Adaptive Behaviours Assessment - Vineland

Assessment 1 of 182

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  • 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.
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Note: This is a screening and assessment tool, not clinical (medical).

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Information about the individual being assessed.

1. Follows "if-then" directions. Examples: "If you're thirsty, then get a drink"; "If you are cold, then get a sweatshirt."
2. Answers questions that use when. Example: You ask "When do you eat breakfast?" He/she says "In the morning."
3. Pays attention to a story for at least 15 minutes. (Score 2 if he/she did this when younger, but has now outgrown listening to stories)
4. Answers questions that use why. Example: You ask "Why are you crying?" He/she says "My toy broke."
5. Follows directions to do the same thing to two different objects. Examples: "Bring me the crayons and the ball," "Put on your shirt and your shoes."
6. Follows directions to do two things that do not go together. Example: "Turn off the TV and get my keys."
7. Follows three-step directions. Example: "Get dressed, eat breakfast, and brush your teeth."
8. Follows directions involving left and right. Examples: "Go to the left," "Look to the right."
9. Pays attention to a 15-minute informational talk and understands what is being said.
10. When told to do something a little later, remembers to do it. Example: "When your show is over, put your dishes in the sink."
11. Understands what people really mean when they are being sarcastic. Example: Knows when "That's just great!" really means "That's awful!"
12. Pays attention to a 30-minute informational talk and understands what is being said.
13. When told to do something much later that day, remembers to do it. Example: "When you get home from school, let the dog out"
14. Knows how to say more than one of something. Examples: "Two cats," "More crackers," "Those flowers."
15. Uses and in sentences. Examples: "Mom and Dad are here," "I want ice cream and cake."
16. Makes at least three more advanced gestures such as these: {1) Motioning come here with the hand,{2) Putting a finger over lips to mean he quiet,{3) Holding hands apart to show this hig,{4) Shrugging shoulders to mean I don't know.
17. Uses adjectives to describe things. Examples: "Pretty picture,""Big doggie."
18. Says both his/her first name and last name when you ask.
19. Uses all pronouns {words that refer to himself/herself and others) correctly. Examples: I, she, us, them, your, our, their.
20. Uses two-part sentences joined by and or but. Examples: "She asked me, and I told her no"; "Jerome wanted to go, but I didn't."
21. Knows how to say that something happened in the past. Examples: "I walked to the store," "Molly baked a cake."
22. Tells the basic parts of a well-known story: The characters, what happens, how it ends, etc.
23. Tells about his/her everyday events in detail. Example: When you ask what happened at a friend's house today.
24. Says something in a different way if needed to help someone understand what he/she means.
25. Says his/her complete home address correctly when you ask. Must include city and state.
26. Gives complex directions with three or more steps. Examples: "Go to the end of this street, turn right, and go half a block untilyou see the two-story white building"; "First cook the noodles, then toss them in a pan with the sauce, and then put the crumbs on top and bake for 10 minutes."
27. Knows left and right on his/her body.
28. Copies his/her own first name without mistakes. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.)
29. Writes simple sentences of three or more words.
30. Writes alphabet letters correctly, not backwards or upside down.
31. Writes atleast 10 words from memory. Examples: HAT, BALL, THE.
32. Reads simple sentences of three or more words out loud.
33. Understands alphabetical order. Examples: Finds a name in an address book or list of phone numbers, finds a word in a dictionary.
34. Reads at a second-grade level or higher
35. Writes or draws instructions for others. Examples: How to do something, how to get somewhere.
36. Uses the Internet or a library to find information for writing a paper or completing a job assignment.
37. Checks and corrects his/her written work before handing it in. Example: Checks spelling using computer. (Select "Usually or Often" if he/she did this when younger, but now does not need to hand in written work.
38. Fills out paper or electronic forms of one page or less. Example: Forms for school or work.
39. Reads at a sixth-grade level or higher.
40. Writes papers that areat least three pages long. Must use his/her own words and not copy. (Select "Usually or Often" if he/she did this when younger, but now does not need to write papers.)
