Assessment Report: Alexander Jackson

By: Chelsea Smaellie

10/18/15

Demographics
Name: Alexander Jackson
School/Grade: Preschool at Kidz Corner and Jefferson School District
Date of Birth: 2/10/2012 (Made up by Nevada)
Age: 3 years 7 months
Date of Evaluation: September-October 2015
Family: Jamie (dad), Sherrie (mom), Brandon (brother), Nick (brother), Ashley (sister), Jocelyn
(sister), Krissy (sister), Sabrina (sister), Austin (brother), Andrew (brother), Nathan (brother),
Alex, Caleb (brother).
Examiners: Brittany Sullivan and Chelsea Smaellie
Report writer: Chelsea Smaellie
Reason for Referral
Alexanders parents Sherrie and Jamie Jackson have referred him because of their concerns in
areas of speech/language as well as adaptive self-help and safety. Alex is three years old and
struggles communicating his needs and emotions.
Background
Developmental History
The birth history of Alex is unknown because he was dropped off at a Safe Haven location in Las
Vegas when we was 20 days old with no paperwork by his mother. Safe Haven suspected that he
was from Mandarin decent because that is the only language that his mother spoke. The hospital
suspected that his birth was normal and that the mother was struggling to feed him. Alex was
taken to a foster home until the age of three months. Alex did not receive the diagnosis of Downs
Syndrome until the age of 3 months old. The foster family could not take care of him so he went
back into state custody. His case worker knew of Sherrie and her family and so they called her to
take Alex into her home. He has been with the Jackson family ever since that time.
Alex has reached only some of his milestones as a three year old. He is mostly at the
developmental level of an 18 mo. old. He is working with his speech therapist to build the
muscle strength in his mouth. He goes to speech three times a week and occupational therapy
Family Information and Social/Emotional History
Alex was adopted by the Jackson family at the age of three months. His family consists of two
biological children from the parents and different sets of siblings that have also been adopted. He
has a warm and inviting home where his parents are very involved in every part of his life. His
father works and his mother stays home with the children. He is very close to his 18 month old
brother.
Medical
At the age of three months Alex was diagnosed with Downs Syndrome. He also has a visual
impairment and wears glasses at school. Alex has allergies and reactive airway disorder that

requires him to take the following medications: Singular, Zyrtec, and Flonase. In 2015 Alex was
hospitalized because he got a virus that required him to be put on oxygen. He has had
complications with his tonsil and adenoids that required hospitalizations. When he gets sick his
airway closes and his recovery is slower than most children.
Educational History
Since Alex is three years old his education has not been very extensive. He currently attends
preschool at Kidz Corner and another preschool at an elementary. The teachers in the preschool
are trying to work on peer interaction with Alex. There are some times when he wants to hug and
kiss the children because he is affectionate. They are also currently working with Alex to hold a
pencil or crayon properly.
Observations
General Observation
During our first visit to Alexs house he was a little shy and wanted his mom to hold him. His
mother got out some toys and his sensory table that is filled with beans and scoops. At first he
did not want to play with anything and threw a small tantrum. After a couple minutes he warmed
up a little bit and started playing. He was scooping the beans and mixing them around. He took
the lid of the sensory table and set it on the ground. He poured beans out of the sensory table and
onto the lid. He then would lift the lid and dump the beans back into the sensory table. Some
would spill onto the carpet. I said wow Alex you are so smart and he gave me a big grin on his
face. After that he continued pouring beans out and back into the table. He continued to spill
more onto the carpet as he played and would laugh as they fell. He would look to the adults in
the room to see if he could get a reaction from us.
Home Observation
With our most recent visit at Alexs home he was interested in playing with bubbles. His mother
helped him go outside on the patio. He came outside and sat down on the table. He pointed to the
bubbles so that Brittney would open them. When Brittney opened them she started blowing the
bubbles toward Alex. At first Alex was excited to try and grab the bubbles but then he made a sad
face when they popped on his eyebrow. Then he signed that he was finished with the bubbles. We
continued to urge him to pop the bubbles and blow them. After a minute or so he pointed to the
bubbles again. He tried to open the lid by twisting it. His mother said that he had never attempted
to open or close the lid of anything before. He continued to try and turn it with the help of
Brittney. He held the bubble wand up to his lips to practice blowing. He was not successful in
blowing any bubbles but he tried at least five times.
Trial Intervention
Target: Alex will put his hand up to show the sign stop after running across the patio.

