Identifying Data

Name: Zella C. Cuago

Address: Airport Road, Purok 4, Booy District , Tagbilaran City
Date of Birth: September 13, 2005
Parents: Mr. Eugene Cuago and Zosima Cuago
Grade: Level 2 – Inclusion Class
School: iSPED@HNU-Innovative Special Education at Holy Name University
Teacher: Ms. Melchora Madronero

Background History/Family History

Zella is the eldest of the two siblings. Both her and her yonger brother is enroled in our SPED program. Both she and her brother has
learning issues but Zella is the most. According to her mother, she took a medicine to avoid miscarriage during her pregnancy of Zella and her younger brother. Both
Zella’s parents are busy working. Her mother run a bussiness and her father is the government empoyee. Thus, they usually left by the nanny.
Zella has a siezure and often get sick since child. She is talking “Depakin” for anti siezure as her maintenance. She learned to walk at the
age of 3 years old and start to talk with few words when she was 4 years old. Zella still has speech issues until now. Zella is generally late in development and has mild
mental retardation.

Different Learning Areas

I. Self Help

Eating & Drinking Skills

Zella eats the same food most often. She is choosy when it comes to food. She doesn’t really like to eat different kinds of foods. Usually her mother prepares the food
she only likes to eat barbecue, chicken and pork adobo.
Zella can manage to eat alone when food is served already in the table. She uses spoon in eating but does not know how to use know how to use fork and knife to cut a
certain kind of food. She can prepares simple food for eating when she feels very humgry already and she can manage to eat with a very little spilling. She swallows
food in mouth before taking another bite. If the food is in the container she can open the container and removes the food from the container.
Zella could not manage to drink water from fountain, she needs to have assistance in doing so. She can refill glass from a container using handle without spilling like for
example putting juice into glass from a pitcher.

Toileting Skills
Zella can really distinguish between urination and bowel movementand able to wash her butt after discharging. She goes toilet by herself without asking assistance with
her family members. Before leaving the bathroom she knows how to put on or dress her clothes like shorts and undies and knows to adjust if it is not properly wear. After
using the toilet, Zella washes her hands in the lavatory with the use of liquid soap and dry hands using towel.

Grooming Skills
 Zella doesn’t have problem when it comes to grooming skills because she can manage to turn water on/off, washes her face using bath soap. She can also manage
washing hair using her fingers and rinse her body areas. In cleaning her finger nails and cutting nails both hands and feet, Zella needs more assistance and couldn’t
apply soap with her clothes and washed it.

Dressing Skills
Her dressing skills need more assistance when it comes on what to wear unless being told. She puts hand through both armholes of front-opening of clothing, pushes
arm into second sleeve and pulls clothing to shoulders. When it comes to brushing she needs other person who can assist her in putting toothpaste on her toothbrush
and brushes after meals as designated times.
She can hold a pencil in a tripod grasp and hold tight and could write her fulll name, but not in the blue to blue line.
She can rolls clay into snake shapes/into ball. And can cuts paper with scissors following straight curved. Zella can also cut cloth with scissor and is able to cut small
squares, triangle and circle and able to cut out complex pictures with scissors.
She can manage to fold paper in half with edge meeting.

II. Motor Development

Gross & Fine Motor/Visual Discrimination Skills
She can excellently strings both small and large beads and can roll clay into snake ball shapes. She can cut out complex pictures following outline but could not match
look alike words. Zella can manage to match three primary colors red, blue and yellow colors and know the concept of colors yet could not match simple and
complicated puzzle.
In areas of gross motor skills, she can walked 10 feet pushing a type of object. She walks but would not like to run, she can stands in tip toe for 5 seconds and walk
down stairs carrying an object, she can also maintains momentum in swings. Zella can also rides in tricycle without bumping into obtacles but couldn’t manage to hang in
bars using overhand grip.

Sensory Perception Skills

Zella can easily determines through tactile cues whether that object is hot cold, wet or dry and she can match object according to shapes such circle, rectangle or
triangle. Zella can able to group objects small or big and able to choose objects long or short yet she cannot determine whether that object is rough or smooth and hard
or soft. Zella likes cutting papers or clothes and anything in her reach, she can already determine whether the scissor she is using is sharp or dull.

Auditory Perception/Listening Skills

Zella can identify sounds, whether it is loud or soft, but sometimes she don’t answers to questions concerning message spoken for less than one minute but she’s able
to identify different roles as being high or low sounds. She can categorize sounds sounds and responds to two simple successive commands in order, like when she is
asked to buy a certain food in the store and after that she was asked by her older sister to get the umbrella in their cousins’ house. Zella can respond to simple
successive commands in order. She is able to repeats simple words too. And is able to repeats rhythm and melody but when it comes to listening a poem, she would not
able to repeat it. And also with three to four successive commands and tasks implied not specifically in spoken language or message.

III. Communication Skills

Language Comprehension Skills
Zella can responds correctly verbally and orally to physically stated questions, she can point to places objects up, down, on, in, out, under over, top, and bottom as well
as the functions too. But she cannot perform appropriately pronouncing words which are less common to her in their home. Furthermore, Zella can answer specific
questions based on spoken materials but cannot correctly responds to questions to questions concerning abstract concepts.
 Language Skills
Zella has difficulty in dealing with language skills such as using plural, verb and noun. Although she can already determine some of the common nouns she often hears,
still she has difficulty in asscociating it with verb. She also has difficulties using pronouns like I, him, he, her and she appropriately. But she can already identify simple
nouns such as dog, flower cat and other things that he usually and often sees in the surroundings. She can answer verbal questions using simple words or simple
phrase but not yet in a sentence form.

IV. Social Skills

Adaptive Behaviors
Zella is friendly to other people who surround her. She plays game with another person. She also like to do activities and relates it with another new activity. She also
does activities voluntarily, and if she failed or she encounter failure in her activity she tries again and remains calm if group norm in moderate structured situation. Even
in routines, she adjusts herself if alternatives are presented. With regards to her social skills, Zella was really trained well with her teacher.

Responsible Behaviors
Zella does not have much problem with regards to responsible behaviors. She can sit quietly for one minute when listening to stories, music or even beyond one minute
she could still remain seated. She take turns in game activity in 25-50% of time. She can also depend on ownership possessions verbally with minimum physical
expressions. If she is told to quiets down after activity period she will also follow. She follows directions also provided by authority figure. She also follows if she you
would give her tasks as long as you would give her clear instructions. In doing activities when she’s done with the materials or objects she used, she will return it to
where she got it or whenever she is aks or told to return it. But sometimesduring games, she has difficulty of following of following rules and she need to be instructed
clearly with those rules.

Inter-Personal Relations
When it comes to her inter-personal relations with her peers, she mingled with them but is somewhat limited to those who are close to her. During playtime, she watches
others play and later on joins with the group fo a few minutes. She also exchanges toys or items during playtime but is sometimes along with adults during play.
Zella cooperates with other children during play and shares toys with other kids. She doesn’t play simple competitive table nor cooperates in group games with rules and
she doesn’t play difficult games requiring knowledge of rules either.
On the other hand, Zella shows sympathetic behavior, she sometimes offers voluntarily and behaves in a courteous manner to others especially to her parents and older
sisters. Zella often shows affection familiar people too but sometimes don’t show comfort to playmates in times of distress. Lastly, Zella do protects animals and she
always shows it to her cat pets at home.

Social Manners
With regards to social manners, Zella needs more practice or training to perform certain things in proper manner. She needs assistance or reminders in doing things and
what’s good to her is that, she knows how to follow. She says, “thank you” “please” with request when appropriate.
While during meal times or eating times, she eats most food in a tidy manner. She cleans up spills if she is told to do so. She seldom use napkins to to wipe hands,
mouth during or after meal. But she can stay modest in sitting on her chair, and she remains quiet when others are talking. She also say excuse me when she wants to
interrupt. On the other hand, Zella has the difficulty to initiate topics in converstaion appropriate for the solution, takes dirty dishes to designated area, adjust responses
or actions to type of call doo or telephone and addresses people with correct title.