41. Uses the toilet during the day. May need help, but must know when he/she needs to go.
42. Wipes or cleans his/her face and his/her hands when eating something messy.
43. Puts on pullover clothing. Examples: T-shirt, sweatshirt, dress.
44. Puts clothing on with the right side forward and correct side out.
45. Uses the toilet during the day and at night without help. Must wipe, flush, and wash hands by himself/herself.
46. Brushes his/her teeth. Must put toothpaste on toothbrush, brush well, and rinse.
47. Buttons large buttons in the correct holes. Example: Coat buttons
48. Turns faucets on and adjusts the water temperature.
49. Knows which foods are healthy and unhealthy.
50. Takes his/her own temperature when needed.
51. Washes fruits and vegetables before eating or cooking them.
52. Uses household products correctly. Examples: Laundry detergent, furniture polish, glass cleaner.
53. Wipes up his/her own spills.
54. Makes a simple snack or meal. Examples: Sandwich, cheese and crackers, microwave foods.
55. Puts his/her clean clothes away where they belong. Examples: In drawers or closet, on hooks.
56. Uses at least two simple kitchen appliances. Examples: Toaster, microwave, electric can opener.
57. Washes dishes. May wash by hand or use the dishwasher.
58. Uses the stove or oven for cooking or baking. Must turn on and off by himself/herself.
59. Cleans bathroom: Toilet, sink, tub or shower, etc.
60. Counts at least 10 objects, one by one.
61. Understands that money is used to buy things. Does not have to actually use money himself/herself.
62. Stays near you in public places. Being carried, pushed in a stroller, etc. does not count. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.
63. ls careful around things that could burn him/her. Examples: Stove, oven, fire.
64. Understands car passenger safety rules and follows them. Examples: Keeps his/her seat belt on, does not distract the driver
65. He or she careful when using sharp objects. Examples: Knives, scissors.
66. He or she looks both ways when crossing streets or roads.
67. Knows what to do in dangerous situations. Examples: When to get help, when to call 911, how to get away from danger.
68. Calls others using a mobile phone, computer (email), or other electronic device.
69. Finds a date on a calendar when you ask. Examples: Today's date, his/her birthday.
70. Acts safely when working and/or having fun. Examples: Wears safety equipment, is careful when operating tools and machinery
71. Chooses to exercise for health or enjoyment.
72. Plans for changes in weather by taking along an umbrella, a sweater, etc.
73. Uses technology for at least two kinds of tasks. Examples: Writing school papers or business documents, email for school or work, organizing information, finding information on the Internet.
74. Keeps money, phone, etc. secure when away from home. Examples: When shopping, eating out, traveling.
75. Secures the home when he/she leaves. Examples: Locks doors, closes windows, turns on alarm.
76. Cuts harder-to-cut food with a sharp knife. Examples: Meat, raw vegetables.
77. Considers quality and price when deciding what to buy.
78. Understands the right to report a problem with a product, a service, his/her living situation, etc.
79. Sets a goal that can be done in six months or more and achieves it. Examples: Works and saves money to buy something expensive, gets in better physical shape.
80. Has worked to earn money outside the family. Examples: Babysitting or yard work for a neighbor, having a job.
81. Says how family members are related to him/her. Examples: "That's my mom," "He's my brother."
82. Realizes when others are happy, sad, surprised, afraid, upset, etc.
83. Uses words to express his/her emotions. Examples: "I'm happy," "I'm scared," "I don't like him."
84. Has a best friend or a few good friends.
85. Uses actions or words to show others that he/she feels happy for them, sad for them, or concerned about them. Examples: Hugs, holds hands, asks ''Are you OK?"
86. Plays with one or more children for at least 30 minutes with someone older supervising. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.
87. Shares his/her toys or other things when he/she is told to.
88. Makes good eye contact when he/she interacts with people.
89. Would rather play with other children than watch them or play alone.
90. Plays simple make-believe games with other children. Examples: Playing "dress-up," pretending to be superheroes. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.)
