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Children Adaptive Behaviour Assessment -ABAS
Assessment 1 of 244
Form Instructions & Things to Know
How to fill this form:
Read each question carefully before selecting an answer.
Select the most accurate option based on your observations.
Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins
Estimated completion time.
Secure
Your data is fully encrypted.
Note:
This is a screening and assessment tool, not clinical (medical).
First, please provide your contact information.
Your Full Name
Email Address
Phone Number
Information about the individual being assessed.
Who are you filing for?
Choose relationship...
Self
Child
Partner
Family Member
Friend
Caretaker
Guardian
Teacher/Tutor
Name of Individual Being Assessed
Date of Birth
Age
Gender
*
Select Gender
Male
Female
School Grade (Optional)
Assessment Reasons / Reason for Assessment
1. Looks at other people’s faces when they are talking to him or her.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
2. Looks up or smiles when someone says his or her name.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
3. Laughs when a parent or other person laughs.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
4. Raises and lowers voice to express different feelings or needs.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
5. Says the names of other people (for example, “Mama,” “Daddy,” or names of friends).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
6. Follows simple commands (for example, “No” or “Come here”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
7. Uses one or more words to get something he or she wants, even if the word is not said correctly or pronounced well
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
8. Shakes head or says “Yes” or “No” in response to a simple question (for example, “Do you want something to drink?”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
9. Points to common items in a room when asked (for example, “Show me the TV”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
10. Repeats words others say (for example, says “baby” when an adult says “baby”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
11. Says phrases with at least two words (for example, “My book”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
12. Says the name of an object clearly enough that others recognize it (for example, “ball,” “dog,” “cup”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
13. Listens closely for at least 1 minute when people talk
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
14. Speaks clearly enough that others who do not know him or her can understand most of what is said.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
15. Follows simple, one-step directions that include “over” or “under” (for example, “Put your hands over your head”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
16. Avoids repeating what he or she says over and over again.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
17. Names 20 or more familiar objects.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
18. Sings all or part of the words to songs.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
19. Makes plurals of words by adding an -s (for example, “shoes,” “socks,” “dogs”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
20. Uses sentences with a noun and verb.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
21. Tells parent, friends, or others about his or her favorite activities.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
22. Asks questions such as “Will you play with me?”
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
23. Speaks in sentences of six or more words.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
24. Uses past tense to talk about prior events (for example, “I stayed inside”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
25. Has a conversation with another person for at least 3 minutes.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
26. Waits for others to finish what they are saying, without interrupting.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
27. Stays with parents or other family members in a store and does not wander off.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
28. Able to recognizes own home (house) in his or her immediate neighborhood.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
29. Able to walks on sidewalk of street rather the street
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
30. Informs parents when someone comes to the door
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
31. Shows respect for public property (for example, throws trash in cans, does not damage property).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
32. Obeys an adult’s request to “don’t touch” items when shopping.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
33. Asks to go to a park or other favorite community place.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
34. Knocks on a door or rings the doorbell before entering another person’s home.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
35. Refrains from talking loudly in a public place (for example, in a theater, movie, or church).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
36. Remains seated during a religious service or a movie.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
37. Asks to eat in a favorite restaurant.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
38. Recognizes and names buildings (for example, hospital, gas station, fire department, Church, Mosque).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
39. Identifies neighborhood locations where his or her family obtains needed items (for example, where to buy food, provision store).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
40. Recognizes the need to pay for an item before leaving a store.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
41. Describes the duties of workers (for example, says that firefighters put out fires and doctors help the sick).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
42. Looks both ways before crossing a street or parking lot.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
43. Asks to go to the library
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
44. Finds the washroom in public places.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
45. Buys own food when eating out.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
46. Able o makes a small purchase at a provision shop or from a food seller.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
47. Carries enough money to make small purchases (for example, a soft drink, toffees, buscuit).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
48. Walks alone to friends’ houses or apartments in the neighborhood.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
49. Points to at least one body part when asked (for example, “head” or “leg”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
50. Turns book pages one by one.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
51. Points to pictures in books when asked (for example, points to a car, house, horse or cow).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
52. Counts three or more objects
