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Child: Harlea M.
Date of Birth: March 7, 2006
Age: 8
RESPONSES/COMMENTS
-Difficult for her to sit still in her desk
for (child).
TEACHER INTERVIEW
noticed?
-Yes
trouble.
TEACHER INTERVIEW
-Soccer, baseball
CONCERNS OR MAJOR
RESPONSES/COMMENTS
PROBLEMS
What are your main concerns? Or
now?
RESPONSES/COMMENTS
Phys Ed, Art, Music, Science
subjects)
TEACHER INTERVIEW
What grades has (child) received in
88%
and ELA
Reading
What types of reading difficulties
does (child) have? Tell me about
these difficulties.
TEACHER INTERVIEW
Silent reading
Oral reading
Reading comprehension
Reading speed/fluency
Word reading
Decoding/word attack
Accuracy
Hear sounds in words
Yes
Mathematics
What types of math difficulties does
(child) have? Tell me about these
problems.
Difficulties with operations
(+,-,x, etc.)
Memorization or recall of basic
facts
Word problems
Oral problems
Numerical reasoning
Fractions, measurement,
geometry, time, etc.
TEACHER INTERVIEW
he/she does math problems?
Spelling
What types of spelling difficulties
Yes
sequences of letters
problems
-spell phonetically
sentences
Using correct words
Vocabulary
articulation
Receptive language
TEACHER INTERVIEW
TEACHER INTERVIEW
instructions and following them.
assignment?
No
about that.
No
home?
Yes, likes to talk out of turn. Doesnt
Does (child) need a lot of
supervision?
acts impulsively.
Yes, has organizational issues (loses
assignments).
TEACHER INTERVIEW
of time? A long period of time?
Yes
TEACHER INTERVIEW
recently. Ha greater difficulty
Does (child) often ask to have
questions repeated?
Usually because she is very sociable
How does (child) attend to visual
to do with numbers.
numbers?
Perceptual Difficulties
What types of perceptual difficulties
Matching forms
Discriminating figure-ground
Identifying key letter, form,
TEACHER INTERVIEW
shape on a page
Recognizing letters or words in
different forms (lowercase vs.
uppercase, standard vs. italic)
Position of an object on a
page/room
Appreciating relative sizes,
overhead?
Keep place on page while
reading
TEACHER INTERVIEW
- visual (with limited text)
Homework
How much homework does (child)
typically have?
- look at pictures
any way?
TEACHER INTERVIEW
finish them up with me.
-Sometimes I will give her more time
to complete assignments but
otherwise, I dont adapt or modify my
assignments in any way.
TEACHING STRATEGIES
What teaching or instructional
RESPONSES/COMMENTS
Large group
instruction/teacher lecture
Small group instruction
1:1 instruction (or individual
aide)
Independent seatwork
Independent hands-on
projects
Peer cooperative groups
Peer tutoring
Manipulatives
Graphic organizers
RESPONSES/COMMENTS
-She is okay with a work partner or
his/her classmates?
TEACHER INTERVIEW
In larger groups and with the class,
she can become quite loud and
distracting
Does (child) have many friends?
She has a couple of friends in her
Do the children include (child) in
class.
academic struggles.
-If she is feeling picked on, she will
argue with those kids. Otherwise,
(child) in general?
TEACHER INTERVIEW
Does (child) have social &
disruptive.
Give up easily
Anger easily (with no obvious
cause)
Fear trying new things
Lie or cheat
Have problems losing (in
games)
Show over controlling
tendencies
Prefer the company of
younger children
Prefer to be alone
Have difficulty waiting for
his/her turn
Frequently interrupt other
children
Fight, hit or punch other
children
Always tell other children what Sometimes
to do
Yes
Yes
Yes
No
Sometimes
Sometimes
No
Yes
TEACHER INTERVIEW
easily
Refuse to participate
Yes
No
Sometimes
No
Yes
Yes
RESPONSES/COMMENTS
Waiting your turn, raising hand
classroom?
TEACHER INTERVIEW
it off)
What classroom activity is
usually going on at the time of
the behaviour
How does the behaviour affect
classroom
How long does the behaviour
last
How often does it occur
How many other children in
problem
How does the level of the
worse
What makes the behaviour
better
TEACHER INTERVIEW
behaviour occurs?
plan/contract
Class social skills instruction
Peer buddy
Self-monitoring
Class rules/behavioural expectations,
Day-sheets (daily report cards)
Time-out
token/reward system, individual
TEACHER INTERVIEW
Other accommodations
student plan/contract
behaviour?
reading/writing
TEACHER INTERVIEW
No
Id appreciate your comments about any type of special services (child) is
receiving or you feel are needed.
SPECIAL HELP/SERVICES
RESPONSES/COMMENTS
- Sometimes I assign more time for
IEP
Remedial Instruction
her to complete an exam or extend
Speech & Language services
Accommodations
due dates on some of her
Guidance/counselling services
Mental health services
assignments
Social skills training
Social worker/Family School
Liaison
Other?
TEACHER INTERVIEW
beneficial for her to continue.
STRENGTHS
What are (childs) strengths?
RESPONSES/COMMENTS
- Very sociable, energetic, creative,
friendly, enthusiastic, athletic
helping (child)?
Are there any questions you would like to ask? Or any other information you
think is important or would be helpful.
NO
TEACHER INTERVIEW
SUMMARY
*Brief review of salient points
I just want to briefly review what we discussed
General functioning
Main concerns
Academic performance & Teacher strategies
Relationship with Peers
School Behaviour Problems
Special services
Transition plan
Strengths