V. Learning Cognitive
Math skills
In this area, Zella finds difficulty with Math concepts. Though she can counts orally to three, and little knowledge in sorting objects according to shape, size, length and
locating big and little objects in groups of two. In addition to that, she can match or arrange in objects in order of size from smallest to largest with assistance, she cannot
really constructs set 4, 5, 6, 7, 8........ and so on. Though she can counts orally to ten. She cannot locate objects of given numbers in groups of ten, more so in locating
the first, middle, and last group of object. Zella also has the difficulties in distinguishing today, tomorrow and yesterday of the week and also finding group in succession.
She really can’t write the numerical figure but she can counts orally. She cannot read and write numerals up to 49 and can’t locate day of week on calendar.

Reasoning Skills
Zellla has the difficulty sorting objects according to size, shape and color. Zella has the difficulty sequencing simple pictures and identifying them and so with determining
the length and width of an object and much more also on categorizing them as to the size of the particular object.

Writing Skills
Zella has difficulty when it comes to writing. Although she can hold a pencil in a tripod grip, she doesn’t have enough skills to write because she cannot hold a pencil
tightly. She can write her full name but not following the blue to blue line. She can ably draws vertical cross line between two parallel lines, lines, triangle, square with
adult’s supervision. She could not draw recognizable face with eyes, nose and mouth.

I. Eating and Drinking Skills

Terminal Objective: A) To perform priritized task related to eating and drinking.
Enroute Objectives:
1. To serves self at table.
2. Know how to use fork in eating together with the spoon.
3. To liquid from one cup to another without spilling.
4. Drink from water fountain without aid of adult.

II. Fine Motor/Visual Discrimination Skills

Terminal Objective: B) To engage and perform art activities enhancing fine motor skills.
Enroute Objectives:
1. To rolls clay into snake shape and ball shape.
2. Put together simple puzzles.
3. Builds tower of a block and more.

Terminal Objective: C) To perform activities enhancing and developing visual discrimination.

Enroute Objectives:
1. Places small pegs in holes on boards.
2. To match six colors or more.
3. To spread paste on one side of paper and turns over to stick it to anothe rpaper with less assistance.
4. Places key in lock and open lock up to 85% effectively.
5. Make live visual discrimination through watching letters that look very similar.
 6. To identify lokk alike words correctly up to 90%.

III. Gross-motor Skills

Terminal Objective: D) To engage in activities developing gross motor skills.
Enroute Objectives:
1. To jump 2-feet distance feet together.
2. To runs a 20-feet distance.
3. To runs through obstacle course avoiding objects.
4. Hangs from bar using overhand grip for 5 seconds.

IV. Writing Skills

Terminal Objective: E) To engage in writing activities.
Enroute Objectives:
1. To write first name with less assistance.
2. To write last name with less assistance.
3. To write owns full name with less assistance.
4. To write the letters of the alphabet A-Z with adult assistance
5. To write numbers 0-9 with less assistance.
6. To draw diamond, square, triangle, circle, rectangle, copying model or imitating.
7. To print simple words copying models.
V. Toileting Skills
Terminal Objective: F) To engage in toileting skills
Enroute Objectives:
1. Ask location for bathroom in new situation.
2. Wash butt after discharging.

VI. Grooming Skill

Terminal Objective: G) To perform prioritize task related to self care responsibility.
Enroute Objectives:
1. Disposes or hangs towel after using when requested or on own.
2. Applies soap to cloth.
3. Uses towel to dry body after washing.
4. Cuts own nails on hand and feet.
5. Cleans finger nails using brush.

VII. Dressing Skills

Terminal Objective: H) To performed prioritized practical task related to grooming.
Enroute Objectives:
1. Pinches Tissue off end of nose.
 2. Rinses mouth out without swallowing water, spits, into sink
3. To brush teeth with less assistance.

VIII. Inter-personal Relations

Terminal Objective: I) To engage in socialization skills involving play.
Enroute Objectives:
1. Plays puzzle with adult
2. Shares toys with other children

IX. Sensory Perception Skills

Terminal Objective: J) To perform prioritized task related to sensory perception.
Enroute Objective:
1. Match objects that are circular, triangular and rectangular through tactile cues.
2. To match like objects sticky and non-adhesive through tactile cues.
3. To match objects that are rough and smooth.
4. To match objects that are hard and bound.

X. Auditory Perception/Listening Skills

Terminal Objective: K) To developed auditory skills through listening.
Enroute Objective:
1. To categorized sounds.
2. To carries out 2 simple unrelated successive command in order.
3. To tell recently told story maintaining original sequence.

XI. Language Comprehension Skills

Terminal Objective: L) To enhance language and communication skills.
Enroute Objectives:
1. Responds correctly and non-verbally to questions concerning abstract concepts.
2. Answers specific questions based on spoken materials.
3. To ask questions usin why, where, who and when.
4. To answers specific questions based on spoken materials.

Name: Zella C. Cuago Date: January 31, 2014

“Mental Retardation Checklist”
Name of Person/s Completing the Checklist: Address: Airport Road, Purok 4, Booy District,
Melchora Madronero Tagbilaran City

Relationship to Student/Client: Teacher Students age: 11 years old

 Each item that applies to the child or adolescent should be check off using the following rating scale:

0- Not at all

1- Mild, sometimes observed, applies to some extent

2- Moderate, oftenobserved, certainly applies

3- Severe, frequently, strongly applies

Please use 0 to indicate that an item has been considered and does not apply. If the 0 is not checked, it is not clear if the item is overlooked.

Early Development Delay 0 1 2 3

Was slow to learn to walk √
Was delayed in achieving physical milestone √
Was later than usual in achieving toilet training √
Needs more help than usual for a child or adolescent of same age group
Needs more help than usual with personal hygiene √
Needs more adult guidance with regard to organization √
Needs more adult supervision with basic chores such as bed making √
Needs more adult supervision with regard to safety √
Needs more adult supervision with regard with money √
Needs adult guidance with regard to sexually explicit behavior √
Social Difficulties
Finds it difficult to make friends of own age group √
Often gets teased or bullied √
Is socially naive √
Is often too trusting of others, very gullible, at easily duped √
Is easily led or set up by others √
Is uninhibited does not realize when it is important to hold back √
Makes inappropriate friends √
Thinks someone is a friend when he/she isonly acquaintance √
Believe in Santa, tooth fairy, etc. Much later than peers √
Immature Play and Recreation
Often play with younger age group √
Often like toys, books, TV programs, or activities suitable for younger age group √
Gets frustrated and confused by age appropriate toys or games √
 Is physically rough or silly in organized games √
Assessment indicate well below average abilities √
IQ score less than two √
Scores two or more standard deviation below the mean on test intelligence
Additional Difficulties or Disorders
Speech and language and language less well developed than peers √
Physically clumsy √
Has additional difficulties or imparments, such as hearing or usual difficulties √
Classroom Difficulties √
Restless and inattentive in group activities √
Avoid school work √
Depends very much on others √
Needs a lot a teacher attention √
Gets distressed at uncooperative when tasks assigned E.O √
Does not ask for help (may not realize that he or she is on the wrong track) √
Learning Difficulties √
Makes very slow academic progress in comparison to peered √
Is significantly below standard in all curriculum areas √
Needs a lot of repetition to master new learning √
Needs concrete hands-on learning experience √
Needs explicit teaching √
Reading comprehension is poor even when accuracy is reasonable √
Finds abstract concepts difficulties √
Drawing and bookwork is immature √
A high level of effort does not produce expected expected outcomes √
Seems to be falling further at behind as time goes by √

Terminal Objective: A) To engage in activities related to personal hygiene.