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
53. States his or her age in years when asked (Example; 4 years)
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
54. Sings the alphabet song.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
55. Names six or more colors, including red, blue, and yellow.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
56. Names four or more shapes (for example, circle, square, rectangle, triangle).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
57. Recites nursery rhymes from memory
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
58. Reads his or her name when written or Printed
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
59. Names at least two letters when shown his or her name.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
60. Identifies at least one coin by name (for example, 20 pesewas or 50 pesewas).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
61. Answers simple questions about a story read to him or her.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
62. Counts 10 or more objects without using fingers.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
63. Draws a recognizable face that includes two eyes, a nose, a mouth, and hair.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
64. Names most letters when shown the alphabet.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
65. Counts from 1 to 20.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
66. Write at least two letters in his or her name.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
67. Reads and obeys common signs (for example, Do Not Enter, Exit, Stop).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
68. States the days of the week in order
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
69. Writes his or her first and last name.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
70. Writes numbers 1 through 10 correctly.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
71. Tells which day comes before another (for example, “Wednesday comes before Thursday”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
72. States days and times of favorite after-school activities, such as sports practice, music lessons, or television shows.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
73. Removes buscuits, chips, or other food from a lunch box or School bag
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
74. Shows concern when he or she spills something (for example, says “Oh no” or tells the parent or other adult).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
75. Points to where commonly used foods are kept in the house (for example, the refrigerator, kitchen cabinet).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
76. Points to the place where his or her clothes are stored.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
77. Takes a shirt, dress or other piece of clothing out of a drawer or bag when asked
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
78. Assists parents, siblings or other people with putting away toys, games, cloths, bags, shoes and other items.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
79. Picks up and throws away trash items or paper at home.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
80. Does a simple errand when asked (for example, runs to get a towel for a spill).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
81. Avoids kicking or hitting a furniture or a table
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
82. Turns television on and off.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
83. Avoids throwing food or paper on the floor.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
84. Washes hands without splashing water on the floor.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
85. Gets own snacks from cabinet or lunch box or school bag.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
86. Assists adults with preparing simple snacks or meals (for example, hands slices of bread to adult for making sandwiches).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
87. Places dirty clothes in the proper place (for example, clothes basket or bag).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
88. Wipes up spills at home
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
89. Takes own clothes from drawers or bag or cabinet or closet when getting dressed.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
90. Keeps dirty shoes and feet off furniture
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
91. Puts his or her own dirty glass or plate in the sink or dishwasher.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
92. Puts things in their proper places when finished using them.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
93. Keeps toys, games, and other belongings neat and clean.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
94. Disposes of his or her leftover food.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
95. Pours liquid from a larger container or bottle into own cup or glass without spilling.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
96. Makes or dress his or her bed
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
97. Folds clean clothes.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
98. Swallows liquid medicines as needed, without worrying.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
99. Sits calm in high chair, booster seat, or chair, without climbing or sliding off.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
100. Avoids bumping into walls or objects when crawling or walking.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
101. Allows temperature to be taken without worrying.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
102. Shows, points to, or tells parent or another person about a cut, bruise, or other minor injury.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
103. Follows parent or another person’s direction to “stop” when near danger, such as fire or broken glass.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
104. Points to the body part that hurts when he or she is sick or injured.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
105. Remains fairly calm when an the parent or an adult treats his or cut or wound.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
106. Avoids putting non-edible objects in mouth (for example, crayons, blocks, sand).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
107. Avoids getting too near a fire, broken glass, or other potential danger
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
108. Avoids touching or playing with dangerous items (for example, insect spray or sharp knives).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
109. Avoids crawling or climbing on high or dangerous places.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
110. Tells parents or an adult if he or she has a stomachache or other illness.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
111. Tests hot foods before eating them.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
112. Puts on a coat when the weather is cold.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
113. Carries breakable objects safely and carefully.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