91. Tries to make friends with others his/her age. Examples: Asks for a play date, asks to go somewhere with another child.
92. Apologizes after hurting someone's feelings, and means it.
93. Talks with the right loudness, speed, and level of excitement for the conversation.
94. Copies a child playing nearby, even though they are not playing together. Example: Sees another child stacking blocks and then begins to stack blocks. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.)
95. Does things to try to please others. Examples: Makes someone a card or gift, helps without being asked.
96. Gets together with two or more others his/her age at someone's home
97. Talks with others about things that they are interested in, even if he/she is not.
98. Plays with others at board, card, or electronic games that need decisions and skill. Examples: Monopoly"', poker, Scrabble, two-person video games.
99. Does things that his/her friends want to do, even when he/she would rather do something else. (Select "Never or Estimated" If you do not know, guess a score.)
100. Plans ahead on his/her own to do things with others his/her age. Examples: Plans to go to dinner with a friend on Thursday, plans to go to the movies with a group on the weekend.
101. Goes places with others his/her age during the day without someone supervising. Examples: A shopping mall, park, community center.
102. Changes easily from one activity to another. Example: Changes from playtime to bath time without getting upset.
103. Takes turns without having to be asked while playing games or sports.
104. Uses words or gestures when he/she is upset instead of screaming, hitting, throwing something, etc.
105. He or she is willing to compromise to get along with others his/her age.
106. Moves easily from one topic to another in conversation when needed. Does not "get stuck" on one topic.
107. Shows good sportsmanship in games or sports: Plays fair, is not too aggressive, congratulates winning players, is not mean when he/she loses, etc.
108. Follows time limits given by a parent, grandparent, etc. Examples: How long he/she is allowed to watch TV, play agame, use the Internet, play outside. (Select "Estimated" if he/she did this when younger, but has now outgrown it.)
109. Is cautious when someone who he/she doesn't know well tries to get him/her to do something risky. May be in person or through the Internet. ((If you do not know, guess a score, select Estimated.)
110. Realizes when someone needs something explained in order to follow what he/she is saying.
111. Stays out of a group when they let him/her know without words that he/she is not welcome. Example: Ignoring him/her.
112. Controls his/her anger or hurt feelings when he/she does not get his/her way. Example: Does not cry or get mad when not allowed to do something that he/she wants to.
113. Respects other people's time. Examples: Not keeping others waiting, not interrupting others who are busy.
114. Keeps others from controlling or taking advantage of him/her.
115. Thinks through the consequences of his/her actions before doing things.
116. Understands that a friendly acting person may actually want to take advantage of him/her.
117. Lets you know about his/her plans when he/she goes out. Example: Tells you or leaves you a message about where he/she is going and when he/she will be home. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it)
118. Understands that some things conveyed in advertising might not be true.
119. Picks up hints in conversation. Examples: Knows that someone who yawns may be bored, that people may change the subject because they do not want to talk about something, that looking at the time may mean that the person needs to end the conversation
120. Gets schedule information for movies, sports events, concerts, etc. Examples: Looks at a newspaper or on the Internet, phones a movie theater.
121. He or she can unwraps small objects. Examples: A piece of candy or gum.
122. He or she can walks down stairs, one foot on each step. May use railing.
123. He or she can climbs a set of eight or more stairs at a normal pace. May use railing (Fence).
124. Runs smoothly, changing his/her speed and direction. Examples: Playing tag or sports, chasing a pet.
125. Jumps forward at least three times with both feet without falling.
126. Walks two or more blocks without needing rest or help.
127. Pedals a tricycle or other vehicle with three wheels for at least 6 feet. (Select "Usually or Often" if he/she did this when younger, but has now outgrown it.)
128. Catches a beach ball-sized ball from at least 6 feet away. May catch with two hands or one.
129. Hops forward on one foot with ease without holding on.
130. Rides a balance bike or bicycle with training wheels for at least 10 feet.( Select "Usually or Often" if he/she did this when younger, but has now outgrown it.