Quarter Enroute Activity Procedures Objective Service Require Date Duration of Responsible Material Inst.
Objectives Criteria Strategy Initiated Services Person Accommodation
Evaluation
1st  To bath self (School and Home bound Instruction) Behavioral Checklist
Verbal Prompting June 7, August 31, SpED Teacher Pail with Providing pictures or
independently.  Prepare necessary materials. 2014 2014 (Ms. Melchora) Water Books on proper
 Bring the child to bathroom. bathing
 Tell her to take off the clothes. Soap
 Let her use the dipper I getting water (Safeguard)
inside the pail. Task Analysis
 Let her put water throughout the body. Shampoo
 Tell her to gently rub her body with her Oral Questioning (Vaseline)
hands and put soap.
 Let her wash again her body with Towel
water.
 Use shampoo into her hair.
 Let her wash again with water.
 Let her use towel in wiping her body.
 Praise her for successful activity.
2nd  To cut nails  Prepare nail cutter and 2 chairs. Task Analysis Minimal September 1, November SpED Teacher Nail cutter Extended time for
with Less  Model first the child in cutting nails. Prompting 2014 30, 2014 (Ms. Melchora) The activity
assistance.  Guide her in holding the nail cutter. Chairs
 Physically prompt her in cutting her Oral Questioning Verbal Prompting
nails.
 Tell her to cut one finger nail at a time Modeling
 Tell her to do it slowly.
 Let her cut the next finger nail, if she’s
doe with with the first one.
 As she continue with the flow just give
minimal prompting.
 Praise Zellal if she successfully do the
Activity.
3rd  To brush  Prepare the materials. Task Analysis Verbal December February SpED Teacher Glass Providing
teeth  Let her watch first a movie presentation/ Prompting 1, 2014 27, 2015 (Ms. picture/varied multi-
independently. Powerpoint presentation on proper Madronero) Water media
brushing of teeth. presentations
 Verbally prompt the child to get the Behavioral Toothbrush
toothbrush. Checklist Assistant (Oral-B)
 Tell her to put a little amount of Modeling Teacher
toothpaste on toothbrush. (Ms. Kudemus) Toothpaste
 Wet the toothbrush. (Colgate)
 Tell Zella to slowly brush her teeth from
upper to lower teeth. Towel
 After brushing, tell her to gargle water on (small)
her mouth from the glass.
 Tell her to spit water.
 Let her wipe her mouth with a towel. Movie
  Tell her to return the towel and return it, Presentation
and fold it. Materials
 Tell her return brush and toothpaste
where it was placed.

