1. Jackson Rodriguez
Age: 15 months

2. Description of Jackson
Caucasian
Blue eyes, brown short hair.
Taller than most of his peers.
Laughs and plays a lot.
Jackson likes to play in his walker and loves any sort of interaction with his parents.
His favorite foods are cheerios, goldfish, and mac and cheese.

3. Family Background Jackson is an only child.
Father is a principal and mother stays at home with Jackson.
Jackson’s parents speak both English and Spanish to him at home.
Family just moved from one house to another. Jackson is having a hard time adjusting to the new environment.
Jacksons mother has just become pregnant.

4. Reason for Referral 15 months and not walking.
Prefers to scoot, creep, or cruise.
Jackson does not crawl on all fours with tummy fully off the ground.
His mother is also concerned about his language development
She wants to know..1. is Jackson developmentally behind in all developmental areas? 2. what should she do next?

5. Assessment and Results
Battelle Developmental Inventory Screening Test, 2nd Edition (BDI-2 Screener)
Unable to feed himself and drink from a cup by himself.
Does not attend to someone speaking to him for at least 10 seconds
Unable to walk 3 or more steps with assistance and or stand for 30 seconds
Domain
Standard Scores
Percentile
Description
Range
Adaptive 78 7
Low/Delay
Personal-Social 99 47
Average
Communication 77 6
Motor 76 5
Cognitive
106 66
Total Screening Score 87 19
Low Average

6. Conclusion
From this assessment it is concluded that Jackson could be referred to a speech therapist, occupational therapist and physical therapist.
Jackson needs additional help in order to reach the developmental milestones that children his age should obtain.
With this information it is advised that Jackson’s parents seek intervention as soon as possible.

7. Recommendations and Goals
Motor development: Be able to walk and stand.
When held, stand him up on the couch instead of letting him sit.
Communication: Be able to talk to people and associate words with objects.
Ask him question that he must reply to or develop his vocabulary by talking to him consistently.
Adaptive: Be able to feed himself and drink with assistance.
Put his food in front of him instead of feeding him.