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Background

Ryan is an 18-month-old boy who enjoys cars, mickey mouse and toys with moving

parts. Ryan is a healthy toddler who has difficulty with allergies but is usually a happy and

energized young boy. Although Ryan passed his newborn infant hearing screening, his mom was

concerned about his language development. He is able to use the word mom as of a week ago

and he is able to use a pointing/reaching gesture to communicate his need for more food, drink,

tickle time, and rocking games. Ryan has been using more eye contact with familiar and

unfamiliar individuals, he is also willing to interact with them. Ryan likes to engage in activities

such as tickle time, car crashing, sensory rocking games, and stacking objects (blocks, cups). He

will stay with these activities for a duration of 2-4 minutes. In these interactions, he will show he

wants more,by reaching or using vocalizations, when mom embeds wait time into the play.

We are working on increasing Ryans vocalizations by encouraging mom to use sign

language and enhanced milieu teaching strategies. Ryans mom has been using the signs for:

more, all done, sleep, play, milk, water, eat, and drink. Secondly, the mother is embedding:

expectant wait, modeling, environmental arrangement, responsive interactions, and expanding;

into daily routines to encourage Ryans verbal and nonverbal communication.

Assessments

The two assessment tools used for Ryan were the Bayley Scales of Infant Development-

3rd edition and the Hawaii Early Learning Profile (HELP). The Bayley is a norm-referenced

standardized test that helps determine eligibility, based on Ryans results of this assessment he

displays a global delays and qualifies for early intervention services. The second assessment, the

HELP, was used as a curriculum based assessment that is an in-depth assessment that determines

a child's current level of functioning and progress over time. It is important to administer both of
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these assessments in order to see a full picture of an individual childs development, as it allows

professionals to determine the best course of intervention and what areas are of concern and need

the most support.

Bayley Scales of Infant Development-3rd edition

Subset Total Raw Percentile Scale Score Composite Developmental

Score Rank Quotient

Cognitive 42 16 7 85 72

Language 7-Expressive <0.1 1- E 50 27- E

8-Receptive 2- R 22- R

Motor 26-Fine 5 4- F 76 55- F

45-Gross 8- G 77- G

Social-Emotional 48 0.4 2 60 N/A

Adaptive 9- Com 4 2- Com 74 N/A

Behavior 0- CU 7- CU
0- FA 6- FA
6- HL 7- HL
19- HS 8- HS
20- LS 7- LS
23- SC 3- SC
32- SD 11- SD
20- Soc 4- Soc
55- MO 13- MO
68=sum
Adaptive behavior includes: communication (Com), community use (CU), functional pre-
academics (FA), home living (HL), health and safety (HS), leisure (LS), self-care (SC), self-
direction (SD), social (Soc), and motor (MO) scales.
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Summary:
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Ryan was 15 months and 25 days old when the Bayley was administered. When Ryan

was given the assessment, he sat in his highchair and was given standardized items, based on the

test protocol, to interact with. He was put in his high chair so he would be able to focus and

interact with the specific toys he was given rather than his own toys. Placing him out of reach

from his personal toys limited distractions during the assessment. Ryan showed a score of 85 on

the cognition subset, which indicates that he is within the typical range. Ryan showed other

global delays in language, motor, social emotional, and adaptive behaviors, which qualified him

for early intervention services.

Although he had receptive language difficulties, he was able to respond to sound and stay

engaged with an activity for over 60 seconds He also expressively uses gestures to communicate,

for example, he shakes his head for no. when it came to his fine and gross motor Ryan showed

some emerging skills such as: flipping through a book (fine), moving from a sitting position to a

standing position without assistance (gross, and he is able to take steps backward (gross). Ryan is

still working on scribbling on a paper (fine) as well as walking down stairs (gross). Lastly, in the

social emotional and adaptive behavior scales, Ryan showed a lack of interest in others around

him as he plays and his mother reported that he would rather be alone. We are working with him

to help him be more engage with others and participate in more turn-taking activities with others.

Some of these areas were not assessed due to the childs age.

Hawaii Early Learning Profile (HELP)

The HELP was given to Ryan when he was 18 months and 1 day. He was observed in his

natural environment as he played with his own toys. He was also given the opportunity to use
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some of the toys from the Bayley kit when his mom was unsure if he was able to accomplish a

targeted skill. The majority of this assessment was based on the mother's report of skills; yet, we

were able to see him perform some of the skills independently. This assessment is intended to be

used to monitor progress, so we will continue to use this throughout his early intervention

services and update newly acquired skills to the assessment as Ryan proceeds in his

development.

Hawaii Early Learning Profile- Results

Strand Raw Score Number Completed

Cognition (+) 10 22/93

(+/-) 2
(-) 10

Language (+)16 25/129

(+/-) 4
(-) 5

Gross Motor (+) 6 8/151

(+/-)2

Fine Motor (+) 28 32/104

(-) 4

Social Emotional (+) 30 57/113

(+/-) 16
(-) 11

Self-Help (+) 28 45/95

(+/-) 9
(-) 8

Total 189/685
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Regulatory/ (+)6 11/32

Sensory (+/-) 4
Organization (-)1

Cognition

The cognitive domain involves a childs intellectual skills. The cognition subset of the

HELP focuses on the development of symbolic play, the ability to imitate gestures, sound

awareness and location, problem solving, means-ends, cause and effect, spatial relationships, and

picture and number concepts.

Ryan was able to engage in symbolic play by engaging in simple relational play uses

such as: brushing a dolls head and scooping a spoon in a cup. Secondly, Ryan was able

to understand cause and effect when he rides his tricycle, since he knows that when you

turn the handle, the bike moves in a new direction. We will continue to work with him to

engage in symbolic play as well as looking for objects that go outside his field of vision.

