were more developed than his gross and fine
motor skills, which were in the below age expectations. He was able to walk backward
for 5 feet, jump forward with both feet together, remove forms from a form board,
string 4 large beads, stack 8 cubes vertically and copy a circle. He had difficulty walking
down stairs without assistant, alternating feet, use pads of fingertips to grasp a pencil
and copy a cross. He was not able to copy the letters V, H, L, draw a person with 6 parts
trace designs with curved part or walk in a straight line, heel-to-toe for 4 or more steps.

Sebastian‘s teacher reports that he cannot copy letters or simple shapes, does not have
a dominant hand and does not have a mature grasp.

On the Child Development Inventory (CDI), completed by Sebastian’s father Bo,


Sebastian was well below 2 standard deviations below the norm for gross motor and
more than 1 standard deviations below for fine motor.

Needs:
Sebastian needs to improve his gross and fine motor skills, including being able to walk
down stairs without assistance, to copy simple letters and shapes and developing a
mature grasp.

Self-Help / Adaptive:

The adaptive domain of the BDI-2 measures the child's ability to use the information and
skills acquired in the other two domains. The subdomains in this area are self care,
which assesses a child's ability to perform the tasks associated with daily routines and
increasing autonomy, and personal responsibility which assess a child's ability to
perform simple chores, initiate and carry out play, carry out tasks with minimal
prompting and avoid common dangers. On this measure Sebastian received a score of
78; which is in the below age expectations. His skills in personal responsibility were
much more developed than his self care skills; which fell in the low range. He was able
to feed himself, remove his own clothing, unassisted, show care when handling an
infant or a small animal and demonstrates caution and avoids common dangers. He had
difficulty initiating and organizing his own activities and responding “yes” or “no” when
asked if he needed to use the toilet. He was not able to control his bowel movements,
express a need to use the toilet and answer “what to do if” questions involving personal
responsibility.
Sebastian’s father reports that Sebastian is not potty trained.

On the Child Development Inventory (CDI), completed by Bo, Sebastian was at age
equivalent for self help.

Needs:
Sebastian needs to increase his self help skills including being able to express a need to
use the toilet and being able to control his bowel movements.

Social / Emotional / Behavioral:

The personal-social domain of the BDI-2 assesses abilities and characteristics that allow
a child to engage in meaningful social interaction with adults and peers and to develop
his or her own self concept and sense of social role. On this domain Sebastian received a
score of 77; which fell in the below age expectations. His skills in adult interaction, peer
interaction and self concept and social role; the three subdomains for this domain were
all equally equivalent, which were in the low range. Sebastian is able to help with simple
household tasks, show appropriate affection toward people, pets or possessions,
express affection or liking of a peer, show sympathy for others and is aware of the
differences between males and females. Sebastian has difficulty showing a positive
attitude toward school and responding to positively to adult praise, rewards or promise
of rewards. Sebastian is not able to initiate social contact or interactions with familiar
adults, play cooperatively with peers or demonstrate the ability to show and tell.

The Preschool and Kindergarten Behavior Scale was administered to measure


Sebastian‘s social skills and problem behaviors compared to same age peers. On this
measure Sebastian received an overall standard score of 65 on the social skills scale;
which is below age expectations and a standard score of 117 on the problem behavior
scale; which is in the below average age expectations.

Sebastian‘s father reports that Sebastian is sometime withdrawn and seems overly sad
and shows little interest. He also reports that Sebastian cares deeply about others but
can’t “connect” with other children. Bo also reports that Sebastian has sleep problems,
and is timid, fearful and worries a lot.

On the Child Development Inventory (CDI), completed by Bo, Sebastian was more than 2
standard deviations below the norm for his age group.

Needs:
Sebastian needs to develop social skills by using language for social contact and
interactions.

