# Child Observation Data Form Walkthrough

Use this handy walkthrough to familiarize yourself with the Child Observation Data Form, used to record a child’s performance data.

| Score Key |  | 10 |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Mastery performance 2 | Emergency performance 1A = Assistance 1I = Incomplete 1AI = Assistance/Incomplete | C= Conduct M= Modification Q= Quality R= Report |  |  |  |  |  |  |
| A. Reach, Grasp, and Release |  |  |  |  |  |  |  |  |
|  |  | Target | Score | Notes | Score | Notes | Score | Notes |
| 1. Makes directed batting or swiping movements with each hand |  | 13 | 14 | 15 |  | C M QR |  | C M QR |
| 1.1 Brings hands together near midline |  |  | C M QR |  | C M QR |  |  |  |
| 1.2 Makes directed movements with arms |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2. Grasps pea-size object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2.1 Grasps hand-size object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2.2 Grasps small cylindrical object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2.3 Grasps pea-size object using fingers in raking or scratching movement |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2.4 Grasps hand-size object using whole hand |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3. Stacks objects |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3.1 Releases object into targeted space |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3.2 Releases object into nondefined space |  |  |  | C M QR |  | C M QR |  | C M QR |
| B. Functional Skill Use |  |  |  |  |  |  |  |  |
| 1. Activates object with finger |  |  |  | C M QR |  | C M QR |  | C M QR |
| 1.1 Uses finger to point or touch |  |  |  | C M QR |  | C M QR |  | C M QR |
| 1.2 Uses hand to activate object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 1.3 Uses fingers to explore object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2. Rotates wrist to manipulate object |  |  |  | C M QR |  | C M QR |  | C M QR |
| 2.1 Turns object using either hand |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3. Manipulates object with two hands, each performing different action |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3.1 Assembles toy |  |  |  | C M QR |  | C M QR |  | C M QR |
| 3.2 Aligns objects |  |  |  | C M QR |  | C M QR |  | C M QR |

---

| Score Key |  |  | Note Key |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Mastery performance 2 | Emerging performance 1A = Assistance 1I = Incomplete 1AI = Assistance/Incomplete | No performance 0 | C = Conduct M = Modification Q = Quality R = Report |  |  |  |  |  |  |
| Exam(s) |  |  |  |  |  |  |  |  |  |
| B. Functional Skill Use (continued) |  |  |  | Target | Score | Notes | Score | Notes | Score | Notes |
| 3.3 Fits variety of shapes into corresponding spaces |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 3.4 Holds object with one hand and manipulates object or produces action with other hand |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 3.5 Transfers object from hand to hand |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| C. Mechanics of Writing |  |  |  |  |  |  |  |  |  |
| 1. Holds writing tool using three-finger grasp to write or draw |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.1 Writes or draws using mixed strokes |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.2 Writes or draws using curved lines |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.3 Writes or draws using straight lines |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.4 Scribbles |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| D. Use of Electronic Devices |  |  |  |  |  |  |  |  |  |
| 1. Uses finger to interact with electronic device |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.1 Uses finger to interact with simple electronic game |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |
| 1.2 Uses finger to interact with touch screen |  |  |  |  |  | C MQ R |  | C MQ R |  | C MQ R |

---

| To calculate Area Raw Score: Add the 2 and 1 scores in the Score column for the specific test date. To calculate Area Percent Score: Divide the Area Raw Score by the Area Raw Score Possible, then multiply by 100. |  |  |  |
| --- | --- | --- | --- |
| Test date |  |  |  |
| 16Area Raw Score |  |  |  |
| 17Area Raw Score Possible | 62 | 62 | 62 |
| 18Area Percent Score |  |  |  |

---

**19 Test date and examiner’s name**  
Space for comments related to the test area. Comments should provide critical information about the circumstances under which a child performed certain skills.

| Fine Motor |  |  |  |
| --- | --- | --- | --- |
| Total % correct | 100 |  |  |
| 80 |  |  |  |
| 60 | 23 |  |  |
| 40 |  |  |  |
| 20 |  |  |  |
| Test date: |  |  |  |

| Social-Communication |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |

| Literacy |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |

| Gross Motor |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |

| Social-Emotional |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |

| Cognitive |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |

| Math |  |  |  |  |
| --- | --- | --- | --- | --- |
| Total % correct | 100 |  |  |  |
| 80 |  |  |  |  |
| 60 |  |  |  |  |
| 40 |  |  |  |  |
| 20 |  |  |  |  |
| Test date: |  |  |  |  |