ECS 476

Spring 2019
Transdisciplinary Play Based Assessment-2 Comprehensive Report

Child’s Name: Kassandra Mathews

Date of Birth: 1/5/2002

Date of Assessment: 10/20/2006

Age at Evaluation: 4 years, 9 months, 15 days

Parent’s Names: Karen and Wade Matthews

Team Members: Carson Hope, Haley Chase, Jessica Howe, Caitlin Raye

Reasons for Referral: Kassandra shows developmental delay and a severe health condition.

Social History: Kassandra attends preschool. She also interacts with her brother Jonathan who
is 7 years old. The parent questionnaire indicates that she mostly only plays with her brother.
She is often fussy and irritable.

Health and Developmental History: Kassandra has a genetic diagnosis that was brought to
attention at birth. Her family history shows a wide array of health issues. She was diagnosed
with cardio-facio-cutaneous syndrome as well as other various health issues that affect her
kidneys and heart in particular. She is already receiving OT and speech services including a
feeding program. She was born at 7 pounds, but her weight dropped down to 4. She was one
month premature. She spent 2 months in the NICU. She has a feeding tube as well as a heart
monitor. She failed a vision and a hearing exam. Her vision is still being evaluated. She has
food and environmental allergies and has poor reactions to sunlight. Kassandra also has
seizures.

Medication Summary: phenobarbitol, metaclopramide, amantadine, nitrofurantoin

Questions to Address per the Parents: “Are there things I can do at home to help her walk and
talk?” “How can we encourage her to eat more real food?”

Assessment Method and Domains Addressed: Transdisciplinary Play Based Assessment 2;

