Parent/Child

Evaluation

Child: G.U. Age: 7 years Evaluator: Shayna Roberts

Parent: J.U. Date of Evaluation: September 3, 2016

G.U. was evaluated on September 3rd, 2016 in order to help prepare Shayna
Roberts (OT student) for practice as an occupational therapist. Assessments were
administered to develop the skills necessary to evaluate children. This evaluation
was done through administration of the VMI, BOT-2, and COPM. These assessments
examine daily activities, priorities, ability to copy shapes, write, and use hand skills.
G.U. is a 7 year-old Caucasian girl who lives with her parents and siblings in a
single-family home in Cedar City, Utah. She is the second of four children. Her father
is a financial planner and her mother stays home with the kids. G.U. was born at 33
weeks and spent one month in the NICU. Her mom (J.U.) reports that G.U. met all
milestones by the appropriate ages and that she is typically developing. They have
had no concerns with her development. G.U. is in 2nd grade at South Elementary.
She rides the bus to school and is able to navigate her school on her own. G.U. likes
school but has had problems with behavior in the classroom in the past. She is
expected to help with chores around the house, such as picking up the toy room and
her bedroom, clearing the table, and helping to unload the dishwasher. She likes
acting, swimming, crafts, and reading. She also participates in soccer and dance but
does not enjoy them. J.U. reports G.U. has difficulties with coordination. G.U. thinks
of herself as sweet, fashionable, smart, strong, and fast. She wants to become an
American Ninja Warrior and a mom.
Canadian Occupational Performance Measure
The COPM is designed to detect change in a clients self-perception of
occupational performance. It is an outcome measure and is administered through
interview at the beginning of service in order to establish goals. It is often given
throughout the intervention process to determine progress and outcomes. The
COPM addresses occupational performance in self-care, productivity, and leisure.
Problems are identified and rated based on importance (1 being not important at all,
10 being extremely important). The client is then able to choose their 5 most
important problems with occupational performance and rate their performance (1
being not able, 10 being able to do it extremely well) and their satisfaction with
performance (1 being not satisfied at all, 10 being extremely satisfied). Scores are
compared after a re-assessment is given to determine any changes in occupational
performance and satisfaction. Information is gathered from direct interview with
the client, or the clients caregiver.
The COPM was administered through an interview with G.U.s mom. J.U.
expressed concerns with G.U.s performance at school. G.U. is very social at school but
she does not participate in class very well. She is easily distracted by noises in the
environment and has a hard time focusing on her work. G.U. has a hard time giving her
schoolwork all of the attention it requires so she often misunderstands instructions. When
she gets answers wrong she gets discouraged and thinks she is not good enough.
 G.U. has problems with anxiety at school and at home. She will sometimes freak
out about getting her hair brushed and has anxiety about having snarles in her hair.
She has a hard time with chores. J.U. reports that G.U. panics when she has a job to do.
She does well with play and quiet recreation activities and has interests in swimming,
acting, and singing. She plays well with her siblings and friends.
J.U. identified 3 areas that she would like to see G.U. improve in. It is most
important to J.U. that G.U. improve her occupational performance in school and
emotional regulation. She performs lowest in those areas and J.U. is least satisfied
with her performance in those areas. J.U. would also like to see improvement in
G.U.s performance with chores, however it is less important to her and she is most
satisfied with G.Us performance in that area.
Occupational Performance Importance Performance Satisfaction
problems
School 10 6 6
Emotional Regulation 10 4 4
Chores 7 8 7
Total scores 18 17
Average Scores 6 5.7

