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SAMPLEPediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)PEDI-CAT ReportStephen M. Haley, Wendy Coster, Helene M. Dumas, Maria A. Fragala-Pinkham, Richard Moed
Examinee InformationName: Anna SampleBirth Date: 04/14/2006Gender: Female
SAMPLEPEDI-CAT Report05/01/2020, Page 4 Anna Sample
Climbs over 2 foot high obstacle such as a baby gate. Please do not consider use of walking aids(walker, crutches or canes). Unable
Climbs up ladder of a slide Unable
Gets in and out of bathtub. Please do not consider use of walking aids (walker, crutches or canes). A little hard
Goes up and down an escalator. Please do not consider use of walking aids (walker, crutches orcanes). Easy
Walks and carries a full shopping bag with handles. Please do not consider use of walking aids(walker, crutches or canes). Unable
Walks fast enough to cross two-lane street safely. Please do not consider use of walking aids(walker, crutches or canes). A little hard
Moves across monkey bars Unable
Walks on a raised narrow surface (curb/low wall). Please do not consider use of walking aids(walker, crutches or canes). Hard
Stands up from an adult-size chair. Please do not consider use of walking aids (walker, crutches orcanes). Easy
Walks up a flight of stairs without holding onto handrail. Please do not consider use of walking aids(walker, crutches or canes). A little hard
Gets on and off an adult-sized toilet. Please do not consider use of walking aids (walker, crutches orcanes). Easy
Walks down a flight of stairs holding onto handrail. Please do not consider use of walking aids(walker, crutches or canes). A little hard
Walks down a flight of stairs without holding onto handrail. Please do not consider use of walkingaids (walker, crutches or canes). Hard
Climbs on and off a climbing structure Unable
Walks up a flight of stairs holding onto handrail. Please do not consider use of walking aids (walker,crutches or canes). Easy
Jumps down off a single step. Please do not consider use of walking aids (walker, crutches orcanes). Easy
Climbs out of swimming pool using pool ladder A little hard
Opens and closes door to enter and exit home. Please do not consider use of walking aids (walker,crutches or canes). Easy
Stands while holding on in a moving vehicle (bus, train, trolley, boat/ferry). Please do not consideruse of walking aids (walker, crutches or canes). Hard
Walks in between a row of auditorium or movie theater seats A little hard
Steps up and down curbs. Please do not consider use of walking aids (walker, crutches or canes). Easy
Pushes adult-size shopping cart A little hard
Walks and carries a food tray. Please do not consider use of walking aids (walker, crutches orcanes). A little hard
Social/Cognitive
Recognizes numbers such as on a clock or phone A little hard
Teaches another person a new game or activity by giving examples and explanations Unable
SAMPLEPEDI-CAT Report05/01/2020, Page 5 Anna Sample
Associates a specific time with a specific activity such as a favorite TV show starting at 3 pm Hard
Describes what help is needed to solve a problem such as approaching store staff to locate item orasking a friend to borrow a book needed for homework Hard
Prints first and last name legibly Hard
Checks traffic in both directions and knows when to cross street Hard
Explains reasons behind actions such as why he/she spent money on a particular item Hard
Tries to resolve a conflict with friends or classmates Unable
Attends to and follows direction given by a coach or teacher while in a large group (20-30 children orteenagers) Unable
Maintains friendships that involve give-and-take, compromises and loyalty Unable
Asks permission before using someone else's property Hard
Shows positive reactions to friends' success such as congratulating a peer for scoring a goal ordoing well on a test Hard
Accepts advice or feedback from a teacher, coach, or boss without losing temper Unable
Accepts the need to wait an hour or two before a request can be met Hard
Uses several words or signs together such as "go home now" and "daddy go" Easy
Takes turns sharing a favorite toy with peers Hard
Stays quiet in public places when expected Hard
