aggressive out of child. frustration). If the needs / functioning fall within a shaded box, explain why: child’s I-11. Sleep Child Must be 12 Months or Older (PAST 30 DAYS) – Child gets a sleep Child has some problems Child is having problems Child is experiencing full night’s each night. Any concerns are sleeping. Toddlers resist with sleep that might include significant sleep problems age / developmentally sleep and consistently need difficulty falling asleep, night that result in sleep appropriate or this a great deal of adult support waking, night terrors or deprivation that affects the information is unknown to me. to sleep. Preschoolers may nightmares on a regular functioning. Parents child’s have a history of poor sleep basis (4 or more times per have exhausted numerous or continued problems 1-2 week). strategies for assisting child. nights per week. If the needs / functioning fall within a shaded box, explain why: child’s I-12. Attachment (PAST 30 DAYS) No evidence of problems with Mild problems with Moderate problems with Severe attachment attachment. Any concerns are attachment. Children may attachment and may fail to problems. Children age / developmentally be overly reactive to demonstrate stranger attachment to anyone or no appropriate or this separation or seem anxiety or have extreme one in an extreme manner. information is unknown to me. preoccupied with parent. reactions to separation Child meets criteria for Boundaries may seem resulting affecting Reactive Attachment inappropriate. development, may avoid Disorder. caregivers and have inappropriate boundaries putting them at risk. If the needs / functioning fall within a shaded box, explain why: child’s A. EMOTIONAL CHARACTERISTICS (Ages Birth to 5) (Continued) I-13. Depression (PAST 30 DAYS) No evidence or concern about Child may be depressed or Moderate problems with Clear evidence of a depression. Any concerns are has experienced situations depression are present. disabling level of depression age / developmentally that may lead to depression. Children may have negative that makes it virtually appropriate or this Infants may appear verbalizations, no emotional impossible for the child to information is unknown to me. withdrawn and slow to response, dark / sad play function in any life domain. engage at times. Older and demonstrate little children are irritable or do enjoyment in play and not demonstrate a range of interactions. emotional response / affect. If the needs / functioning fall within a shaded box, explain why: child’s
aggressive out of frustration). child. If the child’s needs / functioning fall within a shaded box, explain why: I-11. Sleep – Child Must be 12 Months or Older (PAST 30 DAYS) Child gets a full night’s sleep each night. Any concerns are age / developmentally appropriate or this information is unknown to me. Child has some problems sleeping. Toddlers resist sleep and consistently need a great deal of adult support to sleep. Preschoolers may have a history of poor sleep or continued problems 1-2 nights per week. Child is having problems with sleep that might include difficulty falling asleep, night waking, night terrors or nightmares on a regular basis (4 or more times per week). Child is experiencing significant sleep problems that result in sleep deprivation that affects the child’s functioning. Parents have exhausted numerous strategies for assisting child. If the child’s needs / functioning fall within a shaded box, explain why: I-12. Attachment (PAST 30 DAYS) No evidence of problems with attachment. Any concerns are age / developmentally appropriate or this information is unknown to me. Mild problems with attachment. Children may be overly reactive to separation or seem preoccupied with parent. Boundaries may seem inappropriate. Moderate problems with attachment and may fail to demonstrate stranger anxiety or have extreme reactions to separation resulting affecting development, may avoid caregivers and have inappropriate boundaries putting them at risk. Severe attachment problems. Children attachment to anyone or no one in an extreme manner. Child meets criteria for Reactive Attachment Disorder. If the child’s needs / functioning fall within a shaded box, explain why: A. EMOTIONAL CHARACTERISTICS (Ages Birth to 5) (Continued) I-13. Depression (PAST 30 DAYS) No evidence or concern about depression. Any concerns are age / developmentally appropriate or this information is unknown to me. Child may be depressed or has experienced situations that may lead to depression. Infants may appear withdrawn and slow to engage at times. Older children are irritable or do not demonstrate a range of emotional response / affect. Moderate problems with depression are present. Children may have negative verbalizations, no emotional response, dark / sad play and demonstrate little enjoyment in play and interactions. Clear evidence of a disabling level of depression that makes it virtually impossible for the child to function in any life domain. If the child’s needs / functioning fall within a shaded box, explain why:
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