4th  To sweep  Prepare the broom and the dustpan. Event Sampling Minimal June 1, 2014 August 31, SpED Teacher Brooms Increase/promotion
floor with  Model first the child in sweeping the floor. with checklist Prompting 2014 (Ms. Madronero) To student
other  Let her do it with you after modeling. Dustpan independence
members of  Tell her to start at the back corner. (plastic if
the family.  Guide her to sweep going to the main Narrative Verbal Prompting possible)
door. Description
 Tell her to slowly sweep the floor
 Let her get the dustpan.
 Physically prompt her to hold the Frequency Use of plastic
dustpan near the garbage. Counts Modeling broom or dustpan
 Let her do with herself after modeling.
 Praise her if she is able to do the activity.
1st  To wash  After meal time let her help you washing Event Sampling Scaffolding September November Mother Plates Provide extra time
dishes with the dishes. with Checklist 1, 2014 5, 2014 (Mrs. Z. Cuago) for the activity
the other  Arrange first, plate and other utensils. Verbal Prompting Spoon/Fork
members of  Model first the child how to hold properly
the family. the utensil in washing. Behavioral
 Let her imitate you washing plate. Checklist Cups
 Tell her to wash utensils one at a time. Modeling
 Model first the amount of liquid to be put Glass
on the sponge. (utensils
 Tell her to wipe gently the utensils with Narrative must be
the sponge. Description plastic if
 After wiping it with the sponge, tell Zella possible)
to wash utensils with water. Liquid Soap
 With minimal prompting let her help with
you arranging the wash dishes utensils. Sponge
 Say “Thank you” to Zella for helping.
2nd  To help  Explain first to the purpose of watering Task Analysis Task Analysis September November Mother Hose Giving hints/Clues
watering the plants. 1, 2014 5, 2014 (Mrs. Z. Cuago) to correct
the plants.  Prepare the necessary materials responses
 Let Zella hold the hose and let mother
often the faucet. Narrative Verbal Prompting Water
 With verbal prompting, tell her to directly Description
position the hose to the plants.
 After watering the plants tell her the
benefits of it and how significant the
activity is.
  To apply  Prepare two seats, table, drawing book Narrative Modeling December March 20, SpED Teacher Watercolor Provide short
water color and water color. Desciption 1, 2014 2015 (Ms.Madronero) breaks while doing
on drawing.  Show to Zella to use the water color. Chairs the activity
 Let her do the same after showing to. Physical Table
 Guide her hand while applying the brush Assistant
of the water color. Task Analysis Teacher
 Let her use the appropriate color in (Ms. Kudemus) Drawing
drawing. book
 If it is a tree, then let her use the color Behavioral Task Analysis
green for the leaf and brown for the trunk. Checklist Parents
 Tell her the names of the different colors. (Mr. & Mrs.
 Give her the drawings which are simple to Cuago)
color.
 Let her tell the names of the colors she
used.
 Let her repeat the cactivity until she can
master the activity.
 Give praising comments words like “very
good!” “nice work!”.
3rd  Pinches  Prepare the tissue. Checklist Modeling December February Parents Tissue Giving hints/clues
tissue of  Modelthe child in tearing/folding the evaluation Prompting 1, 2014 27, 2015 SpED Teacher to correct
end of tissue. One on one (Ms. responses
nose.  Model pinching tissue off end of nose. session Madronero)
 Let the child imitate while doing the
activity.
 Apply verbal and physical prompting.
 Praise the child after doing the activity.
 Rinses  Bring the child in her lavatory. Task and Modeling December February Parents Toothbrush
mouth out  Prepare the glass of water, mouthwash, Analysis 1, 2014 27, 2015 SpED Teacher Water
without toothpaste, and toothbrush. (Ms. Toothpaste
swallowing  Explain to Zella the mouthwash and the Madronero) Mouthwash
water. bubbles are necessary to spits into sinks.
 Model to Zella how to gargle and how to
spit the bubbles.
 Let Zella follow the activity.
 Wipe the mouth towel.
4th  Hangs  Bring the child to the place where you can Evaluation Modeling March 1, May 30, SpED Teacher Towel Providing real
towel after hang the towel. 2015 2015 Parents Rope/string object Zella able to
using.  Introduce to Zella the towel, rope or Verbal (Mr. & Mrs. follow the activity
string. prompting Madronero)
 Apply modeling.
 Get the towel and hang it on the string
 Let Zella hang the towel with verbal
prompting.
 While Zella Hanging the towel you can
say to her that it is necessary to
hang/dispose the towel the right place
after using.
 Be sure that towel is properly hang.
 Apply soap  Bring the child in the laundry area. Checklist Modeling March 1, May 30, SpED Teacher Basin Provide enough
to cloth.  Prepare the basin, a pail of water, 2015 2015 (Ms. time to do the
detergent bar. Madronero) Pail activity
 Put water in the basin and some pieces of Task Analysis One on one
clothes. session Water
 Let Zella get one piece of cloth. Parents
 Give her the detergent bar and model her (Mr. & Mrs. Detergent
on how to apply soap in a cloth. Diary Physical Cuago)
 Let Zellal wash the cloth with verbal Description Prompting Soap
prompting. Evaluation
 After putting soap and washing, sqthe
cloth.
 After the throw the water.
 Put clean water in the basin and piece of
cloth.
 Let Zella rinse the piece of cloth
 Repeat the activity if there is more
bubbles in the water.
 After rinsing the cloth let Zella hang the
cloth.
1st  Uses towel  Bring Zella to the bathroom. Evaluation Prompting June 1, August 30, SpED Teacher Bath soap Giving hints/clues
to dry body  Let her undress herself in washing her 2015 2015 (Ms. to correct response
after body. Madronero)
washing.  Let Zellaopen the faucet. Narrative Task Analysis Towel
 Wet her body with with water and apply Description
soap. with Checklist Parents
 After putting soap all over into her body (Mr. & Mrs.
and rinse it with water (let Zella do this Cuago)
activity).
 After cleaning her body give her a towel.
 Let Zella wipe and dry her body.
 Again give verbal and physical prompting
while doing the activity.
 Explain her that it is necessary to
wipe/dry our body after washing.
 Hang the towel after using.
 Wash butt  Bring the child to the washing area. Evaluation Task Analysis June 1, August 30, SpED Teacher Soap Use simple
after  Open the faucet and let the child get the 2015 2015 (Ms. Cuago) instructions
discharging. dipper and put water on it. Dipper
 Wash first her butt with water.
 Get soap and apply in to her butt. Behavioral Verbal Towel
 After applying soap rinse it with water. Checklist Prompting
 Let Zella wash her butt properly.
 Let Zella wash her hands with soap.
 Get a towel and dries her hand and so
with her butt.
2nd  Cleans  Bring Zella in washing area or bathroom. Evaluation Task Analysis September November SpED Teacher Brush Use simple
fingernails  Prepare the water, soap and brush. 1, 2015 30, 2015 (Ms. instructions
using  Explain Zella that you are going to brush. Event Sampling Modeling Madronero) Water
brush.  Let Zella wash her fingernails with water. with Checklist (Mr. & Mrs.
 Give Zella the brush, let her brush her Cuago)
fingernails and apply soap.
 While the activity explain to her that it is
necessary to clean fingernails.
  Shares toys  Bring Zella in the play area. Checklist Play therapy September November Parents Doll house Increase/promotion
with other  Let Zella choose the toys that she wants Role playing 1, 2015 30, 2015 to student
children. like doll house, ball, blocks. Caregiver Ball independence
 Invite also some friends or her sister to (Ms. Bitoonan)
play with her. Blocks
 While playing ask something to her sister
that you want to play the blocks.
 Let Zella hear it or see it that you are
sharing your toys.
 After that ask something or ask Zella that
you want to join to play.
 Explain to Zella that if someone borrow
her toys, that’s one way of sharing toys
with other children.
3rd  Play simple  Let Zella sit beside you in the table. Task Analysis Play therapy December March 30, SpED Teacher Table Increase/promotion
competitive  Introduce to Zella the snake and ladder 1, 2014 2015 (Ms. to student
