School Contribution to Multi-Agency Assessment
Name:DOB:
School:Year Group:
Dear Colleague
The above child is undergoing an assessment to determine whether their difficulties could be attributed to a complex developmental disorder. The following should be completed by an adult(s) who knows the child well.
Please provide information about level of attainment eg Age Related Expectations, school-based assessment, literacy levels.Please comment on progress over the last 2-3 years (where possible).
Does the child currently receive any additional support? If so, at what level?
SEN Support Education, Health and Care Plan (or statement of SEN)
If additional support is provided, please outline this support, including any special arrangements during luncthtime/breaktimes.
Please attach current SEN Support Plan.
Has an EP been involved? Are there any formal written records/reports? If so, please attach.
Have any other agencies been involved? eg BSS, SALT, CAMHS, CSC, Outreach, SENISS......
(please indicate and add as necessary).
Please attach any relevant reports.
How would you describe the child’s relationships with peers?
How would you describe the child’s relationships with adults?
Does the child demonstrate imagination? In eg play/ writing/ story generation.
Does the child show any rigidity of thinking eg over routines or obsessions?If so, please give examples
Does the child show any difficulties with social communication eg turntaking/ sharing/ starting and maintaining conversation/ awareness of others/ eye contact? Please give details.
Does the child show any unusual sensory reactions to eg light/ noise/ touch/ materials, or appear overly fidgety and restless? Please give further information.
Does the child show understanding of his own and others emotions (Theory of Mind)? Please provide examples.
Please comment any other information you feel relevant? eg significant life events or significant family circumstances, organisation issues, physical skills, anxiety or other emotional health.
Please continueon a separate sheet if necessary.
Completed by: ………………………………………………………….. Role: ………………………………………..Date: …………
Please return to:…………………………………………………………......
Many thanks
V.27.4.17