DRAFT: This module has unpublished changes.





Bureau of Early Intervention
Division of Family Health
New York State Department of Health
Corning Tower, Room 287
Albany, New York 12237-0660
518-486-1090 (FAX)



Name:  Kyle T.  Swaby                                              Parent(s):  Roxanne and Carl Swaby


Date of Birth:  January 5, 2009                                 Date of Evaluation:  April 2, 2012


Chronological Age:  3                                               Location of Evaluation:  665

                                                                                    Mother Gaston Blvd. Brooklyn,

                                                                                    NY, 11212



Reason for Referral:  Kyle was referred to the agency by his pediatrician out of 


concerns for his delayed speech and also upon recommendations of his parents.



Back Ground Information:

 Kyle T. Swaby was born on January 5, 2009 to Roxanne and Carl Swaby.   His weight at birth was 7lbs 2 ounces.   His mother had a normal full term pregnancy at the age of 28 with no major complications.   His parents are concerned because at three, his vocabulary is less than 200 words with less than 50% intelligibility.  It is recommended that at three years of age a child should have a vocabulary of at least 600 words with 80% intelligibility to a listener who does not know the child.  Although his weight was normal at birth, he was hospitalized for jaundice.  Since his birth he has suffered numerous ear infections which may have contributed to his speech delay.


Health History: 

Kyle is a fairly healthy child; however a history of ear infections may have contributed to his delayed speech.

Previous Assessment Information:

The previous assessment information that was done using the lists of assessments listed below indicates that Kyle needs assistance in his speech development.  References of this information are summarized in the background information.  Kyle’s vocabulary is very limited and he needs assistance with his social skills.

Observation of the Environment:

After visiting the home of Kyle the following observations were made.

  1. The home environment was conspicuous.
  2. There was no evidence of child neglect.
  3. There was adequate space available for the child.
  4. Parent and child interaction was excellent.

Behavior Observations:

Kyle seems to be a very happy child.  When the observation was conducted, he was seen playing with his toys and acting like a typical three year old.  His social interaction was very limited at the time of observation and he appeared to be very shy.

Tests and Interviews:

List of Assessments administered:

  • Child Behavior Checklist
  • Social Development History
  • Modified Checklist for Autism in  Toddlers -  M Chat
  • Communication and Symbolic Behavior Scales

Assessment Results:

Child Behavior Checklist

Cognitive Domain

The child behavior checklist reveals that Kyle uses baby talk constantly.  He is behind in his verbal skills, jabbers a lot and most of his words are not understandable.  When a word is said and he is asked to repeat, it sounds much differently than the word that was spoken He seems to try very hard to speak clearly but finds it extremely difficult to articulate what he wants.  In addition the child behavior checklist reveals that most of the words that he uses are basic survival skills words such as “mummy”,   “food”, “juice, and “milk”.

Physical Domain

Physically, Kyle is developing normally when compared with a child of his age. 

Social Emotional Domain

Kyle is a very humorous child.  However, he gets frustrated easily because of his inability to articulate what he wants.   His demands must be met immediately.   He has temper tantrums most of the times and resorts to hitting people and hurting animals. 

Self-Help Domain

In terms of helping himself, Kyle is mostly independent.  He does not seek help constantly in doing what he wants.  He plays with his toys with no assistance.




Social Development History

Cognitive Domain

Based on the results of the Social Development History Questionnaire, Kyle spoke his first words between 7-12 months.  He spoke short phrases that are were not very clear between 13-18 months, however at the age of three he is unable to speak short sentences. 

Physical Domain

Kyle crawled between 4-6 months.  He walked alone between 13-18 months and walked upstairs between 19-24 months.  At the age of three he is now fully bladder and bowel trained although he has accidents at times.  In addition to this the questionnaire reveals that his gross motor skills are developing normally.  He is able to jump and run and perform other activities that involve the use of gross motor skills.  However his fine motor skills have not yet developed fully.

Social Emotional Domain

It must be noted that during infancy Kyle was not easily calmed by being held or stroked. He was very colicky and difficult to comfort.   Kyle is easily distracted. He does not deal with transition well and as a result throw things when he cannot get his way.  Although Kyle is a happy child he gets upset easily.  When playing with children in the neighborhood he frequently whines or cries. He has difficulties sitting still at meal times, paying attention when read to and staying focused on TV, movies or video games.

Self Help Domain

The only self help skill that was revealed by this assessment is Kyle’s ability to pack his toys away.