table game. board. Madronero) Snake & independence
 Explain to her that you want to play the Checklist Modeling Ladder
snake and ladder game. Parents board
 Model to her throwing the small dice in Verbal (Mr. & Mrs.
the board. Prompting Cuago)
 If the dice fall in number 3 you count 3
steps moving to the next level. Siblings
 Let Zella imitate throwing.
 Then count if where the dice fall on next Friends
level.
 Explain to her if the dice fall on the
ladder you can easily move the next leve
but if the dice fall on the snake you go
back to the staring point.
 Model the child in throwing the dice and
fall under the ladder on snake.
 Let Zellal follow the activity.
 Repeat the activity if necessary until
Zella wants to stop playing.
4th  Comforts  Let Zella watch picture or clippings a Observation Modeling June 10, July 30, SpED Teacher Picture Giving hints/clues
playmates person comforting his/her friends. 2016 2016 (Ms. Cuago) Clippings to correct
dirtiness.  While watching the picture, explain Zella responses
that the person is having a problem and Checklist Minimal Assistant Various
she needs someone to comfort her. Prompting Teacher Pictures
 Bring Zella in the play area, let Zella Task Analysis (Ms. Kudemus)
watch the children playing.
 If someone is crying tell Zella that the Mother
 child is hurt and need someone to (Mrs. Z. Cuago)
comfort.
 Model to Zella that you approach the
child crying and talk to the child.
 Let Zella imitate actions.
 Rewards her for correct responses.
Terminal Objective: A) To engage in writing activities.
Quarter Enroute Activity Procedures Objective Service Date Duration Responsible Material Inst.
Objectives Criteria Required Initiated of Person Accommodation
Evaluation Strategy Services
1st  To write first  On a sheet of paper write Zella’s first Event Physical June 4, August 5, SpED Teacher Paper Providing Zella
name with name (done by adults). Sampling Prompting 2015 2015 (Ms. ample time to do
less With your assistance, guide her in copying Madronero) Notebook activities.
assistance. her first name. Diary Verbal
 With physical prompting, hold/guide her Description Prompting Assistant Pencil
in imitating her first name slowly. with Checklist Teacher
 After she could able to write her first Modeling (Ms. Kudemus) Sharpener
name, repeat the process as often as
possible until she can master the activity. Mother Eraser
 Do activities at home too. (Mrs. Z. Cuago)
 To write  Provide Zella a sheet of paper with last Event Physical June 4, August 5, SpED Teacher Paper Providing Zella
owns full name “Dote” clearly written. Sampling Prompting 2015 2015 (Ms. ample time to do
name with  Guide her hand in copying her last Madronero) Notebook activities.
less name. Diary Verbal
assistance.  Prompt/model her in writing her last Description Prompting Assistant Pencil
name. with Checklist Teacher
 You can also provide a dotted/broken Modeling (Ms. Kudemus) Sharpener
lines in the activity for her to traced. Frequency
 Let Zella trace the broken lines/dotted counts Mother Eraser
writings so that she would be able to (Mrs. Z. Cuago)
master in writing her last name.
 To write  On a sheet of paper write Zella’s full Diary Verbal June 4, August 5, SpED Teacher Paper Give Zella
owns full name, with your assistance, guide her Description Prompting 2015 2015 (Ms. independence in
name with hand in copying her full name. with Checklist Madronero) Notebook writing but her at
less  Gradually, prompt her verbally since she Modeling the same time.
assistance knew already how to write from the Frequency Assistant Pencil
previous activity. This time just verbally counts Teacher
prompt her in writing name. (Ms. Kudemus) Sharpener
 Give Zella ample time to write
independently. Mother Eraser
 If Zella finally writes her full name, praise (Mrs. Z. Cuago)
her and give her reward. (e.g., Favorite
junk food: Oishi, Funky Chips Snax. must
be seldom done)
 Repeat activity until she get use to it and
master the skills in writing.
 To form and  So that it would be easy for Zella to write Event Physical August 5, October 5, SpED Teacher Paper Increase/promotio
write letters the letters provide her with a copy with all Sampling with Prompting 2015 2015 (Ms. n to student
A-Z copying the letters from A-Z. Checklist Madronero) Notebook independence
model.  Guide her hand in writing.
 In times of break/during break time, grab Diary Verbal Assistant Pencil
the chance by showing her movie Description Prompting Teacher
presentation of the letters of the alphabet (Ms. Kudemus) Sharpener
in order for her to be familiar with all the Frequency Modeling
letters. Counts Mother Eraser
 Use verbal and minimal prompting in the (Mrs. Z. Cuago)
activities so that she’ll be more
independent in writing.
 From time to time, acknowledge her
efforts and improvements in the activity.
 Repeat the activity with less assistance.
 To write  Introduce to Zella the concept of numbers Event Physical August 5, October 5, SpED Teacher Paper
numbers 0- 0-9. Sampling with Prompting 2015 2015 (Ms.
9 with less  With the use of flash cards/by presentting Checklist Madronero) Notebook
assistance a movie presentation of.
 The numbers 0-9, show the concept so Diary Verbal Assistant Pencil
that she will be motivated to learn writing Description Prompting Teacher
the numbers and for familiarization. (Ms. Kudemus) Flash Cards
 Model her in writing the numbers. Frequency Modeling
 Assist her by writing the numbers and Counts Mother Movie
verbally prompt Zella in writing each (Mrs. Z. Cuago) Presentation
number. of of
numbers 0-9
3rd  To draw  Begin activity by presenting to her the Event Task August 5, October 5, SpED Teacher Drawing Giving hints/Clues
diamond, target shapes to be print/draw. Sampling with Analysis 2015 2015 (Ms. Book to correct
square,  Use concrete examples to show the Checklist Madronero) responses
triangle, shapes to Zella so that she will be more Physical Different
rectangle, familiar with the shapes and would truly Diary Prompting Assistant objects
coircle understand the concepts of each shapes. Description Teacher pertaining to
copying  Show to Zella or demonstrate to her how Direct (Ms. Kudemus) various
model and to draw each shapes, do it slowly. Frequency Instruction shapes
imitating  After drawing all the shapes, guide her Counts Mother needed i the
adult hand in imitating all the shapes. Modeling (Mrs. Z. Caugo) activity
 Give her opportunities to scribble or to
make errors in drawings until she can
achieve to write with her own.
 Continue to encourage her and teach her
to draw all the shapes until she would be
able to draw the shapes successfully.
 To print  Since Zella could not read yet, when you Event Task August 5, October 5, SpED Teacher Paper Giving hints/Clues
simple word present the words, read it clearly to her. Sampling with Analysis 2015 2015 (Ms. to correct
copying  Give simple words as much as possible Checklist Madronero) Notebook responses
model. for her to be copy. (e.g., cat, dog, happy, Physical
smile, nice, rich, power, etc.) Prompting Assistant Pencil
 Allow her to copy simple word Frequency Teacher
independently. Counts Direct (Ms. Kudemus) Sharpener
 Repeat activity until she can ably write Instruction
well independently. Mother Eraser
Modeling (Mrs. Z. Cuago)
4th  To serve  Since Zella can already identify foods, Event Demonstration October 11, December SpED Teacher Table Giving hints/Clues
self at table. give her a chance to serve self at table Sampling 2015 11, 2015 (Ms. to correct
during meal time. Modeling Madronero) Chair responses
 Give Zella opportunities to serve self at Diary
table. Description Verbal Parents Food (rice
 Instruct her what to do in order in order Prompting (Mr. & Mrs. and any
for her to know what must be done. Cuago) viand)
 Model Zella on what to do: Task Analysis Glass
 Putting/preparing plate, glass, spoon
and fork. Spoon/Fork
 Preparingand serving the rice in the
center of the table. Plate
 Next, preparing the viand correctly.
 Allow her to practice the activity during Water
meal time.
 Use minimal prompting and modeling in
executing to her the activity in order to
fulfill the goal/activity.

