ate of Test: December 6, 2022

Four Sectors:

1. Personal Social – task which indicate the child’s ability to get along with people and to take
care of himself.
2. Fine Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick
up objects and to draw
3. Language – tasks which indicate the child’s ability to hear, follow directions and to speak;
4. Gross Motor – tasks which indicate the child’s ability to sit, walk, and jump.

Test Scoring:

 Passed
 Failed
 Refused
 No Opportunity

PERSONAL-SOCIAL

Procedure Score Analysis Interpretation

 Smiles PASSED The tester smiled and Even though the
Responsively talked to the child and examiner does not speak
didn't touch her. to the child during the
entire test, the child
Pass if the child smiles smiles at her.
back.

 Smiles PASSED During the test, the tester The child is more socially
Spontaneously sees if the child smiles to aware and cheerful
her or to the parent during the test.
without any stimulation.

Pass if child smiles on

her own at any time
during the test without
any stimulation.

 Regards Face PASSED The tester placed the The child first looks at the
child on his back. The tester with interest and
tester went within 12 never stops staring at the
inches face to face with tester.
the child.

Pass if the child actually

looks at the tester.
INTERPRETATION:

The client was able to pass the three activities: smiles spontaneously, smile responsively and regards
face. For personal-social sector, the client has no developmental delay.

FINE - MOTOR ADAPTIVE

Procedure Score Analysis Interpretation

 Grasps Rattle PASSED While the child is sitting The child is curious and
on his mother’s lap, the grasps the rattle. The
tester put the rattle at ability to grip a little
the back of child's object is shown.
hands.

Pass if the child grasps

the rattle for a few
seconds.

 Regards Cheese PASSED As the child is sitting on The kid made an

Curls her mother’s lap, the attempt to grab the
tester dropped cheese cheese curls. The child
curls in front of the develops eye-hand
child. coordination.

Pass if the child looks

at the cheese curl.

 Reaches Object PASSED As the child is sitting on The child reaches for
the chair, while his the item and displays
mother is holding him, interest in it. The kid is
the tester put toys (2 capable of accepting
blocks of wood) in front and grabbing things.
of him.

Pass if the child

reaches toward the toy

 Follows 180º PASSED The tester put the red The child could follow
yarn in about 6 - 8 moving items. On the
inches in front of the same trajectory as the
child and wiggled it to yarn movement, eye
get his attention. Then and neck movement
it was transferred from were seen.
his left going to his right
side in a slow motion.

Pass if the child follows

the wool within his
head and eyes through
the complete arc form
 one side to the other.

 Hands Together PASSED The tester watched the Without any issues, the
child to see if she child touches her hand.
touches her hands This indicates that the
together in the middle. child is learning about
herself.
Pass if the child
touches her fingers
together in the midline.

 Follows Past PASSED While the child is lying The yarn caught the
Midline in a supine position, the child's attention. Eye
tester held the red yarn movement was noticed.
for about 6-8 inches in
front of her and moved
it slowly from one side
in an arc over the
middle of the child to
the other side.

Pass if the child follows

the yarn past the
middle point of the arc
either eyes alone or her
head and eyes
together.

 Follow to Midline PASSED While the child is lying The yarn caught the
in a supine position, the child's attention.
tester places the yarn Binocular vision was
at about 6-8 inches in developed in the child.
front of the child. Then
place it from her left
side going to the
middle.

Pass if the child follows

the yarn to the middle
point of the arc either
his eyes alone or her
head and eyes
altogether.

INTERPRETATION

The examiner performed seven activities under the fine-motor adaptive sector. These are: grasp
rattle, regards cheese curls, reaches object, follows 180°, and follows past midline and hands
together. The child passed all these seven activities. For this sector, the client has no developmental
delay.
LANGUAGE

Procedure Score Analysis Interpretation

 Turns to Voice PASSED As the child was sitting The child was attentive
on her mother’s lap, the whenever her name
tester went to her right was called. The child
side and called him by turns to find the voice.
her name.

Pass if the child turns

to the direction of the
voice.

