C Case History (Sammy) continued:

MOTOR DEVELOPMENT


1. Developmental Response


At what age did your child reach the usual developmental milestones?


Sitting?______6 months__________


Crawling?____10 months____________


Walking?____11 months_____________


Talking?___12 months_______________


YES NO COMMENTS


Does your child lack adequate protective reactions when falling _____ __no___


____________________ 2. Muscle Tone Does your child: Have a grasp of a crayon/ pencil that is less mature than his peers? __yes _____ ____fisted_____________


Have good balance? __yes__ _____ ______________________


Drool? __yes___ _____ __stopped 6 months ago


Have any diagnosed muscle pathology (i.e., spasticity, flaccidity, rigidity, etc.)? _____ __no___ ____________________________


Seem weaker or stronger than normal? _____ _no __ ____________________________


Frequently grasp objects too lightly/strongly? _____ _no___ ____________________________


Tire easily? _____ _no___ ____________________________


3. Coordination


Does your child:


Manipulate small objects easily? __?___ _____ Doesn't play with toys yet spins tiny objects


Seem accident prone (i.e.: have frequent scrapes and bruises)? __yes __ _____ Not aware steps on people


Eat in a sloppy manner? __yes___ _____ ___________________________


Have difficulty with pencil activities? _____ _____ Not interested


Have difficulty with dressing and/or fastening clothes? __yes___ _____ ___________________________


Have a consistent hand dominance? _____ __no___ Switches, maybe right______


S ENSORY DEVELOPMENT


1. Tactile Sensation


Does your child:


Object to being touched? _____ __no___ ___________________________


Dislike being cuddled? _____ __no___ ___________________________


Seem irritable when held? ___yes__ _____ Doesn't sit still for long periods


Prefer to touch rather than be touched? __yes___ _____ ___________________________


React negatively to the feel of new clothes? _yes___ _____ ___________________________


Dislike having hair and/or face washed? __yes__ _____ This has become very difficult


Dislike having teeth brushed? __yes__ _____ ___________________________


Dislike having nails clipped? __yes__ _____ Do it when he is asleep


Prefer certain textures of clothing? ___yes__ _____ Soft cotton cloths no tags


Avoid certain textures __________yes________ _______________-


Isolate self from other children? ___yes__ _____ Not really interested in other children


2. Vestibular Sensation


Does your child:


Dislike being tossed in the air? _____ __no__ ___________________________


Seem fearful in space (i.e.: going up and down stairs, riding teeter- totter)? _____ _ no____ ___________________________


Appear clumsy, often bumping into things and/or falling down? ___yes__ _____ Sometimes he will walk right through you.


Prefer fast-moving, spinning carnival rides? __ yes___ _____ Likes them


Avoid balance activities? _____ _ no____ ___________________________


Spins self? __yes___ _____ A little but prefers to spin objects


3. Olfactory Sensation


Does your child:


Explore the environment with smell? _____ _____ Don't know!


Discriminate odors? _____ _____ Don't Know!


React defensively to smell? _____ _____ Not observed!


Ignore noxious odors? _____ _____ Doesn't notice the babies dirty diaper


4. Gustatory Sensation


Does your child:


Act as though all food tastes the same? _____ _no___ Very picky!


Explore by tasting? _____ __no___ Will touch things and gag!


Dislike foods of a certain texture or multiple textures? _____ _____ Don't know


Avoid or crave certain temperatures of food? _____ _no____ ___________________________


V ISUAL SENSATION


Does your child:


Have difficulty maintaining eye contact? __yes___ _____ ___________________________


Have a diagnosed visual deffect? _____ ___no__ ___________________________


Make reversals when copying? _____ ___no__ Doesn't draw__________________


Have difficulty discriminating colors, shapes? _____ _____ Used to be very interested in letters and #'s


Appear sensitive to light? __yes___ _____ Squints in sunlight___________


Become over excited when confronted with variety of stimuli? __yes___ _____ In mall gets overwhelmed.______


Have an attraction to spinning objects or vertical and horizontal lines? __yes___ _____ Wheel and toys, spinning tops


Explore objects using peripheral vision? __yes__ _____ Holds objects to side of his eyes____


Squint or close one eye when looking at things? __yes___ _____ Occasionally ____________


Appear not to notice things in their environment or focus on minute detail? __yes___ _____ Into minutia at times__________


AUDITORY DEVELOPMENT


Has your child experienced any problems with his/her hearing? (operations, infections, tubes)


First ear infection was at 6 months. He had frequent infection for the next 18 months. Just when we were considering tubes the ear infections stopped. He now get sinus infections which clear up with anti-biotics


Ear infections? seldom________ sometimes________ often__X______ mild__________ moderate____X_____ severe_______



Has your child had his/her hearing tested? If yes, what were the results?


Yes Normal_______________________________________________


Are there any current/past hearing problems of which you are aware? ___NO________