Behavior During Testing: Kassandra was patient for a lot of the assessment and was pleasant to
the assessor. She was reluctant to do some activities (ex. Art, feeding) while she enjoyed
others (ex. Marble track, dolls). She seemed to enjoy the presence of the adults but especially
enjoyed being with Mom.
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Developmental Observations
Sensorimotor:
Functions underlying movement:
Kassandra demonstrates core strength in the sitting position, as her hands are
free for play and her head is held up. She began sitting independently at 2 years
old. However, she sits in a position one leg folded in and one leg turned out that
may put strain on the hips. She pulls herself to stand with the support of a
strong surface (ie. bookshelf) or with the hand of an adult. She walks well while
pushing a chair or other object, so using a walker may be beneficial for her as a
tool to stand and walk. When walking, her right leg appears to be rigid/stiff, and
walking seems was led by the left leg.
Gross motor activity:
As previously mentioned, Kassandra has a seated play position that she
demonstrates frequently the leaves her hands free for play. She turns around on
her bottom in this seat position, and ‘scoots’ across the floor by using her right
hand on the floor and propelling herself forward with her left leg. She seems to
prefer to play in this seated position, and a goal for her may be working on
finding other comfortable play positions. Moving in a less physically demanding
and more effective way may be another goal for Kassandra. Kassandra reaches
across midline with the right hand, but was not observed doing this with her
left. She also demonstrated difficulty with symmetrical activity at the midline
such as clapping. She demonstrates passing objects between hands at the
midline, as shows preference of using her right hand. The parent questionnaire
indicates that she is beginning to move more now, especially to get her wants
and needs met.
Arm and hand use:
Kassandra shows great fine motor skill, particularly in her right hand. She
showed both small (ie. pincer to grasp a marble) and larger grasps with the right
hand. She also demonstrated passing between the right and left hand, but used
the left hand minimally, usually to hold an object stationary while she used her
right hand for a more complex movement or grasp. She attempts to use scissors
but held them on the outer edges rather than putting her fingers in the
designated holes. Several times, Kassandra pushed objects to put them where
she desired to instead of lifting them. She demonstrates accurate release of
objects from a grasps. She points at and taps objects when communicating.
The parent questionnaire indicates that at home she can lift, push, and pull
things that are not heavy.
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Spring 2019
Motor planning and coordination:
Kassandra demonstrated knowing what to do with objects and how to use her
body in the way that worked for her to use them. She shows more difficulty in
planning gross motor movements. She demonstrates being able to use support
or a surface to stand and attempt to walk. She sat on the riding toy well but did
not use her legs and feet to push the scooter. She moves through the classroom,
but does best doing so in a large, open space. When asked to try movements
with her left hand, she continued to use her right, but continued to complete the
actions effectively.
Modulation of sensation and its relationship to emotion, activity level, and attention:
Kassandra seemed focused on some of the activities she was doing such as
experimenting with the marble track and playing with dolls. At other times, she
was distracted, and this seemed to be by other people in the room. She also
seemed to have strong interests about what activities she did or did not want to
partake in. She showed joy when music was played and did not seem
overwhelmed by the noise.
The parent questionnaire indicates she doesn’t like toys with textures or that
have a smell (or taste if she puts them in her mouth) but enjoys toys that make
noise.
Sensorimotor contributions to daily life and self-care:
Kassandra’s sensorimotor contributions to adaptive skills will require further
assessment. Kassandra has a g-tube, so she does not have much experience with
feeding, but her mother and teacher are working with her to begin finger feeding
with snacks. She was able to grasp marshmallows with her right hand and bring
them to her mouth, however she did not put the marshmallow in her mouth.
She was not observed attempting dressing.
From her parent questionnaire daily routines rating form, feeding appears to be
a very stressful and difficult time as she is attempting to move to eating food for
the first time rather than using a feeding tube. She attempts to help with
dressing but exhibits some difficulties. She does help raise her arms and legs to
dress. The parent questionnaire indicates that she does not do any self-care
tasks independently.
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Spring 2019
Emotional and Social:
Emotional expression:
Kassandra has a range of emotions that she can show through her facial
expressions and body language. The emotions observed were happiness,
frustration, caution, and pride. Kassandra did not verbalize her emotions nor did
she vocalize anything that would point to her feeling the way she did. Kassandra
interacts with a wide variety of things that bring her pleasure. Babies are
something Kassandra seemed to have joy from playing with and a great
opportunity for other children and adults to facilitate learning and play
opportunities with Kassandra.
Emotional style/adaptability:
Kassandra adapted nicely to the different stimuli within her classroom and
showed minimal attention to the amount of other people within the room.
Kassandra did continue to look back for her mother on multiple occasions to see
if she was still within eyesight. It was stated that sometimes Kassandra has
difficulty adapting to certain stimuli especially after seizures. The adaptability
between different activities ranges on what the activity is and how preferred the
activity. All transitions were made easily within the play session. The only
unengaged behavior that was seen was during snack time. Kassandra seemed to
easily transition between her play choices and the speech pathologists play
choices within the play session and seemed happy within the play choices as
well.
Regulation of emotions and arousal states:
Kassandra understood when she became frustrated especially with the shape
sorting lid being stuck. She handed the sorter to her speech pathologist and
immediately started to calm her frustration. When it was handed back to her she
continued to look for the shape spaces for the shapes in her hands. Within the
parent report it was stated that Kassandra has a difficult time moving from
calming to arousing activities such as sleeping to waking up and it was stated
that she needed time to warm up. Within the play session she did move between
calming activities such as puzzles and playing to other activities such as songs
and dancing as well as the swing. Kassandra did have a difficult time staying at
one activity for a long period of time and would move from one to another
quickly regardless of when the teacher chose or Kassandra chose. Kassandra
seemed very predominantly happy and content within the play choices that were
made.
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Spring 2019
Behavioral regulation:
Kassandra did not demonstrate behavioral regulation skills during the
observation. Kassandra’s mother did state that Kassandra does need time to
warm up to activities as well as becoming angry and frustrated when certain
schedule shifts occur and when Kassandra’s “blanky” is taken away. The
episodes were estimated to last 15 to 20 minutes depending on the situation and
could become longer if a seizure occured. Within the play session Kassandra
seemed very happy throughout and compliant with adult requests for activity
shifts as well as within the dramatic play feeding session allowing the speech
pathologist to ask Kassandra to feed the babies because they were hungry.
Sense of self:
Kassandra did comply and tolerate a range of activities regardless of if the
speech pathologist chose them or Kassandra’s mother chose, or Kassandra
herself chose the activity. Kassandra correctly labeled her knee and started to
label her speech pathologist’s knee as well using the speech pathologist’s name.
Kassandra is very persistent within reaching her goal especially when the ball
rolled away and then kept bouncing on her knees and rolling away. She
continued to try and reach for it without giving up and showed pride in her
accomplishments when she finally received the ball. This was seen again when
Kassandra was putting the tool puzzle together for her mom. She put the ruler
piece in and looked at her mom with a large smile upon her face and waited for
her mother to reply to her accomplishment.
Emotional themes in play:
Kassandra seemed to have logical patterns throughout her play. She did move
from activity to activity rather quickly however stayed within a range of activities
that seemed interconnected. For example Kassandra was putting together a
puzzle of different tools. When she had finished the puzzle she moved onto a
shape sorter box. After the shape sorter Kassandra was handed a stack of “O”
shapes that were to be placed on a stand in order of largest to smallest.
Kassandra stacked the “O”’s and then moved onto using grid shaped blocks to
construct different things out of. All of these toys have to do with puzzling or
fine motor manipulation into the designated areas. The puzzle has set cut outs,
a shape sorter, rings that have a set order, and grid blocks interconnect like
fingers. When playing with baby dolls Kassandra showed compassion, love, and
nurturing when she was told the babies were hungry and she fed them as well as
holding the babies.
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Spring 2019
Social interactions:
Within the play session we saw a good amount of Kassandra’s relationship with
her mother and their attachment. Kassandra looks for her mother’s approval,
likes when her mother is around and seems cautious when her mother is not
within eyesight during the play session. As for social interaction with peers
Kassandra does not interact with peers in an engaging and cooperative way. The
peer play was another child handing Kassandra the correct “O” shapes to place
on the stand. There were minimal verbalizations from Kassandra which was
opposite from what was seen during the play session with the speech
pathologist. Kassandra did not seem to engage with the other child or pick up
on the emotions of the other child. Kassandra also did not show any pride of her
accomplishments of placing the “O” shapes on the stand.