114. Asks parent or an adult before going near something that might be dangerous (for example, animals, busy streets, or high playground equipment).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
115. Fasten car seat or seat belt (In a car).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
116. Carries scissors safely.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
117. Carries hot containers safely and carefully
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
118. Uses electrical outlets or sockets safely
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
119. Cares for own minor injuries (for example, paper cuts, knee scrapes, nosebleeds).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
120. Smiles or shows interest when he or she sees a favorite toy.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
121. Plays with a variety of toys instead of only one or two.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
122. Plays with a single toy or game for at least 1 minute.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
123. Plays alone with toys and games, or does other fun activities.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
124. Plays simple games like “peek-a-boo” or rolls a ball to others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
125. Looks with an adult at pictures in books or magazines.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
126. Watches for a few minutes as people play with toys or games.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
127. . Shows interest in a toy or other object by pointing to it.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
128. Chooses a game or toy during playtime.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
129. Plays with toys, games, or other fun items with others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
130. Plays with a single toy or game for more than 5 minutes.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
131. Plays on playground equipment at the park, school, home, or playground.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
132. Asks parent/caretaker to read to him/her from a favorite book.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
133. Attends fun activities at another’s home.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
134. Engages in imaginary or make-believe play with others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
135. Participates regularly in a specific fun activity (for example, listening to a certain type of music or playing a favorite computer game or other games).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
136. Plays simple games with playmates without adult supervision.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
137. Invites others to join him or her in playing games and other fun activities.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
138. Saves things of interest to him/her(for example, rocks, feathers, pictures).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
139. Waits for his or her turn in games and other fun activities.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
140. Follows the rules in games and other fun activities.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
141. Invites others home for a fun activity.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
142. Plays simple board games.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
143. Participates in an organized program for a sport or hobby (for example, practices basketball or takes a music class, football, other sports).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
144. Swallows liquids (water or liquid products) without difficulty.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
145. Sleeps through most of the night, waking no more than one or two times.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
146. Swallows soft, strained, or mashed food such as baby food or applesauce.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
147. Opens mouth when offered food on a spoon.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
148. Feeds himself or herself crackers, cookies, dry cereal, or other finger foods.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
149. Eats firm foods that require biting and chewing (for example, steamed vegetables or others).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
150. Drinks from a cup or glass, even if another person must hold it.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
151. Lifts arms as needed when another person is dressing or undressing him or her.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
152. Points to or asks for food when hungry.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
153. Takes shoes off.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
154. Feeds himself or herself with a spoon or fork, not hands.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
155. Washes hands with both soap and water.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
156. Wipes his or her own face when given a washcloth by an adult.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
157. Remains dry without wetting throughout the day.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
158. Sits on the toilet or potty seat without being held.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
159. Tells parent or other adult when he or she needs to use the bathroom.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
160. Remains dry without wetting throughout the night.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
161. Brushes teeth with little worrying when told to do so by an adult.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
162. Uses bathroom without help.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
163. Dresses himself or herself.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
164. Buttons own clothing.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
165. Takes a bath or shower without help.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
166. Washes his or her own hair.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
167. Cuts meats or other foods into bite-size pieces with a knife.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
168. Shows interest in a toy or other object by looking at it for a few seconds.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
169. Sits quietly for at least 1 minute without demanding attention.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
170. Finds something to do for at least 5 minutes without demanding attention.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
171. Plays with a toy without putting it into his or her mouth.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
172. Explores an unfamiliar room or other new situation, even if a parent must encourage it (for example, a doctor’s waiting room, a new office, new home)
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
173. Chooses the food or snack he or she wishes to eat when given a choice.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
174. Moves a few feet away from a parent in a new situation as long as the parent is in sight (for example, when visiting an unfamiliar residence).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