Visual Motor Assessment

The Beery VMI is used to assess the extent to which individuals can integrate
their visual and motor abilities. It helps identify children who may need special
assistance. This assessment is comprised of copying various shapes. Each shape has
specific scoring guidelines; if the child meets those guidelines they are given a score of 1
for that shape. Each shape that does not meet the scoring guidelines is scored a 0. The
scores are added to get the raw score. The standard scores, scaled scores, and percentiles
are determined based on tables in the manual.
The raw score is simply the sum of all points received. Raw scores are of little
use on their own, but can be used to determine standard and scaled scores through
tables in the manual. Standard scores enable valid statistical comparisons. They can
be added and averaged. Standard scores have a mean of 100 and a standard
deviation of 15. Categories associated with standard deviations include average
(within 1 standard deviation above and below the mean), above or below average
(within 2 standard deviations above or below the mean), high or low (within 3
standard deviations above or below the mean), and very high or very low (greater
than 3 standard deviations above or below the mean). Scaled scores are more
general measures that allow results to be compared. They have a mean of 10 and
standard deviation of 3. Percentiles are also determined through tables in the
manual. Percentiles are not equal units of measure. They are good for
communication as most people are familiar with percentiles. Age equivalence are
difficult for most parents to understand. Ages used for these scores are the age at
which 50% of children develop that skill. There is a wide range of age equivalence
scores that are considered normal.
G.U. was able to imitate the first 12 shapes, which gave her a standard score
of 72 based on her age. This score falls 1.87 standard deviations below the mean.
She performed below average on this assessment. The average range for a child her
age is a raw score between 15 and 23 (standard score between 85 and 115). G.U.
scored in the 3rds percentile, 97% of children her age will perform better than she
did on the VMI. Her age equivalence score is 4:6, meaning her level of development
is equal to the development of 50% of 4.6 year olds. This score will not be reported
to parents due to the high possibility for misunderstanding the meaning of this
score.
G.U. was focused throughout the first 12 items on the assessment. As the
pictures became more complex and difficult for her she began to get discouraged
and not want to try anymore. She sat with good sitting posture (90-90-90) for the
first 5 items, then switched to a slouched posture. She laid her head on the table
during the final 3 drawings. G.U. uses a static tripod grasp with a thumb wrap with
her right hand and stabilizes the paper with her left hand.
G.U. is close to falling outside of 2 standard deviations below the mean on the
VMI, She has no reported functional deficits, but this is an area that should be
watched as she continues to develop. Slow development in this area may begin to
create functional deficits as more is expected from her in school and at home.
Raw Score 12
Standard Score 72
Scaled Score 4
Percentile 3
Age equivalence 4:6

BOT-2
The BOT-2 is used to assess fine and gross motor control in children ages 4-
21. There are four domains of this assessment, but for the purposes of this
evaluation only the manual coordination domain was tested. The manual
coordination domain consists of manual dexterity and upper limb coordination. This
domain encompasses control and coordination of the arms and hands, especially for
object manipulation. The manual dexterity subtests consist of 5 activities. For this
subtest, activities are completed in 15 seconds and the number performed correctly
is recorded. These raw scores are then converted to the correct point score as listed
in the scoring packet. The subtest total point score is calculated by adding all point
scores within that subtest.
The upper limb coordination subtest has 7 activities performed with a ball.
Again, the number of times an activity was performed correctly is recorded and
converted into point scores. The subtest total point score is calculated by adding all
point scores within that subtest. Total point scores are converted to scale score
using tables in the manual. The scale scores for both subtests are added together to
give the sum score for the manual coordination domain. This score can be converted
to a standard score using tables in the manual. All other scoring information is
available in various charts in the manual.
Subtest total point scores are not comparable from one subtest to the next
because subtests contain different numbers of items and are not equally difficult.
Derived scores are used to give a uniform meaning to scores based on the subtest
and examinees age. Scale scores describe the level of proficiency for each subtest.
This score tells how far their point score is from the mean point score for their age
group. These scores have a mean of 15 and a standard deviation of 5, they range
from 1 to 35, with equal unit of measurement. Standard scores are used to describe
level of proficiency on the four motor area composites and the total motor
composite. Again, this score tells how far the examinees score is from the average
score for their age group. These scores range from 20 to 80 with a mean of 50 and
standard deviation of 10.
G.U. scored below average in manual coordination. Scores between 40 and 60
are considered typical for her age group. Her score fell 1.2 standard deviations
below the mean. She is in the 12th percentile in manual coordination, 88% of girls
her age will score higher than she did in manual coordination. G.U. was below
average in manual dexterity. The range of typical scores in manual dexterity for girls
her age is between 19 and 28. G.U. scored 1.2 standard deviations below the mean.
Her upper-limb coordination score fell within the typical range, between 17 and 30.
Her score of 18 is .8 standard deviations below the mean, which is average.
During the manual dexterity subtests G.U. was having a difficult time focusing
and did not fully understand the instructions given to her. She would often pick up
pennies with the wrong hand and did not remember she was supposed to put dots
inside the circles. G.U.s score in manual coordination was just outside the typical
range. Her difficulties waiting for instructions and paying attention to the tester
impacted her score. This score also brought down her manual coordination score.
Based on observation, her manual dexterity skills are appropriate for her age. She
has no reported functional problems related to manual coordination but her mom
has indicated it is an area of weakness for her.
Total Scale Standard Confidence percentile Age Descriptive
point score score interval equivalence category
score 95%
Manual 18 9 5-13 5:6-5:7 Below
dexterity average
Upper-limb 18 11 7-15 6:0-6:2 average
coordination
Manual 20 38 32-44 12 Below
Coordination average