Communication:
Language comprehension:
Kassandra’s ability to understand language seemed to vary. Kassandra seems to
have the ability to understand some verbal language. When people were talking
at her and asking her questions, an example being “can you feed the baby a
bottle?”, Kassandra seemed to understand what was being asked of her and was
able to demonstrate the action. When asked a question, such as if she was
interested in her snack, in which she was expected to respond, Kassandra
showed little interest and more often than not did not respond. With answering
questions, Kassandra does not yet have the verbal communication skills to reply.
Kassandra showed that she was able to recognize sounds and words and was
able to respond with appropriate gestures or facial expressions.
Language production:
Kassandra showed that she was the able to produce many sounds and some
words. Though Kassandra seems to babble a lot, she used her babbles with
intent. When babbling, Kassandra was usually pointing to an object or looking
at the facilitator or her mother. Kassandra also showed intent with her words
during the play session. Kassandra used the word mommy when seeing her
mother sitting off in the distance and used it later in the play session as a way to
get her mother’s attention and approval. Kassandra demonstrated that she has a
lot to say and was able to use both understandable words along with her babbles
to communicate her thoughts. Through observation and parent report, we found
that along with using some words and babbles, Kassandra is also able to
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Spring 2019
communicate through gestures. Kassandra showed that she is able to point to
and go towards objects that she wants or sees off in the distance.
Pragmatics:
Kassandra showed the ability to play with others and engage in joint attention.
Though Kassandra seemed to be pretty independent while playing, she
demonstrated the ability to play with others and produce communication
through the play. While communication exchanges between the facilitator and
Kassandra were limited, Kassandra showed the ability to pair her gestures with
her vocalizations and that she had intent and reasoning behind her babbling.
During the session, Kassandra demonstrated the ability to request for more
during play and the ability to imitate words or sounds being used by the
facilitator and her mother.
Articulation and phonology:
During the play session, Kassandra demonstrated her ability to produce the
sounds g, m, b, and d. Along with producing some consonant sounds. Kassandra
also demonstrated her ability to produce vowel sounds, this was done when
singing the song “Old McDonald Had a Farm.”
Voice and fluency:
Kassandra showed the ability to produce sounds and language that would be
almost typical when thinking about her pitch and volume. When using the few
words that she knows, Kassandra showed the ability to speak and be
understood, while her babbles were not understandable.
Oral mechanism:
Kassandra showed little oral motor control during the play session when sitting
at the table trying to engage in snack time. Kassandra was able to stick her
tongue out of her mouth but showed little ability to move her tongue side to
side or up and down. Kassandra did however show the ability to click her mouth
to produce sound and was able to create bubbles within her mouth.

