Jen Manthey

Ke-Jui Yen
Assignment 6

Introductions:

Paxton is a 62 month old who attends preschool 4 full days per week at a County Board of

Developmental Disabilities. Paxton was born at 35 weeks gestation due to intrauterine growth

retardation. He was born via C-section and had post-natal complications of hypoglycemia that

resulted in seizure activity. He was also diagnosed with adrenal insufficiency and it was noted

that he had a 2 vessel umbilical cord. Paxton spent 2 weeks in the NICU. Paxton has had

problems with feeding and reflux. He was diagnosed with cerebral palsy and failure to thrive.

He received a g-tube in March of 2014 but continued to have problems tolerating feedings.

Paxton had a fundoplication and j-tube inserted in August of 2016. He receives all his nutrition

by j-tube at a slow rate for 18 hours/day. Paxton is currently on Baclofen for three times per day

via j-tube which he receives one dose while at school. He is on Zantac and Prevacid for reflux

which he takes at home. Paxtons seizures, adrenal insufficiency, and hypoglycemia have

resolved and he no longer takes any medication for these. Paxton lives at home with both

parents and his 3 year old sister.

Assessment Tools:

Battelle Developmental Inventory, 2nd edition:

Comprehensive Developmental Evaluation/Assessment Summary of the

Battelle Developmental Inventory- 2nd Edition
& Recommendations for Program Planning

Childs Name: Paxton

Date of Birth: 2-27-2012 Date of Evaluation: 4-27-2017
Chronological Age: 62 mos.

Evaluation Team: Jen Manthey

Ke-Jui Yen
Primary Language
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of the Home: English

Parent/Guardian Questions/Concerns:
Parents are concerned with Paxtons ability to move independently and communicate his wants and
needs.

Background Information:
Paxton is a 62 month old who attends preschool 4 full days per week at a County Board of Developmental
Disabilities. Paxton was born at 35 weeks gestation due to intrauterine growth retardation. He was born via
C-section and had post-natal complications of hypoglycemia that resulted in seizure activity. He was also
diagnosed with adrenal insufficiency and it was noted that he had a 2 vessel umbilical cord. Paxton spent 2
weeks in the NICU. Paxton has had problems with feeding and reflux. He was diagnosed with cerebral palsy
and failure to thrive. He received a g-tube in March of 2014 but continued to have problems tolerating
feedings. Paxton had a fundoplication and j-tube inserted in August of 2016. He receives all his nutrition by
j-tube at a slow rate for 18 hours/day. Paxton is currently on Baclofen for three times per day via j-tube
which he receives one dose while at school. He is on Zantac and Prevacid for reflux which he takes at home.
Paxtons seizures, adrenal insufficiency, and hypoglycemia have resolved and he no longer takes any
medication for these. Paxton lives at home with both parents and his 3 year old sister.

Description of the Evaluation/Assessment Process:

This assessment was completed using the Battelle Developmental Inventory, 2nd edition which is a norm-
referenced diagnostic tool. The assessment was completed at school with Ke-Jui Yen assessing the adaptive
and personal-social domains. Jen Manthey assessed the domains of Communication, Motor, and Cognitive.
Information was gather using a combination of interview, direct observation, and structured skill assessment.
Both Paxtons teacher and his Mom answered interview questions. Mom was not present for the assessment
but available by phone. Testing was completed with Paxton in his wheelchair with a tray that was fitted so he
could easily reach items provided to him. Additional wait-time was used as an accommodation to give Paxton
additional time to perform structured skill assessments.

Current Skills and Observations:

ADAPTIVE:
Self-Care (independence in eating, toileting, and dressing)
Paxton will hold out an arm or leg to assist with dressing. He can sometimes pull off his shoe
if it is loosened for him. Paxton benefits from additional wait time for him to quiet his body
and move purposefully. Paxton is unable to eat orally due to his diagnosis so many items in
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this category were not applicable to him.

