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Purposes, Processes, and Methods
of Evaluation
Asmaa Osama Sayed Abdel-Khalek

1. Apply the Occupational Therapy Practice Framework to the
evaluation process for children and their families.
2. List five primary reasons to conduct evaluations.
3. Discuss the variety of decisions pediatric occupational therapists
make throughout the evaluation process.
4. Describe the specific steps pediatric occupational therapists follow
in the process of evaluating children
5. Describe the primary evaluation methods commonly used in
pediatric occupational therapy.
6. Discuss the major factors therapists should consider when selecting
evaluation methods and measures.

To examine fully a child’s occupational
performance,the occupational therapist
first analyzes how the physical demands and social
expectations of the home, school, and community environments
influence the child’s participation.
then identifying the areas of occupation most important to the
child and the caregivers,
last assesses the child’s performance skills and performance
patterns essential to his / her participation in everyday
activities.

is “the process of obtaining and interpreting
data necessary for intervention. This includes
planning for and documenting the evaluation
process and results” .

1. The evaluation is an ongoing, dynamic process
2. The views and priorities of the child’s primary
caregiver and of the child are central throughout the
evaluation process.
3. Evaluations should be ecologically and culturally
valid.
4. The outcome of the evaluation is an in-depth
understanding of the child’s participation in
occupations meaningful to him / her and to the
caregivers.

1. Comprehensive evaluation to develop an intervention plan
2. Screening to decide if further evaluation of the child is
warranted
3. Eligibility or diagnostic testing to decide if the child is eligible
for occupational therapy services or to assist in the diagnostic
process
4. Reevaluation to determine the child’s progress in therapy and
determine whether further therapy is warranted
5. Research or outcomes testing to evaluate the efficacy of
intervention services and therapy outcomes

The primary reason for screening children is
to determine whether they warrant a more
comprehensive evaluation. Occupational
therapists may participate in two levels of
screening.
The first level is a basic screening of
developmental skills (e.g., motor, social,
language, personal and adaptive skills).

In some settings, such as public school programs,
occupational therapists may participate in the
screening of large numbers of children to
determine which children should receive further
testing.

1. the Bayley Scales of Infant and Toddler
Development-Screening Test,
2. the Denver Developmental Screening Test-II
(Denver-II),

the second level of child screening. This type
of screening usually occurs after a health care
professional or teacher identifies the child as
being at risk for developmental delays or
functional limitations.
At this point in the screening process, the
occupational therapist administers more
comprehensive screening tools specific to a
particular functional area of concern.

• To determine children’s eligibility for services, standardized
measures are used to ensure that the test results are reliable
and valid.
• Many public school systems mandate the use of norm-
referenced tests by school personnel when qualifying students
for special services.
• Because most norm-referenced instruments do not include
children with disabilities in their standardization sample, the
therapist must use caution when interpreting the performance of
a child with a disability.

If the purpose is to determine whether the child continues to
qualify for early intervention or special education services, the
reevaluation may include a norm-referenced measure to ensure
valid and reliable results.
if the primary purpose of the reevaluation is to determine
whether the child is making progress in therapy, criterion-
referenced measures or the specific therapy goals and
objectives are generally more appropriate and sensitive to the
functional changes in the child.

1. the instruments used must be reliable and valid measures of
the dependent variable.
2. The measures selected depend on the research design.
Standardized, norm referenced, or criterion-referenced
instruments are used in large-group designs
3. the measurement of outcomes to document treatment
effectiveness.