Cognitive:
Attention:
Kassandra showed that she was able to respond to her name when someone said
it allowed. She also showed us that she would shift attention to a loud noise or
voice. When she was focused it was very attentive. Her attention did not last for
long periods of time. Kassandra also showed interest in people over objects. She
liked to show people the objects that she had rather than play with the
individual toy and explore it. She was also more likely to respond to prompting,
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Spring 2019
questions or general language when it was coming from mom. Mom noted in
her questionnaire that Kassandra also does not attend long at home except with
her shape sorter. This was also demonstrated in the classroom and we believe
this is because she has shown a high interest in problem solving and shows
strength in the area.
Memory:
When Kassandra was presented with the baby doll and worked to label the body
parts, she showed us her strong knowledge in that area. She also showed us that
her recall skills are present with this and her ability to recall a known song when
the teacher began to sing. When presented with the shape sorter, she was very
drawn to this and worked hard to place all the shapes in. Her interest in it made
it easy to conclude that she was drawn to it because of her memory of a similar
toy at home. Kassandra did not show that her processing time was where it was
developmentally expected to be.
Problem solving:
Kassandra showed an interest in problem solving. When given the puzzles she
was able to complete them very quickly and only showed some distress when
having to try again. Kassandra showed she was determined. We also noted her
ability to request a tissue after sneezing. We noted this because it was an
immediate and appropriate request for the situation. She did not use verbal
request or sign for this but looked to the closest person and referenced to her
nose. She also showed that she was able to problem solve how to communicate
to everyone else when she could not say the word and did not have the sign to
use. She showed us that she was able to ask by signing “more” when she wanted
to do more of an activity.
Social cognition:
Kassandra looked often for mom's approval and whereabouts. She did not seem
upset when mom left the room but noticed immediately and repeated her name
until it was explained where mom was. She smile at the speech-pathologist
when things made her sad. When we were able to see some of her peer time, she
was very quiet and much less animated. She showed that she did not have an
understanding of how to play with the peers and interact with them. She also
showed frustration when her peer took things from her hands or removed toys
to fix them to how they should be.
Complexity of play:
Although Kassandra’s showed more interest in interacting with adults, her
interest in play was very insightful. We observed her pretend to talk on the
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Spring 2019
phone. She responded to this with communication sounds and showed that she
was able to understand the use of the phone. She demonstrated this by placing
to the phone to her ear and pretending to talk. She did not stay with one area of
play for long but showed that she liked to explore many things and asked for
more play of what she did enjoy. When playing with a stacking toy, she showed
us her understanding that when you get all of the pieces back on that she was
done and it was something to be proud of. Once they were all on the inner tube,
she clapped and looked for adult response. She did not show an interest and
making sure they were on in correct size order and was satisfied knowing all of
them made it onto the center piece.
Conceptual knowledge:
Kassandra’s mom informed us that she had a similar shape sorting toy at home.
When watching her play with this toy, she was very engaged and we determined
that although they did not look exactly the same, Kassandra was able to
conceptualize what the toys purpose was based on its similarities such as
appropriate play with dolls and puzzles.
Literacy:
We did not get to see this in our assessment however the family reported that
Kassandra enjoys looking at pictures and labeling them in books. We did get to
see Kassandra recall on a word that she heard. During snack, the speech
pathologist said the word caterpillar and she responded with the sign for it . We
believe that her listening is best when it comes from mom after observing
interactions between Kassandra and Karen as well as between Kassandra and the
evaluator, but she does not always respond to prompting, questions, or
conversation.
Summary:
Kassandra demonstrates strong emotional strength. This is a great basis for her to have
in developing skills across all other domains. She shows a need for support in
communication, gross motor, social, and cognitive development. Developing skills in
each of these areas will allow her to build more independence in adaptive/self-help
skills. The biggest goals for Kassandra currently are more independent mobility (Mom
hopes she will walk independently), discontinuing use of a feeding tube and eating real
foods independently, and developing more communication skills that will allow her to
build strong peer relationships. Continuing attendance in her preschool classroom will
allow her to develop new cognitive skills.
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Spring 2019
Recommendations:
Sensorimotor:
It is highly recommended that Kassandra begins seeing a physical therapist to develop
independent movement skills. She should continue seeing her occupational therapist to
work on more adaptive skills requiring motor development and adaptations for sensory
input.

Social/Emotional:
It is recommended that Kassandra continues to work within speech therapy as well as
within her preschool classroom to build social skills. Specifically working with peers to
create meaningful cooperative play sessions and allow for children to feel more
comfortable interacting with Kassandra. As well as allow Kassandra to be confident
when interacting with other peers.

Cognitive:
It is recommended to implement more opportunities for Kassandra to demonstrate her
recognition of items around her and short/long term memory. We also would
recommend experiences to expand her attention span in terms of length and
objects/people of interest which will allow her explore and expand her complexity of
play skills as well as social cognition.

Communication:
It is recommended that Kassandra continues attending and receiving speech to help
develop and improve upon her communication skills. Developing her communication
skills with help with developing other skills like cognitive and social. It is also
recommended that Kassandra continues to attend the feeding clinic to work on her
feeding and oral function.