Engage: Alex likes to run and race with his siblings. We will play a game similar to Red Light,
Green Light to engage him and cater to his interests.
Prompts: I did a physical prompt by holding Alexs hand to take him to the beginning spot where
he was going to race. I did a verbal prompt by saying on your mark, get set, go. Both Brittany
and I did a verbal prompt by saying run, run, run. I modeled the skill of running by standing
next to Alex and running with him. When Alex got to the end, Brittany was kneeling down and
both of us said Stop at the same time while holding our hands up to model the sign.
He was grumpy before we started trial intervention and his sister gave him a package of fruit
snacks. We decided that once he reached Brittany then he could have a fruit snack.
Responses: The first time that we ran to Brittany he took a couple seconds to run but then he
followed me. Once we reached Brittany he stopped and smiled. He did not put his hand up
signaling stop. He ate a fruit snack given by Brittany. I grabbed a hold of his hand and we
walked back to the beginning of the runway. On the second try he started running sooner after
I said ready, set, go. When he reached Brittany he imitated us by putting both hands up to
signal stop. Then he ate a fruit snack. On the third try Alex started running quicker than the two
previous attempts. When he reached Brittney he put one hand up signifying stop. He continued
to sign stop for two more attempts.
Interview:
RBI:
The parents were concerned with Alexs delays in communication and understanding dangers.
They also ultimately want Alex defend himself and express himself so he doesnt get hurt and
can communicate with his peers, since he is nonverbal right now.
The Jackson family is religious and has varies of church activities. This provides friends for
them, which means help occasionally. They also have community help for resources for a few of
their children. Some services are physical therapy, occupational therapy, speech, and school
services.
Alex wakes up around 6-6:30 along with the other younger children. The rest of the family is
waking up and getting ready for the day. After waking up, the family participates in family
scripture study. Mom explained that the family is normally good about it, and Alex is the Prayer
Nazi. He makes sure every morning there is a family prayer before scripture study. The family
reads a few verses and then eats breakfast.
During breakfast the family talks and eats. When they are finished, they put their dishes away.
They have to keep an eye out for Alex, because he will sign that he is done. A few seconds later,
he will smash his food or flip over his bowl or plate on the table, mom explained.
After breakfast everyone brushes their teeth. Older siblings and parents help the younger ones
when needed. Then the older children get everything together to catch the bus to school. Mom
said, After Alex watches his brothers and sisters get on the bus, he will sometimes grabs his
backpack, because he wants to get on the bus too.

Then around 8:15, Katie (HR from Kidz Corner) takes Alex to school. He is in school from 8:1511:30 on Monday, Wednesday, and Friday at Kidz Corner. On Tuesday and Thursday, he goes to
the public school. Alex sits well in class, but gets upset when his seat is changed or if someone
else is in his seat. He also doesnt interact with other peers and is very independent. He also gets
physical therapy, speech, and occupational therapy in school. His mom is at home with an 18
month old boy.
Then when he comes home, he eats lunch. They watch speech videos together. Again, Alex has
to be watched so he doesnt dump the leftover food he has on the table. Mom, Nathan, Caleb,
and Alex eat together at the table. Mom and Nathan help clean up afterward. Mom looks through
Alexs backpack for school work
Then they all take a nap. Mom will read them a story. They nap anywhere from 1-3 hours. They
go into separate rooms. Sometimes they wake up early for speech on Monday and Tuesday.
When they wake up, normally the older children are home, and they will eat a snack together.
Then they go outside to play until dinnertime. Alex and Caleb play a lot together. Alex normally
doesnt want to leave, so he is carried inside. They play games, jump on the trampoline, swing,
and, play on the teeter totter. During this time, mom is making dinner.
During dinner time Alex will dump his food out of the plate or bowl and then he will smash it.
Sometimes he will eat really fast or really slow depending on when his siblings finish their food.
He didnt eat solid food until he was about 2 years old. At one year he would eat baby cereal and
at 18 months he started eating baby food. Some textures of food he wont eat. His mother says
that the food needs to be simple. He recently has learned how to drink from an open cup.
After dinner time the children in the family will get to play a little longer until bedtime. Around
7pm it will be time for Alex to take his bath. He loves his bath time! He is able to turn the water
on without assistance if there was nobody there to supervise him. He likes to dump water out of
the bathtub. He is able to climb out of the bath by himself and grab a towel as well.
After bath time it is story time. He doesnt like when the stories end because that means he has to
go to sleep. He usually gets mad when it is time to sleep. Bedtime is between 7:30 and 8:00pm.

