Form is Attatched 

Observe three individuals from three points in the life span.  Only use subjects you do not know and to whom you are not related.  Select one subject from each of the following periods.

• Early Childhood  (3-5 years of age)
• Middle childhood through adolescence  (7-19 years of age)
• Adulthood (20 years and older)

Record at least one example for each of the terms on the

Observation Form

.

Assign a code name to subjects observed to protect their privacy. Code names usually reflect a characteristic of the subject such as “Miss Eats A Lot” and “Little Blue Shirt.”

Locations: Complete observations in a public place such as McDonald’s, a classroom, a clinic waiting room, athletic practice, church youth group, retirement center, or a workplace.  

Record specific, objective descriptions of behavior for each term listed.  

This is a clinical style report. List the term and provide the example of the behavior.

Do not state an opinion or make a judgment concerning the behavior.  Simply describe the behavior observed.

Allow yourself sufficient time to gather data.  Young children move more rapidly and produce a great deal of observable data very quickly.  Older adults may require a longer observation period in order to collect a sample for each term listed.

Submit only objective observations.

An example would be: Receptive Language – The teacher asked Red Shirt to place his coat in his cubby.  Red Shirt said, “Yes, mam.”  He placed his coat in the correct cubby.

Be descriptive and provide specifics such as “Hero could hear his coach call him to come on the field from a distance of approximately 50 feet with traffic noise in the background.”

Statements such as “He has a great vocabulary for his age,” “She had an attitude toward her mother,” and “Bright Eyes was the tallest in her class” are not objective.

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Life-Span Development Observation Form

Use the following information to guide observation reporting:

Name (Your name)

Code Name (Name you assign subject observed in order to provide privacy)

Age of Subject

Date

Location

Supervisor Signature or Contact Information

Physical Development:

Height (use actual height if available, frequently need to estimate)

____________________________________________________

Weight (may use actual weight if available, frequently need to estimate)

____________________________________________________

Body Proportions (Example: The head is 25% of the body length, long arms, thin, frail, muscular, obese)

_______________________________________________________
_____________________________

Hearing (state what the subject can hear and from what distance) 

_______________________________________________________
_____________________________

Vision (state what the subject saw, distance, and conditions)

_______________________________________________________
_____________________________

Tactile
Sensitivity (describe what they touched and their response to touching something or being touched)

________________________________________________________________________

Motor Development:

Fine Motor
Skills (small muscle movement such as picking up items, writing, or drawing)
___________________________________________________
______________________________

Gross Motor
Skills (large muscle movement such as running, jumping, walking, or climbing)

_________________________________________________________________________________

Physical Strength (lifting books, moving a desk, running five miles. Describe the movement and object moved.)

___________________________________________________
______________________________

Eye Hand Coordination (must include eyes and hands as in writing, eating, catching a ball)
_________________________________________________________________________________

Cognitive Development:

Attention (be specific. was subject listening, watching, conversing, writing…? How long?)

_________________________________________________________________________________

Short Term Memory (must be 30 seconds or less)
_________________________________________________________________________________
Long Term Memory (may be permanent memory. recall events from the past?)

_________________________________________________________________________________

Problem Solving (Example – When the paint spilled, the subject grabbed the paper towels and quickly wiped up the spill.)
_________________________________________________________________________________

Abstraction (adolescents and adults only) (reflects the use of a representational system. The subject may be observed to solve problems with words rather than having to use trial and error or manipulation of objects. Use of imagination may be displayed.)
_________________________________________________________________________________

Imagination (early childhood and elementary) (Example: The subject pretended to be a rabbit and hopped with hands held in front of his chest as if they were paws.)
_________________________________________________________________________________

Cognitive Strengths (Example: The subject listened to the coach and carried out the play without error.)
_________________________________________________________________________________

Cognitive Weaknesses (Example: Subject picked up the blocks but did not recall the correct shelf on which they were stored.)
_________________________________________________________________________________

Language Development:

Receptive Language/Language Comprehension (understanding, comprehension) (Can the subject follow a complex direction? Did he respond to specific terms?)
_________________________________________________________________________________

Expressive Language/Spoken or Written Language (verbal, gesture) (specific sentence produced by the subject as examples. Examples: Want drink! Make Joey get off of the tricycle, it’s my turn.)
_________________________________________________________________________________

Vocabulary (List of specific words)
________________________________________________________________________________

Grammar/Syntax (Another sentence produced by subject. Try to capture grammatic structure.)

___________________________________________________________
______________________

Articulation (How words are pronounced. Example: My bwofer an my thithter aw wittulu dan me. I have a wittle wed wagon.)
_________________________________________________________________________________

Voice Quality (Rising and falling of the voice for statements, questions. This is not loudness.)
_________________________________________________________________________________

Rhythm (Hesitate to speak, stutter, pause)
_________________________________________________________________________________

Pragmatics (choice of words, body language, physical distance, loudness of the voice)
_________________________________________________________________________________

Soci
oe
motional Development:

Sense of self (specific examples of defense of personal space, ownership, use of “I”, concern for appearance)
_________________________________________________________________________________

Interaction with Authority Figures (Example – “Little Red” lowered his eyes to the floor when spoken to by an adult. The “Teacher” imitated her teacher’s voice and stance.)
_________________________________________________________________________________

Interaction with Peers (Example -The “Terror” shouted directions to his peers on the playground and insisted on leadership in all activities.)
_________________________________________________________________________________

Interaction with Males (Example – “Little Red” avoided males in the classroom and on the playground.)

_________________________________________________________________________________

Interaction with Females (Examples -“Good Grammar” called on more girls than boys when asking questions of her fifth grade class. “Athlete” looked at girls, smiled at girls, but never spoke to girls.)

_________________________________________________________________________________