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Child’s name:________________________
Assessment period:________________________
Family Member:________________________
Date of Conversation:________/________/________
Measures on the |
If confident with existing documentation (including your and other’s observations) indicate a rating |
If more information/documentation is needed to complete the measure: |
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List family and child routines/activities that are likely opportunities for observing skills related to the measure |
Indicate which of these routines/activities you want to observe |
List questions or prompts to ask the family or other providers about these routines/activities |
Notes from conversation |
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Approaches to Learning–Self-Regulation (ATL-REG) |
1. Attention Maintenance Child develops the capacity to pay attention to people, things, or the environment when interacting with others or exploring play materials |
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2. Self-Comforting |
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3. Imitation |
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4. Curiosity and Initiative in Learning |
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5. Self-Control of Feelings and Behavior |
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Social and Emotional Development (SED) |
1. Identity of Self in Relation to Others |
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2. Social and Emotional Understanding |
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3. Relationships and Social Interactions with Familiar Adults Child develops close relationships with one or more familiar adults (including family members) and interacts in an increasingly competent and cooperative manner with familiar adults |
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4. Relationships and Social Interactions with Peers Child becomes increasingly competent and cooperative in interactions with peers and develops friendships with several peers |
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5. Symbolic and Sociodramatic Play |
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Language and Literacy Development (LLD) |
1. Understanding of Language (Receptive) Child understands increasingly complex communication and language |
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2. Responsiveness to Language |
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3. Communication and Use of Language (Expressive) Child’s communication develops from nonverbal communication to using language with increasingly complex words and sentences |
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4. Reciprocal Communication and Conversation Child engages in back-and-forth communication that develops into increasingly extended conversations |
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5. Interest in Literacy |
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Cognition, Including Math and Science (COG) |
1. Spatial Relationships |
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2. Classification |
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3. Number Sense of Quantity |
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8. Cause and Effect |
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9. Inquiry Through Observation and Investigation Child observes, explores, and investigates objects (living and nonliving things) and events in the environment and becomes increasingly sophisticated in pursuing knowledge about them |
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11. Knowledge of the Natural World |
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Physical Development–Health (PD-HLTH) |
1. Perceptual-Motor Skills and Movement Concepts Child moves body and interacts with the environment, demonstrating increasing awareness of own physical effort, body awareness, spatial awareness, and directional awareness |
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2. Gross Locomotor Movement Skills |
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3. Gross Motor Manipulative Skills |
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4. Fine Motor Manipulative Skills Child demonstrates increasing precision, strength, coordination, and efficiency when using muscles of the hand for play and functional tasks |
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5. Safety |
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6. Personal Care Routines: Hygiene |
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7. Personal Care Routines: Feeding |
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8. Personal Care Routines: Dressing |