PSYCHOEDUCATIONAL ASSESSMENT

I - CHILD’S PROFILE
Name :
Nick name :
Date of birth :
Age :
Gender :
Parent’s Name:
Diagnosis :
Date of Assessment:

II- REASONS FOR ASSESSMENT

This is conducted to find out the present level of performance to be used as a
basis for IEP development.

III- Appraisal Measures Conducted and Administered

A. A Scale Detecting Academic Deficits among Children
B. Developmental Skills Evaluation
C. Omnibus Developmental Scale
D. Interview with Parents

A. A Scale for Detecting Academic Deficits among Children

Directions: You will be asked to evaluate your child objectively based on your observation
and interactions with him/her. The child will be rated each item by checking
under the column that best describes home/her.

Legend:
HC = Highly characteristics of the child
CC = Characteristic of thee child
SC = Slightly characteristic of the child
NC = Not characteristic of the child at all

The Child: HC CC SC NC

A. Cognition
1. Discriminates forms, shapes, sizes, colors and other attributes. [ ] [ ] [ ] []
2. distinguishes left and right (directionally). [ ] [ ] [ ] []
3. Discriminates concepts of spatial relations
(e.g. up-down, in-out, under-above). [ ] [ ] [ ] []
4. Exhibits sequencing abilities (e.g. sizes, numbers, letters, etc.) [ ] [ ] [ ] []
5. Possesses associative/analogy skills. [ ] [] [ ] [ ]

B. Writing/Language
1. Writes legibly (i.e. evenness, smoothness, spacing
slant and correct letter and number strokes. [ ] [ ] [ ] []
2. Writes accurately form copy. [ ] [ ] [ ] []
3. Discriminates word correctly. [ ] [ ] [ ] []
4. Spells correctly. [ ] [ ] [ ] []
 5. Uses lower and upper cases appropriately. [ ] [ ] [ ] []
6. Uses punctuation marks appropriately. [ ] [ ] [ ] []
7. Observes correct grammatical use. [ ] [ ] [ ] []
8. Uses references properly including the dictionary. [ ] [ ] [ ] []
9. Composes sentences/paragraphs ably well. [ ] [ ] [ ] []

C. Reading
1. Recognizes letters correctly. [ ] [ ] [ ] []
2. Read words/phrases/sentences. [ ] [ ] [ ] []
3. Follows directions. [ ] [ ] [ ] []
4. Defines words correctly. [ ] [ ] [ ] []
5. Notes details. [ ] [ ] [ ] []
6. Gets the gist/main idea/theme of a selection. [ ] [ ] [ ] []
7. Sequence events. [ ] [ ] [ ] []
8. Makes inferences/conclusions. [ ] [ ] [ ] []
9. Summarizes a selection. [ ] [ ] [ ] []
10. Interprets specific passages in a selection. [ ] [ ] [ ] []
11. Draws the moral of a selection. [ ] [ ] [ ] []

D. Mathematics
1. Recognizes numbers and numbers concepts
(e.g. odd-even, place values, prime-composite). [ ] [ ] [ ] []
2. Reads and writes numbers in word/figures. [ ] [ ] [ ] []
3. Matches numerals with number words. [ ] [ ] [ ] []
4. Matches object-number equivalents. [ ] [ ] [ ] []
5. Differentiates concepts of greater than, less than and equal to. [ ] [ ] [ ] []
6. Discriminates ordinal position of objects/numbers
in relation to a given referents. [ ] [ ] [ ] []
7. Classifies numbers according to their proper place values. [ ] [ ] [ ] []
8. Translates word problem into number sentences. [ ] [ ] [ ] []
9. Solves numbers-series problems. [ ] [ ] [ ] []
10. Tells time by the hour/half-hour/quarter-hour/minutes. [ ] [ ] [ ] []
11. Determine equivalents of varied units of measurement
(e.g. inches-feet, meters-kilometers, feet-yard,
pounds-kilograms). [ ] [ ] [ ] []
12. Discriminates money denomination/values. [ ] [ ] [ ] []
13. Computes money. [ ] [ ] [ ] []
14. Solves number problems involving whole numbers. [ ] [ ] [ ] []
15. Solves word problems involving whole numbers. [ ] [ ] [ ] []
16. Solves number problems involving fraction and decimals
using the four fundamental operations. [ ] [ ] [ ] []
17. Solves word problem involving fraction and decimals
using the four fundamental operation. [ ] [ ] [ ] []

B. DEVELOPMENTAL SKILLS EVALUATION

Observation Remarks
SELF HELP SKILLS
Feeding
Drinks from a cup/glass
Drinks with a straw
Pours liquid from a container
Uses eating utensils spoon, knife, fork properly
Serves self from serving plate
P

