DIAGNOSTIC INVENTORY FOR SCREENING CHILDREN
(DISC)
SUMMARY OF RESULTS

 
 

Name: ____________________________________________________________________

Address: __________________________________________________________________

Postal Code: _______________ Phone: _______________________ Date: ______________

Date of DISC Preschool Screen (DPS): _____________________________________________

Score: ___________________

Date of DISC: __________________ (yyyy/mmm/dd)

Date of Birth: ___________________ (yyyy/mmm/dd)

Age in Months: _______ 

Previous DISC Dates:

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2.________________

3.________________

 
     
 

Reason for DISC Screening:
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Person Present During Session:
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Behavioural Observations During Sessions:
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Summary of DISC Developmental Profile
 
RAW SCORE

% ILE VALUE

INTERPRETATION
AGE EQUIVALENT
Fine Motor        
Gross Motor        
Receptive Language        
Expressive Language        
Auditory Attention & Memory        
Visual Attention & Memory        
Self Help        
Social Skills        
 
     
 
Summary of Performance On Each DISC Scale
 
     
 
Fine Motor: The ability to coordinate the small muscles of the hands in voluntary, controlled and guided
movements. This includes the ability to grasp, pick up, release, imitate and copy patterns
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Gross Motor: The ability to use the large muscles of the body in a coordinated fashion. This includes
being able to maintain balance, both while standing and in motion, and to execute motor patterns accurately and rhythmically.

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Receptive Language: The ability to understand and respond appropriately to verbal commands,
instructions, explanations, questions and sounds.

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Expressive Language: The ability to produce appropriate verbal responses, explanations,
commands, descriptions and questions.
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Auditory Attention & Memory - Auditory and Visual: Attention involves the ability to or
focus on the relevant components of a task for a defined amount of time; Memory is the ability to retain and
retrieve impressions or recall or recognize previous experiences.

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Visual Attention & Memory - Auditory and Visual: Attention involves the ability to or focus
on the relevant components of a task for a defined amount of time; Memory is the ability to retain and
retrieve impressions or recall or recognize previous experiences.

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Self Help: The ability to help or aid oneself in caring for personal needs.
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Social Skills: The ability to interact with others and engage in socially appropriate behaviours.
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OVERALL SUMMARY OF RESULTS
 
     
 


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Strengths:
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Challenges:
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Referral Recommendations:
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Programming Strategies:
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MAINLAND CONSULTING INC.
Marian Mainland
Phone: (519) 699-5429 Fax: (519) 699-4890
Email: mmainland@rogers.com