175. Tries to do most things alone without an adult’s help (for example, dressing or feeding self)
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
176. Follows an adult’s request to “quiet down” or “behave.”
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
177. Resists pushing or hitting another child when angry or upset.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
178. Follows simple household rules (for example, “No running in the house”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
179. Stands still when needed, without fidgeting or moving around.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
180. Starts an activity at once when told to do so (for example, “Go take a bath”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
181. Controls temper when a parent or other adult takes a toy or object away.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
182. Asks permission from an adult when needed (for example, “May I go outside to play?”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
183. Keeps working on hard tasks without becoming discouraged, quitting, or needing reminders.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
184. Works independently and asks for help only when necessary.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
185. Stops a fun activity, without complaining, when told that time is up.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
186. Controls temper when disagreeing with friends.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
187. Follows a routine without being reminded (for example, brushing teeth before bedtime or feeding a pet).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
188. Asks permission before playing with another child’s toy or game.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
189. Chooses own clothes almost every day.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
190. Works on one home or school activity for at least 15 minutes without reminders.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
191. Discusses ways to solve conflicts with others (for example, “You can have this now if I can have it later”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
192. Smiles when he or she sees a parent.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
193. Relaxes body when held (for example, cuddles).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
194. Squeals or laughs when happy or delighted.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
195. Displays closeness to a parent (for example, is happy when parent returns).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
196. Shows a sense of humor (for example, laughs when someone acts silly).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
197. Lifts arms to express a desire to be picked up.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
198. Responds differently to familiar and unfamiliar persons (for example, is less warm to an unfamiliar person).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
199. Hugs and kisses parents or others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
200. Imitates actions of adults (for example, pretends to clean house or drive a car).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
201. Shows respect for persons in authority by following their rules and directions (for example, parents, teachers, police officers).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
202. Shares toys willingly with others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
203. Greets other children (for example, says “Hi”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
204. Says “Thank you” when given a gift.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
205. Shows sympathy for others when they are sad or upset.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
206. Seeks friendship with others in his or her age group.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
207. Responds appropriately when introduced to others (for example, says “Hello”).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
208. Says “Please” when asking for something.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
209. Says when he or she feels happy, sad, scared, or angry.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
210. Displays good table manners (for example, by using a napkin and remaining at the table until excused).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
211. Offers assistance to others (for example, to carry packages or put away food).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
212. Apologizes if he or she hurts the feelings of others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
213. Places reasonable demands on friends (for example, does not become upset when a friend plays with another friend).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
214. Refrains from saying or doing things that might embarrass or hurt others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
215. Personally makes or buys gifts for family members on birthdays or major holidays.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
216. Lifts head to look around.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
217. Follows a moving object by turning head.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
218. Rolls from stomach to side.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
219. Takes a rattle or similar object or toy and moves it back and forth to create sound.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
220. Moves to reach objects such as a bottle or toy.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
221. Transfers objects from one hand to the other.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
222. Sits upright on the floor without support.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
223. Moves to a sitting position, even if balance is unsteady.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
224. Pulls himself or herself to a standing position (for example, in a baby bed or others).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
225. Picks up small flat objects from a table (for example, coins or buttons).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
226. Crawls for about 10 feet without falling over.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
227. When standing, bends over to pick up items from the floor.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
228. Stands up from a sitting position.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
229. Rolls ball to others.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
230. Walks without help.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
231. Throws a small ball overhand.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
232. Walks up at least five to six steps without falling (may use handrail).
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
233. Kicks a ball without falling.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
234. Bounces a ball for several seconds.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
235. Catches a ball tossed from 5 to 10 feet away.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
236. Draws straight lines across a piece of paper.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
237. Colors within the lines of a drawing or in a coloring book.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
238. Removes cover on cups or jar and closes them tightly.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
239. Uses scissors to cut along a straight line.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
240. Uses scissors to cut shapes with curved lines.
Is not able
Never (or almost never) when needed
Sometimes when needed
Always (or almost always) when needed
ONLY if you Guessed
241. Any Comments
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