 Know how  Since Zella don’t use fork in eating, give Narrative Direct October 11, December SpED Teacher Fork Give Cuagol more
to use fork her opportunities on how to use it Description Instruction 2015 11, 2015 (Ms. opportunities in
in eating correctly/properly. with checklist Madronero) Spoon actual events
together  Model to Zella the proper use of fork in during meal time.
with the eatingand in what circumstances for Plate (rice
spoon. should be properly used. Event Physical and viand)
 Give her solid foods so foods so that the Sampling Prompting Mother
use of fork will be maximized. (Mrs. Cuago)
 With physical prompting, direct her
hands unto how to use fork effectively.
 Consider using fork on daily basis or as
often until she can manage to eat with
the use of fork independently.
  To pour  Position Zella in a table Time Sampling Modeling October 11, December SpED Teacher Glass Increase access to
liquid from  Guide her hand in pouring water from 2015 11, 2015 (Ms. learning.
one cup to another cup without spilling Frequency Minimal Madronero) Water
another  Model her in doing such Counts Prompting Independence in
without  Give her allot of opportunities to practice Parents Juice the activity and
spilling and master activity like during snacks (Mr. & Mrs. task presented.
time or whenever she feels thirsty, allow Cuago)
her to pour water/juice in a glass with
her own.
 Praise her whenever she successfully
accomplish the task or activity perfectly.
 To drink  Bring Zella into a water fountain. Event Modeling October 11, December Assistant Water Giving hints/Clues
from water  Demonstrate to her how to drink water in Sampling 2015 11, 2015 Teacher Fountain to correct
without aid the water fountain independently. Verbal (Ms. Kudemus) responses
of adult  With several demonstration, discuss to Time Sampling Prompting
her how important o drink water from the SpED Teacher
fountain independently. Direct (Ms.
 With verbal prompting ask Zella to drink Instruction Madronero)
in the water fountain with her own.
 Repeat activity until she will master the
activity independently.
 Reward her afterwards.
1st  To rolls clay  During art activities, teach Zella how to Diary Minimal January 3, March 5, SpED Teacher Clay (with Using varied
into snake form clays into shape and snake shape. Description Prompting 2015 2015 (Ms. various color material /
shape and  During activities, discuss to Zella the with Frequency Madronero) if possible Instructional
ball shape. clays can be form into different forms Counts Modeling non-toxic) medias
and shape.
 Allow Zella to imitate you in forming the Verbal
clay into snake shape and ball shapes. Prompting Peers/
 Do activities one step at a time. classmates
 If she successfully do act. Praise her.
  To spread  Prepare materials for the activity. Diary Physical January 3, March 5, SpED Teachers Paste/glue Clear instruction
paste on  Set an example for her to imitate. Description Prompting 2015 2015 (Ms.Madronero) and motivation
one side of  In one paper, allow her to see how to with Checklist Paper
paper and use the paste and how to spread it on Direct Assistant
turns over the surface/side of the paper, turn it over Instruction Teacher
to stick it to slowly and stick it to another side. (Ms. Kudemus)
another  Guide her hand in spreading the paste in
paper with one side of paper.
less  Do it successively until she will know it
assistance. indefinitely.
 Build tower  Prepare instructional materials for Zella Frequency Verbal January 3, March 5, Assistant Blocks Motivating
of blocks or to perform the activity. counts Prompting 2015 2015 Teacher (Consisting materials for
more...  Model her in building the blocks step-by- (Ms. Kudemus) number or instruction like
step until you reach in building nine Narrative letter if colorful blocks.
blocks. Description Modeling Siblings possible)
 Repeat the activity/ procedure until she
can build blocks independently.
 Praise Zella whenever she can build
blocks into several numbers until she
can reach nine blocks.
2nd  Put together  Begin the activity by introducing to Zella Event Task Analysis June 9, August 10, Regular Small Puzzle Clear and
simple the puzzle. Sampling 2015 2015 Teacher concise puzzle
puzzle  Show to her the unscribble/undeformed (Ms. Penales) for for the activity
puzzle and allow her to see how you must be used.
break the puzzle and deform it into Narrative Shadow
pieces Description Actual Teacher
 Give a simple puzzle, possible Performance of (Ms. Durante)
consisting of 10 pieces activity
 Demonstrate to Zella how you put the Minimal
piece of puzzle together. Prompting
 Give activities to her that consist of a
simple puzzle only and physically prompt
her in putting the puzzle in order.
 Give opportunities by giving activities to
her that would develop and ability to put
puzzle together with her own efforts and
skills.
 To match 6  Since Zella don’t know the concept of Frequency Lecture June 9, August 10, Regular 8 primary Increase access
colors or colors yet, you can teach her the 8 Counts 2015 2015 Teacher colors to learning
more primary colors. (Ms. Penales) activities.
 Give abstract examples on the 8 primary Narrative Verbal Crayons
colors. Description Prompting Parents
 Lecture her on the concepts of colors. (Mr. & Mrs. Objects that
 If she will know the colors, begin the Event Cuago) represent
activity right away by giving the set of Sampling color. (g.g.
activity which is to match colors. apple for red,
 Continue activities until she would finally Performance the Philippine
accomplish task/activities. Activity Flag)
 Inform the parents in order for them to
do activities at home too.
 Place key in  Engage Zella√ into activities in how to Frequency Lecture June 9, August 10, Regular Key and Use across
lock and place key & open lock by demonstrating Counts 2015 2015 Teacher Lock enviroments and
open lock to her how to perfectly do the activity (Ms. Penales) tasks for Zella to
up to 85% and procedure. Narrative Verbal be more expose
 Explain to her he importnace of the Description Prompting Parents to the activities.
activity so that the she’ll be aware of. (Mr. & Mrs.
 Step by step, perform the actvity and let Event Cuago)
her watch in how to do it Sampling
 This activity pertains to improve her
visual and fine motor coordination so it is Performance
important to implement activity. Activity
 Give the child simple questions to
consider.
 One at a time so that the child will not be
confused.
 Make sure not to give too much
questions rapidly.
 Simple questions like: Where is the key?
Then the child would immediately get
where it was placed and showed it to
you.
 Praise the child if she can do the task.
Or after having the discussion, if you
think that the child learns fast then you
may give the child some sort of reward
for the job well done.
  Makes  Prepare for the things needed if any/the Narrative Verbal December March 30, SpED Teacher Pictures Allow Zellal to
facial venue. Description Prompting 1, 2014 2015 (Ms. play with the toys
expressions  Bring the child to the appropriate place. Madronero) Books that if there is a
appropriate  Say pleasant things to the child like Physical can be used presence of toys
to spoken exaggerating yourself by telling her a Prompting Assistant for story for her to be
material story of your past experince during the Frequency Teacher telling. modeled.
past days. Counts (Ms. Kudemus)
 Pretend yourself and be animated Shadow
enough to express yourself by showing Touching
facial expressions as to what you feel.
 Let the child train to imitate what your
doing.
 If you say, I am sad then show it with
facial expressions and let the child follow
you.
 Praise the child if she can do the task.
1st  To sort  Prepare for the venue. Diary Direct August 16, October SpED Teacher Color Wheel
objects by  Bring the child to the venue. Description Instruction 2015 15, 2015 (Ms. Melchora)
shape.  Introduce to the child the objects with with Checklist
different shapes. Minimal Parents
 Model the child too look for an object Frequency Prompting (Mr. & Mrs.
that looks like the object you are Counts Cuago)
referring to. Modeling
 Apply physical prompting if necessary Narrative
for him to easily know about that Report Verbal
particular thing. Prompting
 Praise the child if she can accomplish
the task.
 Or the teacher may ask again the child
about the shape of a specific object, to
check whether she learns or not.
 Giving reward is recommendable.
2nd  To sort  Prepare the materials. Event Verbal October 16, November SpED Teacher Color Wheel Allow the child to
objects by  Bring the child to the resource area Sampling Prompting 2015 16, 2015 (Ms. have ample time
color. where the materials are located. Madronero) to relax and while
 Introduce to the child the primary colors Direct Charts for relaxing you may
first, for him not to get confused. Narrative Instruction the give him varieties
 Then discuss one-by-one and give some Description identification of foods/candies
examples through pointing some objects of colors. with different
that has the same color with the one Minimal colors.
you’ve introduced. Prompting
 If the child finds it difficult to look for a
thing, then you may give verbal
prompting.
 Then if you find that the child knows
already then praise him.
 Recall afterwards checking whether she
learned the lesson or not.
 You may give incentives to the child.
3rd  To locate  Have the materials prepared in the Narrative Task Analysis June 5, August 5, SpED Teacher Different Allow the child to
which out of place. Description 2015 2015 (Ms. objects and play with the
5 objects or  Bring the child to the place. Madronero) pictures that objects
pictures  Introduce to the child the different Event Actual are used for presented.
does not objects in the place. Sampling Performnace of Shadow sorting
belong in  Then immediately ask him to name a activity Teacher materials.
same class/ specific object after you’d introduce them Performance (Ms. Durante)
category. all. Activity Varbal
 Praie the child afterwards to make him Prompting Peers/
get motivated to participate still. classmates
 After knowing all the objects being
presented, task the child to sort it in a
group.
 You may give physical prompting in
choosing the object/s.
 Praise the child as possible.
 To ask  Prepare for the venue. Narrative Verbal June 5, August 10, SpED Teacher Showcharts Allow the child to
questions  Make sure that the enviroment is Description Prompting 2015 2015 (Ms. with play with the
using “why”, conducive for the child’s learning. Madronero) questions objects
“where”,  Take the child to that place. Behavioral Shadow written in it presented.
“who” and  Start the interaction by building simple Checklist Teaching Shadow and so with
“when”. communication and asking some Teacher the answer in
questions continually using the why, Performance (Ms. Durante) a form of
where, who, and when. Activity drawing, for
 Prompt the child to follow after you have him/her to
the word. follow during
 Give the word one at a time. their
 Praise the child when she can complete recreation
to follow the questions given. For session.
example: When is your birthday? Say,
when...is...your...birthday? in a step-by-
step manner.
 Let the child answer the question.
 Assist the child through verbal
prompting.
 Then repeat the question and let the
child answer it legibly.
 Reward the child afterwards.
 Prepare and set the venue.
 Make sure to have a friendly enviroment
that is conducive for the child’s learning.
  To answer  Bring the child to the venue. Oral Verbal August 10, October Regular Audio Tapes Allow the child to
specific  Start the conversation with a friendly Questioning Prompting 2015 10, 2015 Teacher on have ample time
questions thought, like greeting the child with good (Ms. Questioning to relax and while
based on morning! If it’s morning, good afternoon! Shadow Madronero) relaxing you may
spoken If it’s afternoon. Task Analysis Teaching Pictures can give him varieties