Tests Administered

Battelle
BDI

Date Administered: 9/30/2015, 10/07/2015

Raw Score
Scaled Score
Adaptive
Self-Care
34
1
Personal
4
2
Responsibility

Percentile Rank
0.3
<1
<1

Personal-Social
Adult Interaction
Peer Interaction
Self-Concept and
Social Role
Communication
Receptive
Communication
Expressive
Communication
Motor
Gross Motor
Fine Motor
Perceptual Motor
Cognitive
Attention and Memory
Reasoning and
Academic Skills
Perception and
Concepts
Total

38
12
30

3
2
2

1
1
<1
<1

15

0.1
<1

25

<1

64
29
11
28
12

4
2
2
1
5

0.5
2
<1
<1
0.4
<1
5

17

<1

0.1

Vineland II: Date Administered 10/16/15

Vineland-II
Communicatio
n
Receptive
Expressive
Written
Daily living
skills
Personal
Domestic
Community
Socialization
Interpersonal
Relationships
Play and Leisure
Tine

Raw
Score

V-Scaled
Score

23

11
15
0

6
7
10

28

20
4
4

8
11
9
28

20

13

90%
Domain
Conf. Standard
Interval
Score
7
54

Percentile
Rank

Age
Equivalent

0.1

2
1
3
8

64

2
3
2
6
2

68
-

1:0
1:3
1:10

1:9
1:10
1:6
0:7
1:2

Coping Skills
Motor Skills
Gross
Fine
TOTAL TEST

10

48
24

11
19
10
9

2
8
2
2
5

67
61

0.5

2:1
1:9
2:1

Interpretations
Communication
Alex is in the low average in the communication domain. He has been non-verbal until recently.
He is able to consistently say the words up and hi and recently started saying da to signify
dad. In the Battelle assessment he is in the <1 percentile for both his receptive and his expressive
communication. In the Vineland assessment his standard score was 54 with a percentile rank of
0.1. This is low compared to other children his age.
Alex can consistently:

Sign multiple words including help, finished and more.

Make sounds or gestures to get the parent or caregivers attention.
Say one word requests such as up or hi

Alex can partially or sometimes:

Say da when he wants dad.

Answers or tries to answer with babbles/signs when asked a question.
Sign colors red and blue.

Alex does not yet:

Repeat or try to repeat common words immediately upon hearing them.

Name at least three objects.
Say the names or nicknames of brothers and sisters.

Social and Emotional

In the social and emotional area Alex is in the 2 percentile based off the Vineland assessment.
His adult interaction is greater than his peer action which we see from the Battelle assessment.
From observations Alex has shown that he will initiate hugs and waving to individuals in his
home. The first time we visited he wasnt really social with us as he was trying to get to know us.
In the later visits Alex would come give us hugs and wave goodbye.
Alex can consistently:

Give hugs
Smile at people he recognizes
Shows more than two emotions.

Alex can partially or sometimes:

Look at the person talking to him

Show preference for certain people or objects.
Imitate or try to imitate facial expressions of caregivers.

Alex does not yet:

Stand up for himself when someone takes advantage of him.

Show a desire to please others.
Shows interest in children the same age other than brothers and sisters.

Self-Help Skills
Alex has recently started learning many new self-help skills in the little time that we have been
able to assess and observe him. In the BDI-2 assessment we find that he is in the 0.3 percentile
for his adaptive skills. He cannot yet urinate or defecate in the toilet or get himself dressed. Alex
is able to drink from a cup with occasional spilling and eat with a fork or spoon. While we were
in his home, Alex was observed as being able to get himself out of the bathtub and grab a towel
to dry himself off with. In the Vineland II Alex was scored in the 1 percentile for the Daily living
skills section where he scored the highest in his personal skills in comparison to his community
and domestic skills.
Alex can consistently:

Drink from an open cup with occasional spilling.

Eat with a fork
Suck from a straw

Alex can partially or sometimes:

Drink from an open cup without spilling.

Remove either his shirt or his pants when undressing.
Let someone know when he is wet or soiled.