Personal Responsibility (independence in simple chores and tasks)

Paxtons teacher reports that Paxton responds appropriately to instructions given in a small
group and needs minimal guidance to stay on task and complete an activity such as
coloring. Paxtons skills in this area are below what would be expected for his age related to
his inability to move independently.
PERSONAL-SOCIAL:
Adult Interaction (quality and frequency of interactions with parents and other adults)
Paxton separates easily from his parents to his teacher or therapist. He enjoys having his
peers join him in play and follows adult directions such as activating a switch.
Peer interaction (quality and frequency of interactions with other children)
Paxton enjoys being around other children and can play independently in their presence.
Self-Concept and Social Role (self-awareness and feelings)
Paxton responds to his name by smiling and gazing toward the person speaking. He
expresses emotions by smiling, laughing, fussing, or crying.

COMMUNICATION:
Receptive Communication (listening, understanding, and following directions)
Paxton identifies family members by gazing toward them. He will identify common objects
by gazing to the correct choice and attends to other peoples conversations for over 30
seconds. Paxton could use more practice with possessive forms and prepositions.
Expressive Communication (using words and gestures to express wants and needs)
Paxton will vocalize utilizing different tones to express excitement or unhappiness utilizing mostly
vowel sounds. He will occasionally babble spontaneously during play using vowel sounds. Because
Paxton has limited control over his muscles he has difficulty utilizing gestures and moving his lips
and tongue to form consonant sounds. Paxton is beginning to explore adapted equipment to assist
him in communication but needs more practice in this area.
MOTOR:
Gross Motor (large muscle movement such as crawling, walking, and running)
Paxton will move his arms toward an item he wants and can turn his head from side to side
when in the prone position. Paxton scored well below his peers in this area related to his
diagnosis of cerebral palsy. Paxton is beginning to experiment with a motorized wheelchair
but needs more practice in this area.
Fine Motor (small muscle movement such as use of hands and arms)
Paxton can hold an item against his palm with his fingers for short periods of time. He
needs practice bringing his hands to midline. Paxton scored much lower than his peers in
this area related to his diagnosis.
Perceptual Motor (carrying out coordinated tasks like putting objects in containers and
stacking)
Paxton can reach for an object placed in front of him using one hand. He does not yet have
the muscle coordination to pick up or place items intentionally. Paxton scored below his
peers in this area related to his diagnosis.
COGNITIVE:
Attention and Memory (paying attention and remembering information)
Paxton can attend to a story in a small group for over 5 minutes. He is beginning to be less
distracted by his peers when focusing on a task. He can attend to a preferred activity for
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Assignment 6

over 3 minutes. Paxton scored below his peers in this area partially related to his lack of an
effective means to communicate. Testing in the higher ranges of this category require
answering open ended questions.
Reasoning and Academic Skills (thinking and problem solving)
Paxton was able to match colors by gazing toward the correct choice. He enjoys having
age-appropriate books read to him. Paxton will attempt to retrieve a toy that is behind a
barrier. Paxton scored below his peers in this area related to not having the ability to
communicate answers to open-ended questions or the muscle coordination to complete
required tasks.
Perception and Concepts (matching, sorting, comparing, and sequencing)
Paxton will feel and explore items that are within his reach. He demonstrates awareness of
new people and new situations. Paxton scored below his peers in this area related to his
difficulties in communication and muscle coordination.

Results:
The Battelle Developmental Inventory- 2nd Edition is a standardized evaluation/assessment tool
that was used to determine the childs developmental profile. The following chart documents
the results. Each score represents the childs current skill level in that developmental domain.
For three of the domains (Adaptive, Personal-Social, and Cognitive), 100 is considered to be an
average score, and scores below 77.5 meet the cut-off for Early Intervention services. For the
remaining domains (Receptive and Expressive Communication and Gross and Fine Motor), 10
is considered to be an average score, and scores below 5.5 meet the cut-off for Early
Intervention services. The scores are determined by comparing the child with a national norm
group a group of children the same age as the child who come from different regions of the
United States and are from various racial, ethnic, and economic backgrounds.

