Female Cale C) amie Te Year Month Day———Parent/Guardan Dated ee Soha Gr Date of Binh Respondents tame oe —— ——_ —__ Bibstonship ta cs Ageia Monts (az) Length of Time Respondent Has Known Cid "Standard Scare Dierence Sc Sum of Swile Standard Standard Rank Scores Score SEM Conmuniatin = (cea) __ Section 3. Descriptive Terms Desciptve Tem Very Por Poor Below erage Average __Abore Average __ Super Ver Superr SonéaScre <7 8ST Section 4. Observations and Recommendations ed i a lion cami, Taal i PT ase ne wT KD uaa a peaSection 5. Record of Performance Communication Domain Instructions: Receptive Language Subdomain Starting pont ate determined by the childs age Score 1 the child does exhibit the behole described most of the tine ordi when he or she was younger ut has outgrown the behavior Score Othe cil doesnot exhibit the behavior descibedor exits the behavior inconsistently Basaland Bein atthe staring pont Administer items until tee consecutive items receive a score of fe to establish a Clings cling). the ch receives a scare of on any of the fist tre tems test backward until the child scores a1 on three tems now fe, oesablsh a Basa the chill doesnot recive 2 sore of 0 on thee consecutive items sil establshing a basa etn fo highest Rem number sored and cative testing unt 2 eting is estabshed Entry Point: th-11 months: tem 1 24-35 months Item 16 {46-59 months: tem 27 12-25 months:item 8 36-47 mnths Item 23 ‘0 months and le: tem 31 ‘em Score Tora) |ttem 2 . M. normalbesting ate reacts to oud roy king marin amsr ego stoeping movenent qucted by music tunsheadonard ice when someone peas to himerher ele pron who aking gesturing tuin and aks ond noe ‘bet tops actity when names aed responds th appropiate gestures ou bye-byeror other rvs moves body toms toy step acy han tl Fallows simple spoken conmande e9,"Ghe Morn the cus") responds towhae questions eg "Where the ball” May pint, tatthelocton of go get the bl ‘hen ated il pit fv cr mori pesons anima ots {ols decors about placing one te W not another incase’ (or pgxoprate had movement) In esponse to questions point totes body pans whenasked canes cut two-step directions that ae ested eg, "Gato he able and rng me theo) points oso pars when sted“Entry Points:Bith-11 month: tem 1 24-35 months tem 16 48-59 months: tem 27 12-23 months: em 36-47 months tem 23 ‘50 months and older: tem 34 Rem | Score "| Gero) em 1, oso 15 0 more plete of common objects when they ae name 20. understands a lest hee poses (e9,mip yous and boys" this your” Show me the dogs food) a. pons fv ormorecemman objects dsrbed by the wee, "Show me what et th) 2. caves out two ep unveted commands (e,Putthe slo these and then cp yourhands) a. understands nagatie eg, "Whiehs oe... the deg) 2. rons "ba andi’ (eg,“Tyow te big bao me 2. responds to"whar sd whose" questions feg."Who has on aed stay?) 26, fotous econ bout placog one ter "bese anaunder ant 7. Understands font of and"bein eg. "What behind he screen”) 28, nsmes comprehension questions when ld shr sry 2» emonsatesundestancing of pasve sentences 9, Show me the tan was phe by the ca) 20. canes out tree step commands ha ae nat lated (eRe sllon the tabe shut the door and un aout) e ‘es whether two words hme or have the sme endnaSound erates te werd ase. "Da cata par hve : thesanecndingsoune?y 2. responds to questonsivohing ine concepts (e,"When do we eat rch?) a understands four seasons ofthe yer and what you do meach eg. "Wht owe da inte sume?) Ai an ie at est te eppostes using pictus objects (Show me the oppo of. bgt even, ‘aushor) as erthes and igh’ on oom boc (eg. ae yourighthan!) 2%. cadena atlesttreeunts of urency eg. Point tothe... peony. dia uae) sr an dena teas tee complete sentences (el me thi sa complete sentence, bown dog Te boy on sw) " (cere tancucesvaoonan nan sone Continues with Expressive Language —*Instructions: Expressive Language Subdomain Starting pont ate determined by the hls age Score 1 the child does exit the Behavior described most of ‘the time, or did whene or she was younger but has eutgrown the behavior. Score Oi the child doesnot exhibit ‘the behavior described o exits the behavior inconsistently. Begin atthe stating pont. Administer tems unl thre consecutive items receive a score of (leo establish @ ‘ling. the child ecelvesa score of © onary’ of theft tice tems, et backed ul the ci scores aon ‘thee items in aro fi, to establish a basa. the child doesnot receive a score of on tree consecutive tems ‘hile establishing a basal retum to highest item number scored and contin testing unt acelin is established, Entry Points: th-1 montstem 1 24-35 month tem 6 {6-59 months em 30 12:23 monte 36-47 mont em 24 ‘month andclde tem 34 item ? them " hava svongey 2 rakes sick roses 2 ese nga ucononsble “4 rakes robester han cng e9.<03ra gang) p asiferent cies fp hung demon 6 rocuces tee or more sre owe unde. ah hu) > bvot outloud “a rods Ye ormere conan chy vo a Hodes sting of conaant-swesourds fe, bob dda) 10 ses word eto carpet ici eg mama crn) 1 seston pate when ean eg ase ch a aking 8. question) 2 swonaneaay sta geting andres 2 hasan sound acs rink 4 voce aa veo : - a Sen wor tae gh eng pron te ook may man wis moo ne, anaemia races creme seenonV ern woes 9. Be v. non ramesoftwo o mor pamats 8 125101015 wor pomtneouly ». rodices thee or more twee emi)aeyhke_teictnaaand ieee io eno meas eros AAil raereumneeee Io mois a "ses sentences of thee or more words : ceraias tee note |__| chaiea tenon ezemnme ironman ee soccer ents 26. uses five oF more regular plurals fe, boys. toys) = 7. | ___janoeed tomtesr ees weareavonorean wee 2B. | gives fl mare on request (eg, "Whats your name”) - 7 cin theres gudepnea "30, uses ive of more contractions (eg Ml cant) 7 - a. uses facil expressions and body language to demonstrat atleast five emotions (eg, “Show me haw you would look fF 2 See arseraeeee enna : Se ms ore th et owas reeoryon 9 z _auntenbere colnet cee. oven toc) Si een rnoeessrenerercal : 2. | [ectenmrntenechen tea gee =| eee a a _anenenben che tbr a seg Toren teh a a a [sete orperse coh a. eb TaI