material.  Then through asking simple questions with Checklist Shadow be used for of foods/candies
continuously the child learns to answer. Teacher the with different
And there starts the interaction between (Ms. Durante) interaction colors.
the teacher and the child. process.
 In that way, the teacher may not find it
difficult to give specific questions to the
child with regards to the task that the
child has been assigned a while ago.
 If the child cannot directly/immediately
say what she means. Give verbal
prompting through giving hints and
guiding the child to say the word.
 Praise her when she can accomplish the
task.
 Check if the child is doing well, through
asking her again and again until that she
can memorize it.
1st  To  Prepare the materials. Observation Verbal June 5, October SpED Teacher Cassette More time given
categorize  Bring the child to the venue. Prompting 2015 10, 2015 (Ms. Recorder if to the child for
sounds.  Upon arriving the venue, you may start Madronero) needed play
the conversation by greeting the child. Shadow
 Then before anything else starts, after Time Sampling Teaching
the greetings and giving the instruction, Assistant
let the child concentrate to keenly Teacher
observe the sounds in the surroundings. (Ms. Kudemus)
 Then immediately ask about what the
child has heard after the situation
occurs.
 Let him enumerate the different sounds
by giving verbal prompting if necessary.
 Praise the child when she can do the
task.
 You may also give reward to the child
after having the activity.
2nd  To  Prepare for the venue and so with the Task Analysis Verbal August 10, October SpED Teacher Wet Use across
determine materials for the activity. with Checklist Prompting 2015 10, 2015 (Ms. Handkerchief enviroments and
whether the  Make sure to have a conducive Madronero) tasks for Ethel to
object is environment while teaching the child so Shadow Dry be more expose
wet/dry, that she can easily determine the object. Narrative Teaching Handkerchief to the activities.
hot/cold.  Let the child touch and feel whether that Report Assistant
particular object is wet/dry. Teacher Basin of
 Best example you can give is a wet (Ms. Kudemus) water
handkerchief and a dry one.
 Let the child knows first which of the two Hot coffee
is wet and which is dry.
 Through giving the child a minimal Cold coffee
prompting, she can learn the difference
between the two things.
 Praise her whenever possible.
 If she can now determine the difference
between the two, then that would be the
time that youy are going to introduce her
what is hot/cold.
 Prepare the cup of hot coffee and cold
one.
 Let the child touch the two cups with a
minimal prompting.
 Then let the her utter the word”hot” as
she is touching the cup.
 If she can do the task, praise her again
and let her touch the cold cup of coffee.
And let her feel the difference by giving
the minimal description.
 Now, if she can determine both the hot
and cold, recall the first activity to check
whether there is progress in the learning
process.
 Don’t forget to praise her or give a token
after having the activity as a sort of
reward to her.
 To match  Prepare the materials in the venue. Time Sampling Verbal October 10, December SpED Teacher Sandpaper Allow Zella
through  Make sure that the materials to be uses Prompting 2015 10, 2015 (Ms. tohave more time
tactile cues are safe and cannot harm the child. Madronero) Plain Paper foe play.
like objects  Bring the child in the venue. Task analysis Physical
that is rough  Introduce to her the materials that are with checklist Prompting
and smooth. present.
 First thing to discuss would either be the Shadow
rough or smooth, hard, or soft. Touching
 But if you prefer to start with the rough or
smooth, then it would be fine.
 Present to the child the two papers with
different textures. The other one is a
sand papaer which is rough and a plain
paper for the smooth one.
 To choose  Prepare the venue and so with the Event Verbal August 10, October SpED Teacher Materials Extra time for
through materials needed. Sampling Prompting 2015 10, 2015 (Ms. with shapes play may
tactile cues  Make sure that the materials are raech Madronero) such as motivates the
whether that at hand and so easily accessible. squares, child to
particular  Bring the child to the venue. Oral Assistant circle, accomplish the
object is  Introduce to the child the materials that Questioning Teacher triangle and task earlier as
square are present. (Ms. Kudemus) rectangle possible.
round,  Let the child touch the shape of a square
triangle or while discussing to her. You may
rectangle.  Afterwards, show to her the round also include
shape, the triangle and rectangle. materials that
 And then discussed it to her one by one are similar
for her to best understand the difference shapes like
among the four shapes being presented. what is
 While teaching, do some verbal mentioned
prompting to guide her. above.
 Let the child touch identify which is a
square, round, triangle and rectangle.
 Praise her whenever she can answer
what you are asking
 You may also give consequences
through a minimal punishment whenever
she cannot answer and reward when
she can.
 But make sure not to pressure the child
for her not to panic and afraid of you.
 To  Prepare for the venue. Event Modeling August 10, October SpED Teacher Chairs Table Increase/
responds  Make sure that the venue is free from Sampling 2015 10, 2015 (Ms. (Use for promotion to
correctly noise and any disturbance to be Madronero) interaction) student
and non- conducive for learning. Oral Shadow independence
verbally to  Bring the child to the venue. Questioning Teaching Shadow
questions  Start building the communication Teacher
concerning through simple conversation like asking, (Ms. Durante)
abstract/ how are you today?
concepts.  Then continuously proceed to the next.
 Through verbal prompting, the child utter
the word rough while both of you are
touching the sandpaper which is rough.
 Then let her repeat the word while
holding the rough objects until that she
can do it alone.
 Praise the child if she can do the task.
 To match  Set the materials in the venue. Task Analysis Verbal June 5, August 10, SpED Teacher Block of Extended time for
through  Bring the child in the venue. with Checklist Prompting 2015 2015 (Ms. wood the activity.
tactile cues  Let the child be in her comfortable Madronero)
like objects position. Shadow Cloth/cotton
that are  Introduced to the child the materials to Time Sampling Teaching Anything
hard and be presented. depending
soft.  Discussed to the child the two things, the on the
hard and the soft objects. availability
 Then let the child interact with you.
 Give physical prompting if necessary to
point out the object being referred.
 Let the child touch the object while you
are discussing too.
 For the hard object, you may use a block
of wood. Prompt the child to touch and
feel the hard block of wood.
 Praise the child when she is able to
make it.
 Then next to that is to introduce the soft
object. You may use the cloth or cotton
in which you find much more available.
 Prompt the child in touching the soft
cotton or cloth.
 Grooming Skills/Behavior 0 1 2 3
Turns water off when requested/on own √
Puts comb/brush in hair √
Disposes/hangs towel after using when requested/on own √
Allows hair to be washed without fussing √
Dries face with towel when requested on own √
Applies soap to cloth √
Washes and rinses body areas √
Runs/comb/brush through hair √
Uses towel to dry body after washing √
Washes face and ears while in bath/shower √
Assists while another washes hair √
Washes own hair using fingers to rub/massages scalp √
Bath or showers when reminded √
Washes hands and face when soiled or at regular time √
Cleans fingernails using brush √
Cuts own nails on hand and feet √
Adjusts faucet to desired water pressure √
Washes face with soap when requested/on own √
Dressing Skills/Behavior
Pulls parts of completely from floor to waist √
Obtains specified clothing and puts on without being told √
Puts hand through both armholes of front-opening of clothing √
Pushes arm into second sleeve and pulls clothing to shoulders √
Puts shoes on correct feet √
Pulls sock up from sole to ankle √
Pinches tissue off end of nose √
Returns toothbrush paste to designated container/location √
Replaces caps on toothpaste tube √
Rinses mouth out without swallowing water, spits into sinks √
Wipes nose dry with clean part of tissue √
Disposes off tissue √
Uses proper amount of toothpaste √
Blows nose independently on request √
Blows nose independently when necessary √
Covers mouth with tiussue or hand when sneezing √
Uses proper brushing strokes (with reminding) √
Brushes after meals or at designated times √
Eating and Drinking Skills/Behavior √
Direct spoon fork into mouth, some spilling √
Swallows food in mouth before taking another bite √
Eats holding fork in fist, some spilling √
Directs spoon/fork into mouth without spilling √
Drinks from water fountain when turn on by adult √
Serves self at table √
Refills glass from container holding less than a glass √
Uses spoon for liquids and semi-solids, uses fork for solid √
Eats holding fork in fork in fingers standing position, some spills √
Drinks liquid from soft drink bottle or can √
Prepares simple foods for eating √
Refills glass from container holding more than a glass √
Eats different types of food √
Drinks from fountain without aid of an adult √
Opens container and removes food √
Serves self and carries tray in serving line √
Refills glass from container using handle without spilling √
Carries liquid in open container, without spilling √
Pours liquid from one cup to another without spilling √
Cuts and spread the knife √
Cuts with knife and fork
Toileting Skills/Behavior
Distinguishes between urination and bowel movement √
Goes to toilet with regular intervals without asking √
Tears toilet tissues appropriately and flushes toilet after use √
Goes to toilet when necessary with infrequent accident √
Wipes self after toileting √
Goes to toilet by self with no accidents √
Adjust clothing before leaving bathroom √
Obtains help with any toileting problem √
Remembers to wash and dry hands after using the toilet √
Asks location of bathroom in new situation √
Fine Motor/Visual Discrimination Skills/Behavior
Strings large beads √
Rolls clay into snake shape √
Marches like objects √
Cuts paper into scissors √
Matches the three primary colors: red, blue and yellow √
Rolls clay into ball √
Matches long and short, big and little objects √
Locates up, down, in, out, under, bottom and top √
Puts together simple puzzles √
Matches square, circle and triangles √
Builds tower of 9 blocksor more √
Places small pegs in holes on holes √
Strings large beads √
Matches 6 colors or more √
Spreads paste on side of paper and turns over to stick it to another paper √
Cuts across paper following straight line/curved line √
Finds target object from pictured group of similar objects √
Folds paper in half with edge meeting √
Locates beside, below, above and before √
Places key in lock and open lock √
Matches objects of various shades from dark to light √
Cuts out small square/triangle/circle with scissors √
Strings small beads reproducing color and shape sequence √
Finds two objects in picture and connects them with a line √
Cuts out pictures following general shape √
Cuts cloth with scissor √
Makes line visual discriminations, matches letters that looks very similar √
Cuts out complex pictures following outline √
Identifies look alike words correctly √
Builds 5 blocks bridge √
Copies from models of letters, numbers in correct sequence √
Identifies missing or incongruous element of picture √
Scans horizontal line of objects left to right √
Puts together complex puzzles √
Locates dominant object in multi-visual field √
Reproduces previously viewed complex pattern correctly √
Identifies whole object/design when part viewed √
Reports whole picture as well as details √
