Parent Report and Assessment by Jerri/updated by Wildflower Parent Report and Assessment for [Name of Child, Date of Birth] Prepared by: [Name of Parents/Caregivers] [Photo of Child] Table of Contents: 1. Introduction to [Name of Child] 2. Family History 3. Medical History 4. Mental/Emotional History 5. Social History 6. Scholastic History 7. Assessment History 8. Interventions: Past and Present 9. Concerns: Present and Future 10. Aspirations Notes: Do not try to write this all in one sitting. Start with one area of the document and work your way through, one item at a time. Gather all of the assessments, reports, report cards, journals, baby books and any other support documents into one folder/box so that you have easy access to the information while writing this report. Be mindful that the information will be part of the file/permanent record either at the doctor's office and or the school. Present the information clearly and as objectively as possible. The inclusion of your child's photograph lends a "face to the name" and personalizes the report even further. Introduction to [Name of Child] Describe what your child looks like, who he/she is, what his/her likes and dislikes are. This is meant to be a positive overview of your child. List what your child's strengths are in the home, the school, the community, and within him/herself. Family History Family: Start with whom your child lives with (parents, grandparents, siblings, etc.). When introducing the immediate family, indicate what their jobs are, what their interests are, any awards won, challenges they face, and what their relationship is like with your child, etc. You are trying to provide a picture of the influences in your child's life. Information about length of marriage, divorce, deaths in the family are important to address. Pets: List the number and type of pets you have and your child's relationship to them, how your child treats them. Values: Indicate what your family values are in relation to church, community involvement, volunteer work etc. Concerns: If you have concerns about your home, bring them up only slightly here. Medical History Start with the pregnancy of your child. What complications, if any, were noted? Describe the delivery, birth weight, and any issues of concern surrounding the birth process. List any developmental delays. List immunizations and any reactions noted related to them. List any infections (example: ear), illnesses (chicken pox), injuries, broken bones, stitches, etc. List any medications prescribed over the course of your childâs life. List any previous hospitalizations (physical/mental) your child has had. Mental/Emotional History List Family Medical History in particular, any known disorders such as Bi-polar, Depression, Aspergers Syndrome, Nonverbal Learning Disorder, Attention Deficit Disorder/Attention Deficit with Hyperactivity Disorder, Dyslexia, etc. If any assessments have been documented, note briefly what the outcome of the assessment(s) has been. There is a section devoted to Assessment History that will provide this in detail. Social History Describe how your child developed socially: were they eager to play with other children, how did they respond, did they have playmates, were they invited to parties, etc. Describe any relevant social family information here as well. This would include moves to other locations, divorce, major family upsets, etc. This is the place to frame your family's social history in the light you want it viewed. Describe any relevant information regarding interventions with police or other law enforcement. Scholastic History List the grade level of your child and schools attended. Note any awards or academic achievements your child has received. Note any difficulties your child has experienced in school (bullying, exclusion, grade failures, etc.). If any tutors have been provided, list the subject area and duration. If you have an Individual Education Plan (IEP), include it here. Assessment History Provide any assessments that have been documented. Interventions: Past and Present Note behavior modification plans, if they worked or not. List all medical, dietary, natural remedies that have been utilized and note which worked and which didnât. If therapy has been tried, list the outcome and whether or not it was of any benefit. If you are using â or have used - a methodology (such as the Riley Method, Explosive Child/Basket Method, 1-2-3 Magic, etc.) make note of it. Mention the resources you have found and tried, or wish you could try. Things such as biofeedback, music therapy, art therapy, summer camps, etc. Concerns: Present and Future What is troubling you about your childâs behavior at present (education, social life, spiritual life, home life, etc.)? What are your concerns about it? What are your worries for the future? Why? List what your child's weaknesses are in the home, the school, the community and within him/herself. Aspirations Allow yourself to sit back and dream of the life you want with and for your child. Be as specific as possible (enjoy mealtimes, outings, etc.). How you would like your difficult child to experience life.