Cleans spillage
Shows awareness about dirt and mess
Eats independently
Cleans and clears place on table
Knows proper table setting
Consumes all food serve
Dressing
Cooperates when dressing/undressing
Pulls off shoes
Pulls off socks
Ties Shows
Takes off dress, skirt, blouse
Knows how to zip/unzip
Knows how to button/unbutton
Knows how to hook/unhook
Attempts to dress independently
Attempts to undress independently
Toileting
Sounds off when wet or soiled
Uses toilet with help
Follows complete toileting, wiping, flushing,
washing hand
Hygiene and grooming
Washes hands with soap
Washes face with soap
Knows how to use a washcloth
Dries hands/face alone
Combs/brushes hair properly
Brushes teeth regularly
Blows nose on command
Keeps nose clean with hanky or tissue
Keeps oneself clean and neat
Takes care of personal needs
Safety
Handles sharp objects with care
Recognizes safety rules
Practices rules of safety

MOTOR SKILLS Observation Remarks

Gross Motor Development
Jumps over an object with both feet
Walks forward independently
Climbs upstairs and goes downstairs using alternate feet
Skips well with or without rope
Balances well with a given path
Hops well
Handles balls & blocks with ease Present
Kicks while standing
Fine Motor Development
Builds tower of 2 stage of block building
nd

Strings beads on the thread or shoelace

Performs twisting activities efficiently
Folds paper or napkins with ease
Cuts straight lines
Cuts curved lines
Cuts jagged line
Cuts around picture
Rolls up mats, paper, or any paint brush properly
Ties shoes
Uses 3 finger grasp
Puts small objects in a bottle
Handles pegs on board properly

PERCEPTUAL SKILLS Observation

Classification
Compares objects according to
Size
Height
Color
Texture
Quantity (more or less)
Taste
Shape

Seriation
Orders by size
Orders by length
Orders by texture
Orders by color
Orders by quantity
Recognition
Identifies shapes
Identifies or recognizes Philippine money
Recognizes prominent color
Identifies missing parts of puzzle
Recognizes distinct sounds or tunes simple
Recognizes simple pictures of objects or creatures
Finds out opposites: up-down
Finds out opposites: sad-happy
Spatial Relations
Understands distinctions of in-out
Understand distinctions of under-above
Understand distinctions of front- back
Understand distinctions of up-down
Understand distinctions of left-right
Understand distinctions of beside-between
NUMERICAL SKILLS
Repeats numbers out of sequence
Puts objects in containers (1-10)
Counts or points to 3 objects
Counts or points to 6 objects
Counts 5 objects aloud without assistance
Counts 8 objects aloud without assistance
Counts 10 objects aloud without assistance
Counts and tells how many
Counts beyond 10 (up to ____)
Adds combinations totalling up to 10
Subtract combinations resulting to differences within
the 1 – 10 range
Names positions of subjects from a set
Tells distinction between more or less
Sequence nos. 1 – 10
Sequences symbols
Matches equal set 1 – 10 objects
Points to name numerals (1 -25)

LANGUAGE DEVELOPMENT Observation Remarks

Listening, speaking, and reasoning skills
Expressing thoughts or ideas clearly
Follows oral direction with accuracy
Tells story about a picture spontaneously
Recites rhymes, short poems with proper expressions
or inflections
Speaks distinctly
Listens to orally read stories or poems
Sequences parts of the story as required
Imitates actions that go together with songs or rhymes
Deduces insights related to values from stories
Shows ability to alter parts of stories, poems, or songs
Uses vocabulary normal for the age level
Speaks in proper sentence structures
Reading Skills
Knows – sounds of alphabet
Recognizes his name in print
Discriminates – beginning
Discriminates – middle
Discriminates – ending
Discriminates phonetic sounds
Reads simple c – v – c patterns words
Writing Skills
Executes fundamental strokes
Writes letters legibly following the lines
Writes name accurately
Copies simple words correctly
Grips pencil properly while writing
Colors evenly following lines
Shows mastery of letter forms
Memory Recall
Recalls 4 objects seen in a picture
Tells what is missing when one object is removed
from a group of three
Retells 5 main factors from the story heard 3 times
Retells sequence of a story
Names days of week in order c

