Tip Sheet for Cognitive Domain
Attention and Memory
AM 1: Visually attends to a light source moving in a 180-degree arc. (Structured)
- Child awake, alert, and calm
- Dimly lit room
- 6-8 inches from face; don’t shine in eyes
Make three attempts to recapture the child’s attention. Observe the child’s head and eye
Scoring: Follows continuously with both eyes and head = Score 2; Follows partially with eyes or head = Score 1; Does not respond = Score 0.
AM 2: Turns his or her eyes toward a light source. (Structured)
- Child awake, alert, and calm
- Light approximately 15-16 inches from midline
- Begin on one side and slowly arc to midline
- Repeat beginning on the alternate side
Repeat this procedure three more times. Note whether the child turns his or her eyes to look at the light and the location of the light when the child looks at it. Do not shine the light directly into the child’s eyes.
Check manual for scoring
AM 3: Visually attends to a light source moving in a vertical direction. (Structured)
- Child awake, alert, and calm
- Dimly lit room
- 6-8 inches from face; don’t shine in eyes
- Begin at eye level and slowly move up and down at midline
Make three attempts to recapture the child’s attention. Observe the child’s head and eye movements as the light moves.
Scoring: Follows continuously either with eyes or eyes and head = Score 2; Follows partially with eyes or head = Score 1; Does not respond = Score 0.
AM 5: Visually attends to an object for 5 or more seconds. (Structured)
- This item must be done with the ring as indicated in the directions.
Scoring: Child looks at ring for 5 or more seconds after hand removed = Score 2; 2 to 4 seconds after hand removed = Score 1; 1 or fewer seconds after hand removed = Score 0.
AM 6: Follows an auditory stimulus. (Structured)
- Use rattle
- Keep hand up after dropping rattle
- Three trials
Scoring: Turn head or eyes downward, following the rattle on 2 or more trials = Score 2; Turn head or eyes downward, following the rattle on 1 trial = Score 1; Does not turn head or eyes downward = Score 0.
AM 9: Occupies himself or herself for 5 minutes. (Observation or Interview)
- Excludes Screen Time (Passively viewing TV, Computer, IPad)
Scoring: 5 or more minutes = Score 2; 3-5 minutes = Score 1; Fewer than 3 minutes = Score 0.
AM 10: Attends to a game of peekaboo for 1 minute. (Structured)
- Use culturally appropriate name for the game
- Score on time of active engagement
If necessary, repeat this item throughout the test administration.
Scoring: 1 minute = Score 2; 30-59 seconds = Score 1; 29 or fewer seconds, or the child doesn’t respond = Score 0.
AM 11: Uncovers a hidden toy. (Structured)
- Must use red cups from kit (not see through)
- Small quiet toy that fits under cup
- Interest must be in the toy; not the cup
Scoring: Deliberately in one trial = Score 2. Unsuccessfully = Score 1. Does not attempt to remove cup = Score 0.
AM 12: Occupies himself or herself for 10 or more minutes without demanding attention. (Observation or Interview)
- Excludes Screen Time (Passively viewing TV, Computer, IPad)
Scoring: Typically (90% or more of time) = Score 2. Sometimes = Score 1. Rarely (10% or less of time) = Score 0.
AM 13: Searches for a removed object. (Structured)
- Handkerchief should not lie flat on the table
Scoring: Actively searches for toy as described = Score 2. Briefly searches for the toy but then gives up within a few seconds = Score 1. Does not search for toy = Score 0.
AM 15: Attends to one activity for 3 or more minutes. (Observation or Interview)
Observation.
- e. playing with a toy, listening to a story, watching TV
- Scoring is based on frequency
Scoring: Typically (90% or more of time) = Score 2. Sometimes = Score 1. Rarely (10% or less of time) = Score 0.
AM 16: Finds an object hidden under one of two cups. (Structured)
- Presentation order: Child’s right/left/right/left
Scoring: 4 presentations = Score 2; 3 presentations = Score 1; 2 or fewer presentations = Score 0.
AM 17: Selects the hand hiding a toy. (Structured)
- Presentation order: Child’s right/left/left/right
Scoring: 4 presentations = Score 2; 3 presentations = Score 1; 2 or fewer presentations = Score 0.
AM 27: Recalls facts from an oral story. (Structured)
- Evaluator must read the story from the manual/MDS.
Scoring: 3 questions = Score 2; 2 questions = Score 1; 1 or 0 questions = Score 0.
Reasoning and Academic Skills
RA 3: Reaches around a barrier to obtain a toy. (Structured)
- Must be a clear barrier for the child to reach around (Peel off the blue coating to administer the item).
Scoring: Reaches around or over plastic to obtain toy within 1 minute = Score 2; attempts to obtain toy in any other way = Score 1; Does not attempt to obtain toy in any way = Score 0.
RA 6: Nests objects inside one another. (Structured or Observation)
- Nesting of objects must be in sequential order.
Scoring: 5 cups = Score 2; 4 or 3 cups = Score 1; 2 or fewer cups = Score 0.
RA 16: Recognizes picture absurdities. (Structured)
- Child’s response must be verbal.
Scoring: 2 pictures = Score 2; 1 picture = Score 1; 0 pictures = Score 0.
Perception and Concepts
PC 1: Responds positively to physical contact and tactile stimulation. (Observation or Interview)
- Observe whether the child responds to a familiar person’s touch by quieting when upset or by becoming alert and aroused when quiet or drowsy.
- When administering this item be sure to look at the criteria in Observation or Interview in its entirety.
Scoring: Typically (90% or more of time) = Score 2. Sometimes = Score 1. Rarely (10% or less of time) = Score 0.
PC 6: Imitates simple facial gestures. (Structured)
- If it is more comfortable for the child, the parent or caregiver may administer the stimulus on this item.
- Slowly make facial movements, such as moving your tongue in and out, moving your tongue in a circle on your lips, opening and closing your mouth, raising and lowering your eyebrows, or smiling.
Scoring: Interacts for 30 seconds or more and imitates at least 1 facial gesture = Score 2; Attends to but does not imitate = Score 1; Does not attend to or imitate = Score 0.
PC 7: Places a circle and a square in a form board. (Structured)
- Item should be administered with FM 13
- Allow him or her minutes to complete the task
- Allow a total of three trials, if necessary
Scoring: Correctly places one circle or square in at least one trial = Score 2; correctly places either circle or square in at least one trial=Score 1; Does not correctly place any forms = Score 0.
PC 9: Identifies familiar objects by their use. (Structured)
- Must use all four objects for this item in the following order from the child’s left to right: cup, shoe, spoon, and ball
- Verbally label objects prior to trial (evaluator or child)
- Child may show or give object
- Allow only one trial for each request
Scoring: Identifies 3 objects = Score 2; Two objects = Score 1; One or zero objects = Score 0.
PC 17: Identifies simple objects by touch. (Structured)
- Place only 2 items in the bag for each trial.
Note: Use extreme caution to prevent the child from choking on the round beads.
Scoring: Child identifies object by touch in 2 sets = Score 2; 1 set = Score 1; 0 sets = Score 0.