Observations:
Sebastian was observed in his preschool classroom by the early childhood special
education teacher (and evaluator). Sebastian was not aggressive to peers or staff during
the observation. He followed 25 out of 30 of the directions that were given, however
sometime he appeared to not understand. He was never out of place and off task just
once. He engaged in side by side play during play time. When peers entered the play
area Sebastian would leave. He used limited language (1-2 words at a time) with peers
and adults. He watched his peers a lot for clues on what to do next. During the
observation he referred to the picture classroom schedule twice without prompting. He
used words only to ask for help and when answering direct questions from adults. He
had clear articulation.

Recommendations:

Sebastian needs opportunities to practice fine and gross motor tasks, develop self help
skills and needs to be encouraged in a nurturing way to use his communication skills to
interact with others.

Interpretation of Test Results:


A comprehensive evaluation was completed due to address questions regarding
Sebastian‘s delayed gross and motor skills, along with his social and adaptive
development. The purpose of the evaluation was to determine if Sebastian meets
Minnesota eligibility for services under Part B - Section 619 of IDEA (early childhood
special education). In order to qualify for Part B services a child must have a diagnosed
condition with a high probability of resulting in a developmental delay, OR meet criteria
under one of the 14 disability categories, OR show a delay of 1.5 standard deviations or
more below the mean in two or more areas of development. The results of this
evaluation provides a comprehensive overview of Sebastian's skills based on direct
testing, parent and teacher report and interview and observation in two natural
environments (home and school). When determining eligibility, the team must consider
the impact of socioeconomic status, culture, and situational / experiential factors on a
child's developmental status. None of these factors appear relevant for Sebastian. Based
on observation, parent and teacher reports and interviews, and norm referenced testing
using the Battelle Developmental Inventory - 2, Preschool and Kindergarten Behavior
Scales it was determined that Sebastian demonstrates age-appropriate skills in
Communication and Cognitive at this time. Sebastian shows significant concerns in the
areas of Adaptive, Personal-Social and Motor development. Therefore, eligibility for
services under Part B - Section 619 of IDEA is established under the developmental
disability category. See eligibility determination statement below and eligibility checklist
(attached) for further details.

Eligibility Determination:
As noted above, based on the Minnesota Department of Education criteria for children
Sebastian's age Sebastian does qualify for early childhood special education services at
this time under the developmental delay category under Part B – Section-619 of IDEA.

In order to qualify for services under developmental delay children must show delays in
two or more areas of development. Sebastian shows delays in three areas of
development which are adaptive, personal-social and motor development, based on the
results of this evaluation. Sebastian’s delays in adaptive are documented by a score of
78 on the Battelle Developmental Inventory-2 (BDI-2) and by an overall score of 78 on
the BDI-2. His delays in Personal-Social are documented by a score of 77 on the BDI-2
and by a score of 65 on the Preschool and Kindergarten Behavior Scales. His delays in
Gross Motor are documented by a score of 79 on the BDI-2 and by more than 2
standard deviations below the mean in gross motor and more than 1.5 standard
deviations below the mean in fine motor in the Child Development Inventory Profile.
Please also see eligibility checklist attached.

All standardized evaluations were completed by personnel trained in the administration


of such instruments following standardized protocols. All standardized test scores are
corroborated by parent reports and observations in the child’s natural environment.

Tests Administered and Results:

Battelle Developmental Inventory-2


Personal-social 77
Adaptive 78
Communication112
Motor 79
Cognitive 93
Overall 78
Note: Scores reported above that are below 78 may represent a concern.

Preschool and Kindergarten Behavior Scale


Social Skills Standard Score 65
Note: (Scores below 78 may represent a concern)
Problem Behaviors Standard Score 117
Note: (Scores above 122 may represent a concern

Child Development Inventory (CDI)


Areas at chronological age:
Self Help, Letters.
Areas between 1.3 standard deviations below the mean and chronological age:
Expressive Language
Areas between 1.5 and 1.3standard deviations below the mean:
Language Comprehension
Areas between 2.0 and 1.5 standard deviations below the mean:
Fine Motor, Numbers
Areas 2.0 or more standards deviations below the mean:
Social, Gross Motor, General Development

Documented Observations See discussion.

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