When upset, responds without punching, hitting, or biting Hard
Uses words, gestures or signs to ask for something Hard
Transitions from one familiar activity to another such as playground to classroom, bath time to bedtime Hard
Uses the words yesterday/ tomorrow/ today correctly Easy
Recognizes his/her printed name Easy
Associates days of the week with their typical activities such as football practice on Tuesday, choreson Saturday A little hard
Understands signs in the community such as Restrooms or EXIT A little hard
Provides own address and telephone number when asked Unable
Takes turns and follows rules while playing simple board, card, or video games Hard
Works with friends to reach an agreement when they have different ideas Unable
Participates in role-playing activities such as playing school or acting out famous characters Unable
Puts together an unfamiliar 5-10 piece puzzle with interlocking pieces Hard
SAMPLEPEDI-CAT Report05/01/2020, Page 6 Anna Sample
Keeps unsafe objects and household materials out of mouth Easy
Responsibility
Choosing and arranging own social interactions Adult has full
Keeping track of time throughout the day Adult has most
Managing kitchen appliances such as stove, microwave, or dishwasher safely Adult has full
Selecting clothing that is appropriate given the weather, daily schedule, and activities Shared
Determining the safety of a new location such as an unfamiliar neighborhood or a large event withmany people, and responding appropriately to stay safe Adult has most
Managing menstrual cycle Shared
Taking care of minor health needs Adult has full
Prioritizing and coordinating multiple goals at the same time (e.g. keeping up grades as well as afterschool activities) Adult has full
Staying safe in a familiar location that is known to be safe such as friend's home or local park Adult has most
Eating and drinking appropriate foods to maintain health and energy Adult has most
Keeping personal electronic devices in working order (e.g., cell phone, computer) Adult has most
Making healthy choices to maintain health and well-being Adult has most
Tracking spending and managing money Adult has most
Traveling safely within the community Adult has full
Fixing simple meals that do not involve cooking such as cereal or a sandwich Adult has most
Seeking medical help for serious illness or injury when needed Adult has full
Coping with stress, worry, or anger Adult has most
Supervising or caring for another person (e.g., sibling or other child, grandparent) Adult has full
Eating safely without choking or burning self Shared
Communicating health needs and seeking information and services as needed Adult has full
SAMPLEPEDI-CAT Report05/01/2020, Page 9 Anna Sample
ITEM MAP: Mobility Scaled score = 62, SE = 0.58, Fit = -0.23Running & PlayingRides bicycle 1 2 3 4Jumps rope 10 times 1 2 3 4Moves across monkey bars 11 2 3 4Pulls self out of pool, no ladder 11 2 3 4Pumps legs and swings 11 2 3 4Climbs out of pool using ladder 1 2 33 4Climbs on/off climbing structure 11 2 3 4Rides tricycle 1 2 3 4Climbs up slide ladder 11 2 3 4Standing, kicks rolling ball 1 2 3 4Running, goes around people/objects 1 2 3 4Moves forward on ride-on toys 1 2 3 4
Steps & InclinesClimbs step ladder, puts box on high shelf 1 2 3 4Carries laundry basket up flight of stairs 1 2 3 4Gets on/off bus 1 2 3 4Runs up 2 flights of stairs 1 2 3 4Hikes up hill 2-3 miles/3-5 km 1 2 3 4Climbs over 2 foot high obstacle 11 2 3 4Walks up flight of stairs, no handrail 1 2 33 4Walks down flight of stairs, no handrail 1 22 3 4Walks up/down gym/stadium bleacher steps 1 2 33 4Jumps down off single step 1 2 3 44Goes up/down escalator 1 2 3 44Walks down flight of stairs with handrail 1 2 33 4Climbs indoor step ladder 1 2 3 4Walks up flight of stairs with handrail 1 2 3 44Walks up/down ramp 1 2 3 4Walks on curb/low wall 1 22 3 4Steps up/down curbs 1 2 3 44Crawls/scoots on bottom up/down stairs 1 2 3 4