Referral Gather data
Develop
occupational
profile
Select
assessment
measures
Revise
assessment and
intervention
plan
Develop
analysis of
occupational
performance.
Develop
recommendation
and functional
outcomes
Document
evaluation
results
Plan and
implement
intervention
Re-eval when
needed

The referral form often lists the child’s diagnosis or deficits in
specific developmental areas. To ensure that the referrals to
occupational therapy are appropriate, the occupational therapist
should be involved in the development of the referral form

an evaluation plan is based on
1. the child’s chronologic age,
2. presenting problems,
3. theoretical frames of reference,
4. parents’ priorities regarding reasons for referral,
5. availability of evaluation tools,
6. amount of time and resources available for initial evaluation
activities.
The therapist lists the major concerns and the evaluation methods
and measures that specifically assess those concerns

one of the most challenging aspects of the evaluation process is
managing the child’s behavior during administration of the
evaluation measures, particularly when the measures are more
formal, structured, and standardized. The evaluation of infants
and young children in a structured situation is demanding for the
children, the parents, and the therapist.

Accurate and complete interpretation of evaluation data allows
therapists to make sound clinical decisions, including whether the
child would benefit from occupational therapy services and, if so,
the appropriate frequency, duration, and type of therapeutic
intervention. Once the evaluation data are analyzed, the therapist
turns to the task of developing recommendations for the child.

• The term functional refers to the relevance of
the recommendation to the child’s daily life.
Therapists can translate evaluation findings
into functional, measurable treatment goals
that are relevant to the everyday activities of
children.

EXAMPLE
Evaluation finding. Because of inaccurate release of objects, Jill
does not stack 1-inch cubes on the PDMS-2.Given a 6-month time
frame:
a. Inadequate treatment goal. Jill will stack two 1-inch cubes,
three out of four trials.
b. Functional goal. When playing with small toys, Jill will
independently pick up and place small toys in a container, three
out of four trials.

A second factor to consider when making recommendations is
the parents’ or teachers’ priorities for the
child.
Example
during a feeding evaluation in a child’s home, a therapist
observes a mother and her child who has cerebral palsy and
failure to succeed.
The therapist notes that the mother placed the child in an infant
walker at mealtime. Because infant walkers are unsafe and
because this particular child would benefit from a more stable
seating device that provides trunk and head support for optimal
oral-motor performance, the therapist recommends the use of the
infant walker be discontinued and a special feeding seat be
ordered .

provide written and oral reports on the evaluation
findings and recommendations. The primary purpose of
documenting the results evaluation is to describe to
individuals working with the child the child’s current
abilities and limitations on various functional tasks.

Experienced therapists recognize that their words have
significant impact on the child’s family(can be positive
and supportive or negative and destructive).
When providing written documentation, the therapist must first
consider for whom the reports are intended, then carefully
construct reports that are understandable and useful to those
individuals. The format and content of evaluation reports may
vary significantly, depending on the referral concern, the
complexity of the child’s problem, and the regulations of the
service delivery system in which the child is served

1) Standardized Tests
2) Ecologic Assessments
3) Skilled Observation
4) Interviews
5) Inventories and
Scales
6) Arena Assessments

Characteristics
• Test manual
• Purpose, population, technical information, administration, scoring, and
interpretation
• Fixed number of items
• Fixed protocol for administration
• Fixed guideline for scoring
Copyright © 2015 of Elsevier Inc.

30
Types of Standardized Tests
 Norm-referenced
 Large diverse population
 Norm or average is derived from scores
 Performance is compared with a normal sample
 One or more areas of behavior
 Materials and activities are familiar and typical for
children of the age group
 Strict standardized protocols for administration
and scoring

31
Types of Standardized Tests
 Criterion-referenced
 Performance is compared with a particular criterion or
level of performance of a certain skill
 The purpose is to determine what skills a child can or
cannot accomplish, not to compare the child with
his/her peers.
 Administration and scoring may or may not be
standardized
 Certain scales are both norm and criterion referenced

32
Comparison of Norm-Referenced
and Criterion-Referenced Tests

33
Advantages and Disadvantages of
Standardized Testing
 Advantages
 Well-known and commercially available
 Common interdisciplinary language
 Monitor developmental progress
 Disadvantages
 Cannot be a stand-alone measure
 Provides only a brief “snapshot” of functioning
 Test situations are artificial and not a totally accurate
interpretation of daily functioning

The examination and recording of the
physical, social, and psychological
features of a child’s developmental
context.

ecologic assessments are also concerned with the interaction
between the child and his or her physical and social environments

ecologic assessment of a child uses techniques
that consider the cultural influences, socioeconomic
status, and value system of the family.
These assessments also consider the physical
demands and social expectations of the child’s
environment. Some of these methods include
naturalistic observations, interviews, and rating
scales.

