 Childhood
Disabilities: Early
Identification and Intervention
INITIAL ASSESSMENT DESCRIPTION AND OBSERVATION OF CHILD
- CHILD'S NAME:
- DATE:
- PARENT(S) REPORTING:
I. Child's Capacity to Regulate Routine Sensations:
1 = Over reactive 2 = Typical 3 = Under reactive
(circle rating)
1. Sensitivity to Sound
- 1 2 3 Soft Sound
- 1 2 3 Loud Sounds
- 1 2 3 Motorized Sounds
2. Sensitivity to Touch
- 1 2 3 Light Touch
- 1 2 3 Soothing Touch
- 1 2 3 Painful Touch
3. Sensitivity to Visual Stimuli
- 1 2 3 Far away
- 1 2 3 Close up
- 1 2 3 Bright
4. Sensitivity of Movement
- 1 2 3 Fast-Intrusive
- 1 2 3 Normal-Assertive
- 1 2 3 Slow-Cautious
5. Sensitivity to Smell
- 1 2 3 Sweet Smell
- 1 2 3 Acrid (sour) Smell
6. Sensitivity to Taste
- 1 2 3 Sweet Taste
- 1 2 3 Sour Taste
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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