Alex does not yet:

Motor

Get himself dressed.

Urinate or defecate in the toilet.
Puts on clothing with a button or zipper.

Alex is in the low range of his motor development. He is in the 1 percentile with a v-scaled score
of 19. Alex can consistently walk, run, and throw a ball. He is active and plays with his siblings
learning new things every day. He was observed to be able to pick up a small shovel and shovel
small amounts of dirt into a specific area. Alex cannot go down stairs while walking but chooses
to slide backwards on his stomach. Alex can at times complete simple puzzles and pick up small
objects such as beans and playdough. Alex cannot yet open the door by turning the doorknob or
turn the pages in a book when he is being read to. Alex has been observed swinging on the swing
set on his stomach while pushing with both feet to create the swing.

Alex can consistently:

Throw a ball.
Run smoothly without falling.
Unwrap small objects such as candy or gum.

Alex can partially or sometimes:

Go down stairs while sliding on his stomach.

Complete simple puzzles of at least two pieces or shapes.
Pick up small objects with thumb and fingers.

Alex does not yet:

Walk down stairs using both feet on each step.

Open doors by turning doorknobs.
Turn book or magazine pages one by one.

Cognitive
Alex is in the below average range according to the BDI-2 for the cognitive domain. Alex
demonstrated his cause and effect skills when he poured the beans from the sensory table onto
the carpet. He tried dropping them on the floor and pouring them out of a cup. During the
Battelle Development Inventory, I asked for a block and Alex picked up the block, dropped it in
the box, all while looking at me and laughing. Alex performed this same skill about four times.
He continued to laugh and seek the attention of the adults in the room. Due to Alexs cognitive
delays he has a hard time occupying himself for 10 minutes without seeking attention. He will
have a difficult time in a classroom or other setting that requires his attention span to go for
longer amounts of time.
Alex can consistently:

Imitate correct behavior from siblings and parents.

Follow one step directions.
Find hidden objects behind the back of an individual.

Alex can partially or sometimes:

Place shapes in the correct shape sorter.

Occupy himself for five minutes.
Signs words for colors.

Alex does not yet:

Occupy himself for ten or more minutes without seeking attention from the caregiver.
Points to pictures in a story when he is being read to.
Match colors with objects.

Implications
From observations and assessments we find that Alex is low in many of his developmental areas
specifically in his receptive and expressive communication and his adaptive self-help skills.
Based on the age equivalents of each domain Alex is around the developmental age equivalent of
a 20 month old. Since he is diagnosed with Downs syndrome this age equivalent of development
is common in other children with Downs Syndrome as well. From the information attained in
BDI-2 as well as the Vineland we have reason to be concerned for the development of Alex in
multiple domains. His gross and fine motor skills seem to be coming more easily with activities
and the implementation of intervention by his parents. Alexs speech and language delays are
going to need some intensive therapies and interventions.

Recommendations
For the Professionals:

Continue to offer intensive speech and language therapy to increase his vocabulary.
Continue to teach Alex new signs and implement them with parents and siblings.
Offer Occupational therapy to teach Alex more adaptive skills.

For the Parents:

Take every opportunity to communicate with Alex and have him practice signs and
words.
Stay in good communication with his therapists to implement the new interventions in the
home.
Practice adaptive self-help skills with Alex at every opportunity. Allow him to try things
on his own even if he fails.

For the Classroom:

Integrate social activities that interest Alex so he can be enticed to participate with his
peers.
Continually invite Alex to sit, sign, and talk with his peers.

Model and prompt Alex to stay in activities for longer periods of time.

Summary
Alex is a 3 year 8 month old boy who is showing delays and he been previously diagnosed with
Downs Syndrome. He has a large loving and supporting family that is continually guiding him to
improve his skills. Alex can say the words up, hi, and dad. Other than those words he can
sign multiple signs including help, more, cracker, and finished. From observations,
interviews, and assessments, we have found that Alex is in the low range for most all of the
developmental domains including communication and adaptive. His gross motor and his
cognitive areas are in the below average area. He is constantly learning new adaptive skills such
as drinking from an open cup and unscrewing a bubble lid. His mother and father are most
concerned with his ability to communicate and keep himself safe. We recommend speech,
occupational, and physical therapies. Alex is eligible for preschool services based on the data that
has been found.

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