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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 |
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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 Child increasingly develops strategies for regulating feelings and behavior, becoming less reliant on adult guidance over time |
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6. Engagement and Persistence Child increasingly persists in understanding or mastering activities, even if they are challenging or difficult |
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7. Shared Use of Space and Materials |
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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 |
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4. Relationships and Social Interactions with Peers |
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5. Symbolic and Sociodramatic Play |
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Language and Literacy Development (LLD) |
1. Understanding of Language (Receptive) |
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2. Responsiveness to Language |
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3. Communication and Use of Language (Expressive) |
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4. Reciprocal Communication and Conversation |
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5. Interest in Literacy Child shows interest in books, songs, rhymes, stories, and other literacy activities in increasingly complex ways |
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6. Comprehension of Age-Appropriate Text Child develops capacity to understand details and ideas from age-appropriate text presented by adults |
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7. Concepts About Print Child shows an increasing understanding of the conventions and physical organization of print material and that print carries meaning |
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8. Phonological Awareness Child shows increasing awareness of the sounds (elements) that make up language, including the ability to manipulate them in language |
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9. Letter and Word Knowledge Child shows increasing awareness of letters in the environment and their relationship to sound, including understanding that letters make up words |
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10. Emergent Writing |
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English-Language Development (ELD) |
1. Comprehension of English (Receptive English) |
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2. Self-Expression in English (Expressive English) |
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3. Understanding and Response to English Literacy Activities |
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4. Symbol, Letter, and Print Knowledge in English |
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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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4. Number Sense of Math Operations |
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5. Measurement |
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6. Patterning |
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7. Shapes |
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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 |
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9. Active Physical Play |
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10. Nutrition |