An essential skill of the pediatric
occupational therapist is the ability to
observe keenly and to record accurately
children’s behavior in an objective manner.

(1) do not interfere with the natural course of
events.
(2) pay attention to the physical and social
features of the environment that support or limit a
child’s performance, and
(3) record the child’s behavior in observable and
neutral terms.

When skilled observations are used in the
evaluation process, therapists must select a
systematic, objective recording procedure
so that data collected are accurate and
reliable.
a problem-solving approach to functional
assessments and data based decision
making for occupational therapists
working with children in school settings.

with the child, the child’s parent, the teacher, and other
adults working with the child.
used in conjunction with other evaluation methods
provide a more comprehensive view of the child.
When conducted in a flexible, sensitive manner,
therapists and clients are able to explore areas of
concern as they arise.

Specific questions, which are often closed-ended, allow the
therapist to gather a predetermined set of information from the
individual in a relatively short time.
Unstructured interviews using open-ended questions allow the
child or parent to take the lead and set the priorities in the
discussion. Open-ended questions invite the individual to
elaborate on a topic and provide critical information

The Pediatric Evaluation of Disability
Inventory (PEDI)is an evaluation of
functional capabilities and performance
in children 6 months to 7.5 years of
age

• in some settings, each professional provides an individual
evaluation of the child, then the team members meet to discuss
their evaluation findings and recommendations.
• Sometimes little or no communication occurs among team
members before or during the evaluation. In contrast ,a team
in another setting may use the transdisciplinary approach, in
which one primary team member conducts the evaluation while
other key team members contribute their expertise to the
evaluation process through consultation.

The arena assessment uses a transdisciplinary approach.
• The lead evaluator, depending on the primary
referral concern. The occupational therapist may take the lead
if the child has
1. oral-motor deficits, such as chewing or
swallowing difficulties,
2. postural difficulties that create the need for
external support of posture at mealtime,
3. or fine motor difficulties that limit self-feeding
skills.

Note
 The International Classification of Functioning, Disability, and
Health (ICF) identified three levels of focus for interventions:
body structure or function (impairment), whole body movements
or activities (activity limitations), and involvement in life
situations (participation restrictions).
As a result, methods to assess children’s participation needed to
be developed. Participation measures are incorporated into
some standardized pediatric assessments such as the SFA.

 Sometimes the examiner must deviate from the standard
protocol because of special needs of the child being tested.
i.e a child with visual impairments may need manual guidance to
cut with scissors,
or a child with cerebral palsy may need assistance stabilizing the
shoulder and upper arm to reach and grasp a crayon.
If changes are made in the standardized
procedures, the examiner must indicate this in the
summary of assessment, and standard scores
cannot be used to describe that child’s
performance in comparison with the normative
sample

A test under development initially has a much larger
number of items than the final version of the test.
Through pilot testing, items are chosen or rejected
based partly on how well they statistically discriminate
between children of different ages and/or abilities.
Items are not chosen primarily for their relevance to
functional skills.

• Standardized tests provide uniformity for administration and
scoring.
• Standard scores allow interdisciplinary teams to “speak the same
language.”
• Norm-referenced tests compare the child’s performance to that
of the “normal” population.
• Any test situation is artificial and may not reflect the child’s
performance in the natural environment.
• It is important to be knowledgeable about the test’s reliability
and validity and to consider this information when interpreting
the test’s results.

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