Modified Checklist for Autism in Toddlers

The modified checklist for autism in toddlers was administered by Kyle’s mother.  All the questions in the checklist were simple questions which focused on the social-emotional aspect of his development.  Bases on the M-CHAT scoring instructions Kyle passed the most critical items hence he does not meet the criteria for diagnosis on the autism spectrum. 

 Communication and Symbolic Behavior Scales

Cognitive Domain

Based on the results of the CSBS, Kyle uses over eight consonant sounds.  Without gestures Kyle understands between 11-30 words.  Kyle also uses between 11-30 words that can be recognized easily for example “baba” for bottle.  In addition he sometimes put two words together. 

Physical Domain

The results from the assessment reveal that Kyle is able to use some objects such as cup, bottle, spoon, appropriately. He is able to stack about 3 – 4 blocks.  He sometimes nods his head to indicate yes. 

Social Emotional Domain

Based on the results of this assessment Kyle often time expresses when he his happy and when he is sad.  He often smiles and sometimes shows interest in playing with a variety of objects.  He also shows a wide variety of emotions.

Self Help Domain

The results of this assessment indicate that Kyle practices self help by feeding himself.  He tries to dress himself by brushing his teeth and putting on his clothes.

As a part of the intervention process I will put the following IEP goals in place.  Under each goal I will be listing three objectives.


Having conducted a thorough assessment on Kyle, it is evident that Kyle is progressing normally when compared to a child of his age range.  His gross motor skills are developing normally.  However, it is quite apparent that he has difficulties with his speech.  In addition his social skills need to be developed.  


The following recommendations by the assessment team in the form of IEP goals will be implemented.


GOAL 1:  Kyle will demonstrate improvement in his ability to communicate socially with his peers by enrolling in a pre-school.

  • Kyle will be enrolled in a pre-school for three days per week for three hours per day. During this period Kyle will engage in activities such as playing word games with his peers with the assistance of his teacher enhancing his social interaction skills.
  • Using picture word association Kyle will be introduced to a minimum of three new words daily during one and one interaction with the preschool teacher over a two week period.
  • Using a variety of labels specifically tailored for Kyle around the classroom, Kyle will be given 4/5 opportunities to pronounce the word.


Goal  2.  Kyle will demonstrate increased ability to use language skills to build vocabulary for familiar activities.

  • With the use of nursery rhymes Kyle will develop his vocabulary.  To accomplish this goal Kyle will select a nursery rhyme from two choices placed within his reach in response to the question “Which book would you like to choose?” 4/5 opportunities over a two week period.
  • With the use of nursery rhymes Kyle will choose his favorite rhyme as  apart of building language skills and vocabulary.  He will recite rhymes 5/5 opportunities over a two week period,
  • With the use of  nursery rhymes Kyle will identify the characters in the nursery rhyme by pointing to them and saying their names without any prompting 4,5 opportunities over a two week period.

GOAL 3.  Kyle will demonstrate improvements in his ability to express his needs and wants without frustration and anger.

  • With the assistance of a speech therapist Kyle will be introduced to five new words once a week, for two weeks that will express his needs and wants.   Kyle will indicate that he is making progress by pronouncing the words 4/5 opportunities.
  • Using short sentences Kyle will verbally respond within 10 seconds to a request from an adult with no additionally prompting. 
  • While seated at a table, Kyle will use pictures as symbols to articulate five new words introduced by his mother once a week over a two week period.


Goal 4.  Kyle will use a word wall to identify words used on a daily basis and throughout the day.

  • Using a word wall Kyle will begin by adding his names and the names of his special friends.  Kyle will choose his names from among other names and place it on the word wall within five seconds of the prompt leaving his seat 4/5 times a week over a two week period.
  • Using a word wall Kyle will add to the word wall by placing basic sight words after identifying the letters and sounds of the words that were called 4/5 times a week over a two week period.
  • Using the word wall Kyle will read and attempt to write two friends name of choice within 5 minutes 4/5 opportunities over a two week period.

Signature and Titles of Evaluators:


NAME                                                POSITION                             SIGNATURE

___________________                      Parent                                      ________________


___________________                      Parent                                      ________________


___________________                      Student                                   ________________


___________________                      Regular Ed, Teacher               ________________


___________________                      Special Ed, Teacher                ________________


___________________                      Local Ed. Agency Rep.          _________________


__________________                        Community Agency Rep.       _________________


__________________                        Speech Pathologist                  _________________


__________________                        Reading Teacher                     _________________


__________________                        School Psychologists              _________________















DRAFT: This module has unpublished changes.