 Squeals PASSED The tester asked the According to the

mother if the child mother, the child starts
already laughs, or to develop making
produces a squealing sounds like when she’s
sound if he’s overjoyed. excited and tee-hee
sounds.
Pass if the child makes
squealing sounds.

 Laughs PASSED The tester asked the According to the

mother if the child mother, the child
laughs loud even laughs loud whenever
without being tickled or she is playing or having
any stimulation. fun not necessarily
being tickled.
Pass if the child laughs
aloud without being
tickled.

 Vocalizes not PASSED The tester observed if It shows that the child
crying the child is able to is expressing her
vocalize by producing moods or feelings
different sounds. through other cues
other than crying by
Pass if the child makes producing sound like
sounds other than “aaargh”.
crying.

 Responds to bell PASSED The tester rang the bellThe tester rang the bell
quietly at the left side of
first at the left side of
the child where the the child; it did not quite
child could not see it. catch the child’s
Then the tester rang attention. Then the
again the bell, this time,
tester rang again the
louder. bell, this time more
sound was produced,
Pass if the child shows the child moved her
 in any way that she has head to the direction of
heard the bell. the sound produced by
the bell. She turns her
head toward the
direction of the sounds.

INTERPRETATION:

The examiner performed seven activities under the language sector. These are: turns to voice,
squeals, laughs, vocalizes not crying, and responds to bell. The child passed all these five activities.
For this sector, the client has no developmental delay.

GROSS MOTOR

Procedure Score Analysis Interpretation

 Bear some PASSED The tester held the The child stood straight
weight on legs child upright on the for a few seconds
mattress. holding her weight on
his legs, as the tester
Pass if the child briefly loosen her support to
supports most of her the child. The child’s
weight on her legs stepping reflex has
faded
 Pull to sit PASSED The tester put the child The child’s head did not
in a supine position and hang while she is being
slowly pulled her up pulled up. The child’s
through her hands. Muscles on neck are
strong enough to give
Pass if the child’s head support to his head
does not hang at any while in motion.
time while she is being
pulled up
 Prone chest up FAILED The child is placed on The child lifted up her
arm support the mattress in a prone head and chest but did
position. The tester not extend her forearm
observed if the child for support. This means
can lift her head and that the child cannot
chest up using arms for rest her torso's weight
support. on her hands because
of large abdominal and
Pass if the child lifts her chest circumference
head and chest up, with her extended
using support of arms.
outstretched hands or
forearms so that this
face is looking straight
ahead.

 Rolls over PASSED The child was put on a When the child was on
 supine position, the supine position and the
tester held a rattle and rattle was wiggled at
wiggled it and the testerthe child, he just looked
asked the mother if the at it. When the
child can roll from back examiner asked the
to stomach. mother if the child can
rolls from back to
Pass if the child rolled stomach, the mother
completely over, not said "yes".
just to or from side,
either way (not
accidentally) two times
or more.

 Sit head steady PASSED The child is placed at The tester observed
her mother’s lap, in a that the child’s head did
sitting position. The not sway. The child’s
tester counted for a full muscle control is
minute while looking at already established.
the child’s head if there
is no swaying.

Pass if child holds head

upright and steady with
no bobbing motion

 From head up to FAILED The child was lying in The child was not able
90º her stomach on a to lift her head and
mattress and was chest to produce a 90º
observed if she can lift angle. The child’s head
her head to make a 90º is still held facing
angle. downward.

Pass if the child lifts her

head and chest up so
that her face makes a
90 degree angle with
the table.

 Prone head up PASSED The child was put in a The child was able to
to 45º lying position on her lift her head and raise
stomach and was her chin from the
observed if she can lift mattress. Her neck
her head to make a 45º muscles can support
angle with the table. her head movement up
to 45 degrees angle.
Pass if the child lifts her
head so that her face
makes an approximate
45º angle with the table
INTERPRETATION:

Seven gross motor tasks were carried out by the examiner. Rolls over, sits head steady, pulls to sit,
and prone head up 45 degrees are all given the grade "passed." While all two exercises—prone chest
up with arm support and prone head up 90 degrees—are given a failing grade. Out of the seven
administered items, five were graded as passing.
 FAMILY HEALTH HISTORY

- Rheumatoid Arthritis

- Deceased