Identifies objects, persons, events in stories with

accuracy I

Repeats back rhythm made by teacher

SOCIAL AND EMOTIONAL DEVELOPMENT Observation Remarks

Relates well with others in work
Plays at ease with others
Shares with others
Responds positively to authority
Exhibits self-confidence
Welcomes responsibilities
Shows a happy disposition
Copes well with varying situations
Initiates interaction (through eye contact, touching,
and calling)
Responds to His/her name when called
Stops crying with verbal attention
Shows affection to adults
Seeks comfort through physical contact
Interactions with strangers
Explores his environment
Plays appropriately with toys and packs them away
Plays alone near peers
Initiates plays with peers
Interacts with peers
Waits for his/her turn
Knows how to participate in one rule game
Identifies personal belongings
Cares for his own belongings
Accepts routines and adjust to changes
Knows how to listen
Knows how to follow adult direction
Greets visitors and other familiar personalities
Behaves appropriately in various social settings
Knows how to say “Please”
Knows how to say “Excuse me”
Knows how to say “Thank you”
Knows how to say “You’re welcome”
Knows how to say “Po” “Opo”

CREATIVE ARTS
Expresses ideas through drawings or other arts works
Sings at ease
Draws simple object representation
Participate actively in dramatic plays
Uses modeling dough efficiently
Creates own style of objects

WORK HABITS Observation Remarks

Works neatly
Completes work on time
Handles with care school things
Follows simple instruction with accuracy
Initiates clean-up of things which were messed up
Packs up materials which were used

CHRISTIAN VALUES & ATTITUDES

Shows awareness of God
Listens attentively to Bible
Recites simple memory verses
Knows Christian songs
Knows how to pray
Understands basic Biblical concepts
Practices Biblical values such as love , obedience, kindness, etc.
Desires to attend Sunday Church activities

Legend: Present Not Present Fairly Observed

C. Omnibus Developmental Scale

Directions
This scale is designed to determine the child’s levels along five (5) developmental areas.
Please rate the child as objectively as possible with the help of the SPED Teachers who will
interview you.
Legend:
HE = Highly Evident
E = Evident
SE = Slightly Evident
NE = Not Evident

PHYSICAL HEALTH – GROSS MOTOR

The child: HE E SE NE
1. Possesses good health [ ] [] [ ] [ ]
2. Has normal height and weight. [ ] [ ] [] [ ]
3. Follows good eating and sleeping habits. [ ] [] [ ] [ ]
4. Is normally balanced/coordinated. [ ] [ ] [] [ ]
5. Is normally strongly/fast/does not tire easily. [ ] [] [ ] [ ]
6. Moves about with ease/ability in performing gross-
motor activities like walking, running, jumping,
skipping, climbing, and walking upstairs and downstairs. [ ] [] [ ] [ ]
7. Performs simple chores like making his/her bed,
folding, washing, and his/her clothes; running errands
and cleaning the house. [ ] [ ] [] [ ]
8. Uses age-appropriate play facilities. [ ] [] [ ] [ ]
9. Performs activities such as rhythmic, dancing,
aerobics and calisthenics with ease. [ ] [ ] [] [ ]
10. Participates in games/sports recreation actively. [ ] [] [ ] [ ]
11. Discriminates and avoid dangers [ ] [ ] [] [ ]

FINE – MOTOR

The Child: HE E SE NE
1. Performs simple visual-motor task such as
building blocks, sorting beads, putting forms
in form board and pegs in pegboard. [ ] [ ] [] [ ]
2. Performs less easy visual-motor task such as
assembling Lego pieces following patterns
performing puzzles, arranging objects in series
according to certain rules, and replicating
Block arrangement and bead patterns. [ ] [ ] [ ] []
3. Roll/throw/catches/balls/objects coordinately
and accurately. [ ] [] [ ] [ ]
4. Opens and closes bottles/jars. [ ] [ ] [] [ ]
5. Wipes surfaces efficiently. [ ] [ ] [] [ ]
6. Unbuttons and buttons clothes. [ ] [ ] [ ] []
7. Wraps and unwraps objects/food. [ ] [] [ ] [ ]
8. Pours liquids/sand/beads into glass container. [ ] [] [ ] [ ]
9. Molds clay into different shapes/images. [ ] [ ] [ ] []
10. Sharpens pencil using sharpener. [ ] [ ] [ ] []
11. Fixes and ties shoelaces. [ ] [ ] [ ] []
12. Sews simple stitches. [ ] [ ] [ ] []
13. Uses table knife for spreading, slicing/cutting. [ ] [ ] [ ] []
14. Cuts with scissors accurately. [ ] [ ] [ ] []
15. Holds the pencil/crayon correctly. [ ] [] [ ] [ ]
16. Colors drawings within the lines. [ ] [ ] [ ] []
17. Traces shapes/forms letters/numbers. [ ] [ ] [ ] []
18. Draws objects/persons/and others. [ ] [ ] [ ] []
19. Copies shapes/forms/letters/numbers/words
accurately. [ ] [ ] [ ] []