131. Catches a tennis- or baseball-sized ball from 2 or 3 feet away. May catch with two hands or one, but must catch away from the body instead of trapping the ball against the body.
132. Catches a tennis- or baseball-sized ball from at least 10 feet away, moving to catch it if needed. May catch with two hands or one.
133. Holds a crayon, pen, or pencil properly for writing or drawing. Does not hold with his/her fist.
134. He or she draws a circle by hand while looking at an example
135. Draws more than one form that you can recognize. Examples: Person, house, tree.
136. Pours liquid from one container to another with little or no spilling. Example: Pouring milk or juice into a glass.
137. Cuts out simple shapes. Examples: Circles, squares, rectangles.
138. Makes complex creations using building toys, assembly sets, arts and crafts materials, etc.
139. He or she draws a straight line using a ruler.
140. He or she can ties a knot.
141. He or she can cuts out complex shapes. Examples: Stars, animals, alphabet letters.
142. He or she works with very small objects. Examples: Setting hands on a watch, threading a sewing needle, gluing tiny model parts.
143. He or she can ties a secure bow. Examples: Shoe laces, gift wrapping.
144. He or she ss overly needy or dependent. Examples: Insists on help even when he/she does not need it, clings to parent or teacher.
145. He or she has eating problems. Examples: Overeats, refuses to eat, will only eat one or two things, hoards food.
146. Has sleep problems. Examples: Walks in his/her sleep, has a lot of nightmares, sleeps way more or less than others his/her age.
147. Refuses to go to school or work, or has to come home, because of worrying, sadness, nervousness, etc
148. He or she is extremely anxious or nervous.
149. He or she cries or is sad for no clear reason.
150. He or she avoids interacting with others (withdraws, prefers to be alone, etc.).
151. He or she lacks interest in doing things that he/she enjoys or used to enjoy.
152. He or she is extremely fearful of one or more common objects or situations. Examples: Heights, snakes, elevators.
153. He or she worries for no clear reason.
154. He or she get very irritable or moody.
155. Feels helpless or hopeless. Example: Says that things are bad and will never get better.
156. Complains of feeling sick, exhausted, or in pain, even though there is no medical reason.
157. He or she has temper tantrums: Screams, cries, kicks, etc.
158. He or she disobeys those in authority.
159. He or she bullies others physically or with words.
160. He or she lies, cheats, or steals.
161. He or she is physically aggressive. Examples: Hits, kicks, bites.
162. He or she is stubborn or argues.
163. He or she is verbally abusive: Hurts others on purpose with insults, put-downs, etc.
164. He or she breaks rules or laws because of peer pressure.
165. He or she is much more active or restless than others his/her age. Examples: Moves all the time, cannot sit still, fidgets.
166. Takes or uses school or work property when not allowed. Examples: Books, office supplies.
167. Destroys his/her own or someone else's possessions on purpose.
168. He/she shows an intense focus on objects or parts of objects. Examples include staring at spinning wheels or fan blades, lining up objects, or repeatedly flipping light switches.
169. Talks about hearing voices that others do not hear, or seeing things that others do not see
170. Harms himself/herself. Examples: Bangs his/her head, hits or bites self, cuts self, tears at skin, pulls out his/her hair.
171. Uses strange or repetitive speech. Examples: Has conversations with himself/herselfin public, says things that make no sense, repeats the same thing over and over.
172. Repeats physical movements over and over. Examples: Rocks back and forth, spins, flaps hands.
173. Eats non-food items such as dirt, paste, or soap.
174. Gets so fixated on a particular topic that it annoys others. Examples: Trains, reptiles, maps, subway systems.
175. Talks about killing himself/herself or has tried to kill self.
176. He/she leaves home, school, or care suddenly or runs off without thinking about safety
177. Threatens to hurt or kill someone.
178. He or she is tricked by others into doing something that could seriously harm him or her, or someone else
179. Use this space for any general comments you want to make about the person, or about this form