Domain Area: Cut-Off Score for Childs Meets Eligibility

Eligibility: Standard/Scaled Criteria?
Score:
Adaptive 77.5 55 Yes
Personal-Social 77.5 58 Yes
Receptive Communication 5.5 1 Yes
Expressive Communication 5.5 1 Yes
Gross Motor 5.5 1 Yes
Fine Motor 5.5 1 Yes
Perceptual Motor 5.5 1 Yes
Cognitive 77.5 46 Yes

Eligibility & Summary:

To facilitate continuity of care, please consider sharing the results with the childs primary care
physician as well as any specialist(s) currently involved in the childs medical or developmental
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According to the Battelle Developmental Inventory, 2nd edition, Paxton qualifies for Part B early
intervention services. Paxton would benefit from attending a program with typically developing
peers to motivate him and to model skills. Most of Paxtons scores reflect his difficulty
coordinating his motor movements and his inability to communicate. He would benefit from
additional therapy to address his needs in these areas. Paxton needs opportunities to explore
adaptive equipment to support his communication and motor needs.

It has been a pleasure working with your child and family. If there are any questions
regarding this report, please contact the Evaluation Team at (330) 678-2400.

Ke-Jui Yen Jen Manthey

AEPS:

Assessment, Evaluation, and Programming System for Infants and Children

(AEPS), Second Edition
Na Name: Paxton Date:03/10/2017
History
Paxton is 62 months old.
He goes to preschool for 4 years.
He was diagnosed with adrenal insufficiency. It has resolved and he no longer takes
medicine for this.
He was also diagnosed with cerebral palsy and failure to thrive.
His parents and his sister (age 3) and Paxton lives together.
Results (Score report- percent scores %)
Fine motor: 36.364
Gross motor: 18.182
Adaptive: 4.688
Cognitive: 43.103
Social- communication: 41.304
Social: 88
Fine Motor Gross Motor
He is able to simultaneously bring Paxton is able to turn head, move arms, and
hand to midline with assistance. He kick legs independently of each other. It
can reach toward and touch an object takes more time to turn head to left than
with each hand. He can release an right. The skills that score at 1 are waves
object that he held with each hand. He arms, rolls by turning segmentally from
also can scribble. There are some stomach to back and from back to stomach,
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skills are emerging, for example, he
sometimes brings two objects together
at or near midline. He grasps some of
hand-size objects with whole hand.
The skills has not been observed are
transfer object from one hand to the
other, grasp pea-size object with using
tip of index or whole hand, turn page of
books, draw circles and lines.
Adaptive
Paxton need more supports on
adaptive skills and there are some
skills are observed sometimes, for
example, eats with fork and/ or spoon,
accepts food presented on spoon, and
cooperates with teeth brushing. Some
adaptive skills are not shown such as
oral mechanism skills (drink, bite, use
tongue or lips). Because Paxtons
disabilities, he is not able to wash
hands, brush teeth, undress self, or
takes off pants independently.
Social- communication
He has eye-contact with people who
are speaking. He is good at gazing to
establish joint attention. He can engage
in vocal exchange by babbling and
cooing. Paxton is able to respond with
vocalization and gesture to simple
questions. He is quiet to familiar voice.
He recognizes own name. Paxton
sometimes vocalizes to open syllables
or express affective states. He
sometimes can locate objects, people,
and/ or events without contextual cues.
Recommendations:
Paxtons strengths are in the social and cognitive domains. He can initiate and maintain
creeps forward using alternating arm and leg
movement. Also, Catches, kicks, throws, and
rolls ball or similar object. The observations
that have not seen are rolls, crawls, and sits
balanced without support.
Cognitive
He responds to auditory, visual, and tactile
events. He is visually follows object moving
in horizontal, vertical, and circular directions.
He likes yellow. When we had three blocks
(red, blue, and yellow), he looks at yellow
blocks. He is able to recognize
environmental symbols (signs, logos, labels).
Paxton can label familiar people, objects,
and actions in pictures. The skills that are
observed sometimes are maintains search
for object that is not in its usual location,
correctly activates mechanical toy (adaptive
toy), imitates words that are frequently used
such as hi, bye, yellow, yes, no. When given
a chose of two he can tell you what group to
put in.
Social
He responds appropriately to familiar adults
affect. He likes to smile to his familiar people.
He initiates communication with familiar
adults like his parents and preschool
teacher. He responds appropriately to peers
social behavior. He loves to play with friends,
but the staff or other students need to bring
him to them. He is able to maintain
communicative exchange with peer.
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interaction with familiar adults and participant in established social routines. His emerging

skills can be mastered with assistive technology. He is learning to drive a motorized wheel

chair. Another goal for him is using a communication device that can help him communicate

his wants and needs.