PSYCHOSOCIAL

The Child: HE E SE NE
1. Describes himself/herself/accurately and
adequately. [ ] [ ] [ ] []
2. Identifies/describes family members. [ ] [] [ ] [ ]
3. Exhibits appropriate emotional responses. [ ] [] [ ] [ ]
4. Expresses his/her personal needs. [ ] [ ] [] [ ]
5. Cooperates well with family members/
teachers and peers in work/play. [ ] [ ] [] [ ]
6. Uses polite expressions appropriately. [ ] [ ] [ ] []
7. Follows appropriate social rules expected of
his/her age. [ ] [ ] [ ] []
8. Complies with requests and commands. [ ] [ ] [] [ ]
9. Respects the members of the family, school
and community. [ ] [ ] [] [ ]
10. Behaves properly in varied social settings. [ ] [ ] [ ] []
11. Makes appropriate social judgments. [ ] [ ] [ ] []
12. Observes family, school, community
rules and ordinances. [ ] [ ] [ ] []
13. Contributes in protecting and maintaining a
wholesome and safe environment. [ ] [ ] [ ] []

LANGUAGE COMMUNICATION

The Child: HE E SE NE
1. Listens attentively. [ ] [ ] [] [ ]
2. Repeats sounds listened to. [ ] [ ] [] [ ]
3. Converses with peers fluently. [ ] [ ] [] [ ]
4. Describes pictures/things/persons adequately. [ ] [ ] [ ] []
5. Relates own simple stories/incidents. [ ] [ ] [ ] []
6. Relates stories listened to. [ ] [ ] [ ] []
7. Asks answers questions appropriately/correctly. [ ] [ ] [ ] []
8. Conceptualizes ideas with ease. [ ] [ ] [ ] []
9. Reasons out intelligently. [ ] [ ] [ ] []

WRITING

The Child: HE E SE NE
1. Uses lower and upper cases/punctuation marks. [ ] [ ] [ ] []
2. Observes grammatical rules. [ ] [ ] [ ] []
3. Chooses correct words. [ ] [ ] [ ] []
4. Uses references properly including the dictionary. [ ] [ ] [ ] []
5. Observes correct sentence conclusion. [ ] [ ] [ ] []
6. Writes/composes words/phrases and sentences. [ ] [ ] [ ] []

READING

The Child: HE E SE NE
1. Follows directions. [ ] [ ] [ ] []
2. Discriminates words correctly. [ ] [ ] [ ] []
3. Reads words, phrases and sentences. [ ] [ ] [ ] []
4. Notes details/gets the main idea/theme of a
selection read. [ ] [ ] [ ] []
5. Sequences/summarizes a selection. [ ] [ ] [ ] []
6. Makes inferences/conceptualizes idea with case. [ ] [ ] [ ] []
7. Draws the moral of a selection. [ ] [ ] [ ] []
8. Translates ideas into practical situations. [ ] [ ] [ ] []
9. Solves life-situational problems analytically. [ ] [ ] [ ] []

SELF-HELP

Eating
The Child: HE E SE NE
1. Eats with spoon and fork singly. [ ] [ ] [] [ ]
2. Eats with spoon fork and simultaneously. [ ] [ ] [ ] []
3. Mixes his/her own drinks getting the right
quantities of sugar, milk, powder, etc. [ ] [ ] [ ] []
4. Cleans and clears place at table before/after
eating. [ ] [ ] [ ] []
5. Eats independently. [] [ ] [ ] [ ]
6. Prepares his/her own simple meals independently. [ ] [ ] [] [ ]

Dressing
The Child: HE E SE NE
1. Removes shoes and socks. [ ] [] [ ] [ ]
2. Puts on shoes and socks. [ ] [] [ ] [ ]
3. Removes clothes including unzipping, unbuttoning,
Unhooking, and unsnapping. [ ] [ ] [ ] []
4. Puts on clothes including zipping, buttoning,
Hooking, and snapping. [ ] [ ] [ ] []
5. Chooses and changes his/her clothes whenever
needed. [ ] [ ] [] [ ]
6. Takes care of his/her clothes by hanging folding,
Arranging and washing them properly. [ ] [ ] [ ] []

Grooming
The Child: HE E SE NE
1. Washes his/her hands thoroughly. [ ] [ ] [] [ ]
2. Washes his/her face thoroughly. [ ] [ ] [] [ ]
3. Combs his/her hair efficiently. [ ] [ ] [ ] []
4. Brushes his/her teeth properly/regularly. [ ] [ ] [] [ ]
5. Trims his/her fingernails/toenails properly/regularly [ ] [ ] [ ] []
6. Cleans his/her ears thoroughly. [ ] [ ] [ ] []
7. Washes herself/himself after defecating. [ ] [ ] [ ] []
8. Maintains hygiene everyday especially during
Menstrual period (for girls). [ ] [ ] [ ] []
9. Baths himself/herself independently. [ ] [ ] [] [ ]

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