Gross Motor Skills/Behavior
Walks 10 feet pushing and pulling a wagon-type object √
Catches a large ball thrown from 5 feet by pushing it against body using arms extended √
Jumps from bottom step (12 inches high), feet together √
Walks 10 feet on 4-inch wide line √
Stands on tiptoe for 10 seconds √
Walks 20-feet diameter circle staying on path √
Kicks a stationery ball using a 2-step on start √
Jumps toward 2-foot distance feet together √
Balances on one foot for 5 seconds eyes open √
Gallops forward √
Rides tricycle, turns without bumping into obstacles √
Perform complete somersault √
Maintains momentum on swing √
Hops 10-foot distance on one floor √
Walks 10-feet carrying object blocking view of floor √
Runs a 20-foot distance breaking stride/rhythm √
Walks 12-feet on 4-inch beam without stepping off √
Runs through obstacles course avoiding objects √
Hangs from bar using overhand grip for 5 seconds √
Walks down stairs carrying an object √
Lifts for so from ground to complete one sit-up √
Lifts body with knees on floor to complete one push-up
Sensory Percetion Skills/Behavior √
Matches through tactile cues like objects hot/cold, wet/dry √
Matches through tactile cues like objects that are circular, triangular and rectangular √
Chooses through tactile cues small object on request from group of 5 objects √
Matches through tactile cues like objects objects like objects flat/thin and wide/flat √
Matches through tactile cues like objects sticky and non-adhesive √
Chooses through tactile cues long/short object on request from group of 5 objects √
Chooses through tactile cues square/round and triangular/rectangular objects from group of 5 objects √
Matches through tactile cues like objects that are rough and smooth √
Matches through tactile cues like objects that are sharp and dull, light and heavy √
Chooses through tactile cues sticky non-adhesive object on request from a group of 5 objects √
Chooses through tactile cues hard/soft objects on request from a group of 5 objects √
Chooses through tactile cues light/heavy objects on request from a group of 5 objects √
Auditory Perception/Listening Skills/Behavior
Identifies sounds heard √
Identifies loud/soft sounds √
Correctly answers questions concerning message spoken less than one minute before √
Identifies different roles as being high or low sounds √
Categorize sounds √
Carries out 2 simple unrelated succesive commands in order √
Repeats simple words √
Repeats tapped rhythms √
Repeats melody √
Carries out 3 simple unrelated successive commands in order √
Identifies words that rhyme √
Repeats set of like symbols √
Carries out 4 simple unrelated successive commands in order √
Rephrases what happened in story previously read by another √
Rephrases others comment in a discussion √
Identifies differences in similar speech sounds, fm, s, th, p when in isolation √
Identifies order of sounds in words √
Identifies initial and final sounds of words √
Tells recently told story maintaining original sequence √
Repeats poem just spoken √
Languages Comprehension Skills/Behavior √
Performs appropriate action when self pronouns, me, my, mine, are used √
Responds correctly and non-verbally to physical stated questions √
Points to or places objects, up, down √
Points to or places objects on, in, out √
Points to or places objects under, over √
Points to or places objects by, beside, behind √
Points to or places objects before, after √
Points to or places objects above, below √
Points to or places objects infront, back √
Points to or places objects according to function √
Answers specific questions based on spoken material √
Responds correctly and non-verbaly to questions concerning abstracts or concepts √
Chooses main ideas from spoken materials √
Adaptive Skills/Behavior √
Plays game another person √
Talks about finished activity and relates to new one √
Perform new activities when required √
Performs new activities voluntarily √
Tries again when change or disappointment occurs if reassured √
Remains calm if changes or disappointment occurs and no remedy is possible √
Performs activities in the presence of or when led by new person √
Behaves according to peer group norm in moderate structured situation √
Changes routine when alternatives are presented √
Tries new activities when reason are explained √
Follows routine when there are changes in enviroment √
Independently tries out new activities, put ideas or things into new combinations √
Creates own activities with new objects, use objects in different ways √
Tries again when change or disappointment occurs without recovery period, reassurance, reasons √
Adjust behavior to fit rules and routines of different situations √
Responsible Behavior/Skills
Sits quitely when listening to stories/music √
Takes turn in game activity 25-50% of time √
Defends ownership of own possessions verbally with minimum physical expression √
Sits quietly for 5 minutes when listening to stories or music √
Quiets down after active period if reminded √
Sits without moving for 25-50% of activity √
Follows direction provided by authority figure √
Calls or acts out while raising hand for attention √
Behaves according to desires of others √
Performed assigned tasks √
Obeys newly delegated authority figure √
Returns objects or materials to their assigned/appropriate places √
Quiets down after active period and waits for instructions √
Volunteers for task √
Conforms to group discussions √
Cooperates with teacher request for quiet time √
Treats other property as would own √
Takes turns in game activity 50-75% of the time √
Sits in seat, stands in line without moving for 75% of activity √
Leaves provoking situations √
Performs undesirable task when given choice of doing less desirable tasks in its place √
Sacrifice immediate desires for delayed rewards √
Makes own decision concerning activities with minimal adult supervision √
Displays behavior appropriate for the situation/place √
Acts according to social rules in work and play situation √
Controls temper well, verbalizes feeling in appropriate manner √
Accepts friendly teasing √
Plays and works without disrupting work of others √
Inter-Personal Relations Skills/Behavior
Watches others in play and may join in for a few minutes √
Exchange items for play √
Plays with adult √
Responds to and make verbal greeting √
Plays with one or two others √
Apologizes without being reminded √
Coordinates with another child during play √
Shows affection for familiar person √
Plays with groups of 3 or more √
Shares toys with other children √
Verbalized feelings to another without hitting √
Comforts playmates in times of distress √
Plays simple competitive table games √
Protects children and animals √
Offers help to others voluntarily √
Plays difficult games requiring knowledge of rules √
Behaves in corteous manner to other √
Social Manners Behaviors/Skills
Request aids for spills √
Says “THANK YOU, PLEASE” with request when appropriate √
Eats most food in a tidy manner √
Request food/drink be passed on the table √
Cleans up spills √
Eats at reasonable price √
Passes food/drink on request √
Uses napkins to wipe hands, mouth during and after meal √
Remains quiet when others are talking √
Speaks clearly without mumbling √
Keeps napkin on top √
Says EXCUSE ME when interuppting √
Waits to be acknowledge before speaking √
Answers telephone and carries on simple conversation √
Participates in discussion √
Eats item of meal in standard order √
Makes appropriate request for items in public √
Waits until designated time to leave table √
Initiates topic in conversation appropriate for the soolution √
Pleases to allow others to speak √
Chews and swallows food to empty mouth before speaking √
Takes dirty dishes to deignated area √
Chews and swallows quietly with lips closed √
Speaks using appropriate volume tone and speed in different situations √
Use appropriate non-vulgar language √
Address people with correct title √
Adjust responses or actions to type of call-door √
Math Skills/Behaviors
Counts orally to three √
Sorts according to shape, size and length √
Locates big and small objects in groups of two √
Arranges objects in order of size from smallest to largest √
Matches coins √
Selects, long, longer, longest from group of objects √
Constructs set 4, 5, 6, 7, 8, 9, 10 objects √
Locates big, bigger, biggest and small, smaller, smallest in groups of objects √
Counts orally to ten √
Locates first, middle, and last in group of objects √
Names coins: 1, 2, 4, 5, 10, 15, 25 √
Locates front and back, left and right √
Reads and writes numerical to three (3) √
Counts orally to 19 √
Relates “today” “tomorrow” “yesterday” to days of the week √
Reads numerals of clock’s face and associates hand placement with routine activity √
Identifies what numbers comes before and after numbers or between two numbers √
Names days of the weeks in succession √
Reads and writes numerals to 19 √
Counts oraly to 49-100 √
Reads and writes numbers to 49 √
Locates day of week on calendar √
Writing Skills/Behavior
Perform push-pull strokes, imitating adult √
Draws circle, imitating adult √
Holds pencil or crayon in fingers √
Draws horizontal/vertical lines, copying model √
Draws vertical cross, diamond, square, triangle, line, between 2 parallel lines imitating adult √
Draws recognizable face with eyes, nose, mouth √
Prints letters and numbers imitating adult √
Prints own first name without model √
Prints simple words copying model √
Prints all letters of alphabet, all numbers 0-9 correctly without model √
Prints simple words without model √
Colors within heavy outlines within faint outlines √
Prints last own name, copying model √
Draws letters, numbers, shapes copying model √
Reasoning Skills/Behavior
Sorts object by shape, color, and size √
Points to or places object up, down, on, in, out, under, over, top, bottom, by, beside, etc.. √
Language Skills/Behavior
Uses noun plurals. Uses verb plurals √
Uses noun with article √
Uses noun with possessive √
Uses verb with noun (see dog, push wagon) √
Uses pronouns I, him, he, his, her, she, hers appropriately √
Combines article, possessive, quantifier and/or adjective with noun to form 3-words noun phrases √
Carries on a converstaion √
Uses predicate phrases with noun phrases √
Uses verb with noun phrase √
Uses pivot verb “is” to form kernel sentence √
Combines noun phrase and verb phrase to form kernel sentence √
Asks questions using “is” and “have” forms √
Asks questions using why, where, who, or when √
Combines locator, demonstrations or identifier with noun phrase √
Uses noun with identifier (it’s a car) √
Uses three and four word stereotyped phrase √
Uses conjunctions in sentences √
Uses infinitive verb forms in sentences √
Uses auxiliary verbs “am”, “is”, “are” with present participle √
Describes actions in a picture using the present tense √
Uses past tense by adding “ed” to verb √
Uses past participle to form past tense √
Matches like objects/pictures of objects √
Places 3/4 simple pictures in sequence √
Determines 3 wats in whiuch objects or pictures does not belong in same class/category √
Name classes/categories of sorted objects √
Make judgements in time and speed √
Draws picture to illustrate 3 pieces of information √
Orders 4 written or verbal sentences in sequence √
Makes judgements in distance and temperature, length/weight and size √
Music/Rhythm Skills/Behaviors
Sings parts and phrases of familiar songs √
Entertains self playing with musical toys √
Sways and rocks whole body using simple rhythmic movement √
Plays rhythm instruments √
Claps to beat of familiar songs or to speech patterns √
Makes fine hand/foot rhythmic movement √
Matches in time to repetitious beat √
Shifts body rhythm when music tempo changes √
Participates in group songs with singing voice √
Plays simple rhythmic patterns on rhythmic sticks √
Plays rhythm instrument in simple pattern √
Matches notes or tones √
Imitates high and low notes or tones vocally √
Improvises body movements to follow tempo/rhythm √