Parent Summary:

Assessment was completed as part of a school assignment to look at eligibility for Part B

early intervention services and to identify Paxtons areas of strengths and needs. The Battelle

Developmental Inventory was used to determine eligibility. The Battelle Developmental

Inventory is a norm-referenced assessment tool that and will compare Paxtons development in 5

different domains to other 5 year olds. The AEPS is a curriculum based assessment and will

look closer at the skills Paxton has under each domain so we can plan strategies that build on the

strengths he already has. The 5 domains we are assessing are:

1. Adaptive. This looks at how well a child is able to meet their daily needs such as

dressing, eating, and following simple routines.

2. Personal-Social. This domain looks at how well a child interacts with his peers and other

adults and their awareness of their own behaviors or emotions.

3. Communication. This domain looks at how well a child understands what is spoken to

them and how well they can express themselves to others.

4. Motor. This domain looks at both big motor movements such as walking and jumping,

smaller movements needed for picking up small objects or writing and how well the child

can perform activities requiring hand-eye coordination.

5. Cognitive. This domain covers problems solving skills, general knowledge, and memory.
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Assignment 6

According to the Battelle Developmental Inventory, 2nd edition, Paxton qualifies for Part B

early intervention services which means he can continue receive services through preschool to

help prepare him for school. Because Paxtons diagnosis of cerebral palsy is impacting his

scores in all developmental domains, his educational team should include a physical therapist,

and occupational therapist and a speech language pathologist. Priority should be given to

adaptive equipment and devices to help Paxton access a typical school curriculum. Using results

from the AEPS we are able to identify goals and strategies that build on Paxtons current

strengths and skills. An Individual Educational Plan, IEP, will be developed based on these

results, his educational team and your priorities.

Reflection:

While the Battelle Developmental Inventory was useful in establishing eligibility, it was

too structured to accurately demonstrate Paxtons cognitive abilities. Paxtons level of

expressive communication is at the level of making choices between items with eye gaze and

indicating a yes or no by smiling. Paxton did not have a method to answer open-ended

questions. Additionally, because of the nature of Paxtons disability, he did not have the motor

coordination to complete some of the tasks required. The Battelle does allow for some

accommodations including communication devices, wait time or repeating questions but also

states that these accommodations can affect the validity of the tool (Newburg, 2005).

Additionally, in the developmental domains of motor, cognitive and receptive communication,

test administration relied more on structured skill testing and less on observation or interview so
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Assignment 6

there were no alternatives to demonstrate knowledge or skill. The Battelle identified deficits but

unlike the AEPS did not give an accurate picture of present functioning or foundational skills to

scaffold learning. And finally, the Battelle was not a family friendly tool. Because of his

diagnosis, it is expected that Paxton would score much lower than his typically developing peers.

However, according to the Battelle the gap was huge. Typically the percentile ranking is the

most meaningful score to share with parents. But, with Paxton scoring at or above less than one

percent of his typically developing peers in all domains, I do not feel this would be a helpful

report for families. I only reported that he qualified for services. The AEPS gave a much better

picture of his strengths and progress and was more positive to share with families. According to

his AEPS, the physical therapist, and occupational therapist should include and help on his needs

in adaptive domain. The goal can be established on what he has now, for example, he can eat

with fork and/ or spoon while presenting food on the spoon. The functional outcome would be

increase his use of spoon while eating from twice to five times at lunchtime. AEPS is more

flexible to assess due to his natural of disability. The assistance can be provided while

administrating. Also, each domains skills build on each other. It is easy to show that the needs

and strengths of Paxton in order to set individual goals. In the report that provided by Jen, it also

has a APES Child Progress Record. In each domain, how Paxton has achieved, what he has not

are shown as the coloring format, which helps for set up IEP goals with current progress that we

knew. All the results will share in the Google folder.

References:

Newborg, J. (2005). Battelle Developmental Inventory, 2nd Edition. Itasca, IL: Riverside
Publishing.
Diane D. Bricker (2002) Assessment, Evaluation, and Programming System for Infants and
Children (AEPS), Second Edition. Paul H. Brookes Publishing Company.