Developmental Milestones Birth to 5 years

CASE HISTORY INFORMATION

Important Case History Information: Example Form https://www.kidspeakinc.com/wp-content/uploads/2016/12/updated-Preschool-Case-History-Nov-2016-form2.pdf

Medical History :

Length of pregnancy: Complications during pregnancy: Yes No If yes, please explain: Complications at birth/delivery: Yes No If yes, please explain:

In NICU: Yes No If yes, how long: Spit up frequently/acid reflux? Yes No Strong Suck? Yes No

Has your child had any major accidents/illnesses/hospitalizations? Yes No

If yes, please explain:

Has your child had any ear infections?

Yes No

How many?

Has your child ever received PE tubes?

Yes No

Does your child have a history of seizures?

Yes No

Has your child ever has tonsil and/or adenoid issues? Yes No Please list all current medications that your child is taking and what condition they are indicated for:

Please list any allergies your child has:

Describe your child’s sleep pattern:

Pediatrician’s name/Practice: Pediatrician’s phone:

Oral Development :

Please indicate (X) if your child does the following:

Uses pacifier/sucks fingers or thumb: Eats table food:

Drinks from an open cup: Drinks from a straw: Uses a spoon/fork: “Tongue tie” or a short lingual frenulum: _________

Repaired cleft palate or cleft lip: ______

Is your child a picky eater? Yes No

If yes, please explain:

Does your child gag, choke, or vomit with any foods? Yes No Do you have any concerns about your child’s feeding skills? Yes No

Developmental History :

Please provide the approximate age at which your child began to do the following:

Walk: Use single words: Ask/answer questions:

Combine words into phrases/sentences: Engage in conversation:

Current Communication:

Does your child…..

repeat sounds, words, or phrases?

understand what you are saying?

retrieve or point to objects on request (e.g., ball, cup)?

follow simple directions (e.g., “get your shoes” or “shut the door”)

respond correctly to yes/no questions?

respond correctly to what/where/who/when/why questions?

How does your child communicate at this time? Please check all that apply

Sign language Single words

Gestures or Pointing 2-3 word phrases

Sounds/Babbling 4+ word sentences

Grunting Other

Behavioral characteristics: please check all that apply

□ Cooperative □ Restless

□ Attentive □ Poor eye contact

□ Willing to try new activities □ Easily distracted/ short attention

□ Plays alone for reasonable length of time □ Destructive/ aggressive

□ Separation difficulties □ Withdrawn

□ Easily frustrated/impulsive □ Inappropriate behavior

□ Stubborn □ Self-abusive behavior

Educational History:

Child’s current placement: Home Daycare Preschool

Name of school/ City:

If in preschool/daycare, how many days per week & hours per day:

Has your child ever been evaluated for or received the following services?

Speech Therapy Occupational Therapy Physical Therapy .

Please list all previous and current therapies received:

Where received? Length/ Dates of Treatment:

Current Concerns :

Please describe your concerns today:

When was the problem first noticed? By whom?: What do you hope we can accomplish in therapy?

#3 Identifying Narrative Language

-Identify a stimulus

-Identify the charaters being told in narrative

-Identify the time and order, in preschool children this will typically develop later

(Reuterskiold, A Plan for Language Learning Lecture)

TREATMENT

Factors to consider for Intervention