G.U. was pleasant throughout the observation and assessment. She was
talkative and told stories between most testing items. She did not pay attention to
the instructions and would often start the activity not really knowing what she was
doing. G.U. was very distracted throughout the process. G.U. got discouraged easily.
She said that she was not good at a task 8 times throughout the assessment process
G.U.s preferred hand is her right hand. She used her right hand for writing
and drawing activities as well as for ball activities. She stabilized paper and picked
up pennies with her left hand. G.U. sat with proper posture for the first 3 minutes of
the assessment. She then moved to a slouched posture for the remainder of the
assessment. When she was focused, G.U. put her head down on her left arm for
writing and drawing tasks. During the penny and block stringing tasks she sat on
her heels in the chair and leaned on the table. G.U. held the pencil using a static tripod
grip with a thumb wrap and was able to maintain her grip while manipulating the pencil.
Pencil manipulation was adequate for her age.

Summary
G.U. may not be participating in daily activities as would be expected of peers
her age. Children her age are involved in school, independently dressing,
participating in morning and bedtime routines, performing chores, and participating
in extracurricular activities. G.U. has the skills to participate in all of these
occupations, however, she is experiencing difficulties completing classwork,
completing chores at home, and tolerating her morning routine.
G.U. participates well in social activities and plays well with her friends and
siblings. She is socially appropriate with adults and has good social skills. Based on
results from the COPM, she has difficulties completing schoolwork and chores as
well as managing anxiety. G.U. has no reported functional deficits in visual motor
integration or manual dexterity, however she fell below average on the VMI and the
manual dexterity portion of the BOT-2. G.U. demonstrated signs of weak core
stability and trunk muscles, which may impact her ability to perform the tasks on
these assessments. She demonstrated a lack of attention to details and poor
understanding of instructions, which impacted her scores on these assessments. She
has a hard time focusing on tasks and is easily distracted, which could also influence
her understanding of instructions and ability to focus on details. She is impulsive
with tasks given to her, which influences the quality of her work. These factors could
be making her schoolwork and chores at home difficult to complete correctly and
lead to increased anxiety with completing these difficult tasks.
Further evaluation should be done to determine the underlying cause of
G.U.s below average results in the VMI and manual dexterity. After additional
observation and assessment OT may be recommended to address sensory needs
and strategies to help her pay attention and focus during class as well as addressing
cognitive strategies for completing tasks.



Shayna Roberts 9/3/2016