Language

The language domain involves a childs understanding of information and how they

communicate information. The language subset of the HELP covers multiple areas such as:

verbal communication, learning grammar and sentence structure, development of sounds and

intelligibility, communication through rhythm, understanding the meaning of words,

understanding and labeling body parts, understanding and following directions, expressive

vocabulary and communicating with others.

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Ryan showed an increase in expressive language, for example, he babbles to people and

he shouts to get others attention, he has also been using the work mama to get his

mother's attention. We will continue to encourage him to use expressive language

through gestures, vocalizations and word approximations.

Ryan has shown an increase in his receptive language, he is able to responds to simple

requests and understands the meaning of no. He is also acknowledging a few verbs and

nouns such as, bottle (n), food (n), eat (v), and car(n). We will continue to encourage him

to engage with a speaker as they talk as well as increase him understanding for more

objects and words.

Gross Motor

The gross motor domain involves a childs larger movements and coordination of the

limbs. The gross motor subtest of the HELP focuses on: standing, walking/ running, jumping,

climbing, stairs, throwing, catching, riding and tricycle, and balance beam.

Ryan showed growth in his gross motor skills, he is able to bend over and look at his

legs, walk backward and even run with his brothers. He is also attempting to ride his

tricycle and push the pedals with his feet.We will continue working on helping him

demonstrate more balance, kicking balls and climbing up and descending from stairs.

Fine Motor

The fine motor domain involves a childs smaller movements and coordination with their

hands, fingers, and eyes. The fine motor subset of the HELP focuses on a number of skills
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including: visual responses and tracking grasp and prehension, reach and approach, development

of release and bilateral and midline skills.

Ryan showed growth in fine motor skills such as: grasping a toy or bottle, transfer objects

between hands, and reaching for objects with one hand. He is able to stack two blocks on

top of each other, but struggles with adding a third one on top. He is beginning to watch

adults scribble and imitate the scribbling movements. We will continue to work on

scribbling, placing multiple blocks on top of each other, and placing objects into a

container.

Social Emotional

The social-emotional domain involves a childs ability to control emotions and hold

positive relationships with others. The social emotional subset of the HELP focuses on areas

such as: attachment/separation, development of self, expression of emotions, learning rules, and

social interactions and play.

Ryan has been showing growth in his social emotional development. According to his

mom, he is establishing more eye contact, shows anticipatory excitement, enjoys physical

contact and tactile stimulation, recognizes familiar faces, explores adult features, shows

preference of toys, and smiles when socially approached. He is beginning to show

independence and recognize and socialize with strangers. We will continue working on

engaging in more turn-taking activities as well as interacting more with peers during play.

Self-Help

The self-help, or adaptive, domain involves a childs ability to change and independently

function in their home or community. The Self-Help subset of the HELP includes developmental
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skills such as: oral-motor development, dressing, independant feeding, sleep patterns and

behaviors, grooming and hygiene, toileting, and household responsibilities. Some of these areas

were not assessed due to the childs age.

Ryan has been showing improvement in his self-help skills such as: helping with his

dressing by putting his arms through his shirt and his legs through his pants, he is able to

remove socks and shoes without assistance, and holds a small cup with one hand and

bring it up to his mouth. He has emerging skills in mashing solid foods and bringing a

spoon to his mouth. He is beginning to show more interest in people and objects and is

displaying an increase in his attention when playing with a single toy. We will work on

having him engage more in brushing teeth, bathing self, and biting and trying new foods.

Reflection

The Bayley, is a standardized norm-referenced assessment that was used to determine

eligibility of early intervention services for Ryan. Since this test is standardized, it can be

described as a rigid assessment, involving unfamiliar objects, that is used to observe skills and

does not allow parent report. The Bayley provided us with a snapshot of Ryans functional skills

at the time of administration. It can only be administered one time, which is unlike the Hawaii

Early Learning profile (HELP), which is a curriculum based assessment that monitors

development over time, and can be based on parent report of skills and should be visited several

times throughout early intervention services. The HELP includes a regulatory and sensory

organization strand which differentiates it from the Bayley. Although the Bayley includes a few

simple questions regarding the sensory topic, professionals at our internship site have voiced that

it alone cannot pick up on sensory concerns. It would be more efficient for primary service

providers to administer the HELP because of the significant parent-professional collaboration

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component. Rather than asking the same questions over and over again, the primary service

provider should have a general idea of how a child performs in each strand if they have been

with the family for a few months. Even though these assessments are different, they can both be

used to determine Ryans need for specific services and the intensity of these services at any

given time. Overall, these assessments indicated Ryan has a need for services and that the main

focus includes his communication, social-emotional, and motor skills.

Through the administration process of these assessments we were able to administer them

in the natural environment, the childs home, as well as include the mother in the assessment

process and walk her through the meaning of this testing and the skills we were looking for. We

felt that it is important to inform the mother in the assessment process in order to help her

understand the reason for the services that Ryan might need. For example, Ryan had difficulties

with the language section on the Bayley, because of this we would want to focus on early

intervention services that promote language development. This process was a great experience

and helped us gain competency in administering assessments and working with families and their

children with special needs.

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References

Maccow, G. (2008). Bayley scales of infant and toddler development-third edition. Pearson
Education. Retrieved from http://images.pearsonclinical.com/images/PDF/Bayley-
III_Webinar.pdf

Warshaw, S.P. (1992-2013). HELP strands 0-3: Curriculum based assessment. VORT
Corporation.