Standing & WalkingWalks 50ft/15m carrying 25lb/11kg bag 1 2 3 4Walks 3 miles/5 km 1 2 3 4Stands holding on in moving vehicle 1 22 3 4Walks wearing heavy backpack 1 2 3 44Walks fast enough to cross 2-lane street 1 2 33 4Walks/carries full bag with handles 11 2 3 4Pushes adult-size shopping cart 1 2 33 4Walks/carries food tray 1 2 33 4Walks several hours at family/school outing 1 2 3 4Opens/closes door to enter/exit home 1 2 3 44Walks wearing light backpack 1 2 3 4Walks between rows of seats 1 2 33 4Walks/carries full glass without spilling 1 2 3 4Pulls wagon filled with toys/child 1 2 3 4Walks on wet, indoor slippery surfaces 1 2 3 4Walks in home, no stairs 1 2 3 4Walks outdoors on grass/mulch/gravel 1 2 3 4Stands on tiptoes to reach 1 2 3 4Walks around people/objects 1 2 3 4Bends/picks up something from floor 1 2 3 4Stands for a few minutes 1 2 3 44Squats down/stands up 1 2 3 4Walks holding onto furniture/walls 1 2 3 4
Basic Movement & TransfersGets on/off adult-sized toilet 1 2 3 44Gets in/out of van/truck/SUV 1 2 3 44Gets in/out of car 1 2 3 44Gets in/out of bathtub 1 2 33 4Steps in/out of shower stall 1 2 3 4Stands from adult-size chair 1 2 3 44Gets in/out of bed 1 2 3 4Gets under sheet/blanket and arranges pillows 1 2 3 4Climbs onto couch/adult-size chair 1 2 3 4Sits in adult-size chair with a back 1 2 3 4Stands from middle of floor 1 2 3 4Gets onto hands and knees 1 2 3 4Sits while pushed on infant swing 1 2 3 4Sitting on floor, reaches overhead for toy 1 2 3 4On belly, pushes up on hands 1 2 3 4Sits on floor with pillow 1 2 3 4Sits on floor unsupported 1 2 3 4On back, reaches for toy 1 2 3 4On belly, pushes up on elbows 1 2 3 4Rolls over in bed/crib 1 2 3 4On back, turns head to both sides 1 4On belly, turns head to both sides 1 2 3 4
1 = Unable, 2 = Hard, 3 = A little hard, 4 = Easy20 30 40 50 60 70 80
SAMPLEPEDI-CAT Report05/01/2020, Page 10 Anna Sample
ITEM MAP: Social/Cognitive Scaled score = 61, SE = 0.67, Fit = -2.92Self ManagementAccepts advice/feedback 11 2 3 4Accepts the need to wait 1 22 3 4Keeps unsafe objects out of mouth 1 2 3 44Stays quiet in public 1 22 3 4Behaves safely 1 2 3 4When upset, responds appropriately 1 22 3 4Transitions from one activity to another 1 22 3 4
InteractionAsks for change in plans respectfully 1 2 3 4Uses strategy/follows rules 1 2 3 4Uses appropriate language 1 2 3 4Resolves conflict 11 2 3 4Maintains friendships 11 2 3 4Works to reach agreement 11 2 3 4Takes turns/follows rules in simple games 1 22 3 4Shows positive reactions 1 22 3 4Participates in role-playing 11 2 3 4Asks permission 1 22 3 4Carries on conversation 1 2 3 4Asks peers to play 1 2 3 4Greets new people 1 2 3 4Plays with other children 1 2 3 4Takes turns sharing 1 22 3 4Plays peek-a-boo/pat-a-cake 1 2 3 4Interacts with peer in play 1 2 3 4Follows gaze 1 2 3 4
CommunicationWrites short notes 1 2 3 4Provides address/telephone number 11 2 3 4Describes help needed 1 22 3 4Explains reasons for actions 1 22 3 4Teaches new game/activity 11 2 3 4Uses yesterday/tomorrow/today 1 2 3 44Uses words/signs to ask questions 1 2 3 4Uses several words/signs together 1 2 3 44Uses words/signs to ask 1 22 3 4Uses single word/gesture/sign 1 2 3 4
Everyday CognitionUses map 1 2 3 4Writes 2-3 page report 1 2 3 4Follows complex instructions 1 2 3 4Finds phone number/address 1 2 3 4Uses calendar/datebook 1 2 3 4Counts out correct bills 1 2 3 4Counts out correct coins 1 2 3 4Writes legible 3-4 item list 1 2 3 4Follows written directions 1 2 3 4Uses watch/clock 1 2 3 4Prints name legibly 1 22 3 4Understands signs in community 1 2 33 4Associates days with activities 1 2 33 4Checks traffic in both directions 1 22 3 4Follows directions in large group 11 2 3 4Associates time with activity 1 22 3 4Recognizes numbers 1 2 33 4Recognizes printed name 1 2 3 44Puts together 5-10 piece puzzle 1 22 3 4Follows directions in small group 1 2 3 4Tries things a different way 1 2 3 4Builds simple structures 1 2 3 4Uses toys in pretend play 1 2 3 4Tries to make toys work 1 2 3 4Shows interest in objects 1 2 3 4
1 = Unable, 2 = Hard, 3 = A little hard, 4 = Easy20 30 40 50 60 70 80
Staying SafeTaking precautions to protect personal information 1 2 3 4 5Traveling safely within community 11 2 3 4 5Using internet safely 1 22 3 4 5Determining safety of new location 1 22 3 4 5Supervising/caring for another person 11 2 3 4 5Testing/adjusting water temperature 1 22 3 4 5Staying safe in familiar location 1 22 3 4 5Eating safely 1 2 33 4 5
1 = Adult has full, 2 = Adult has most, 3 = Shared, 4 = Child has most, 5 = Child has full