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Cognitive Scale For Down Syndrome - Adolescence/Adult
Assessment 1 of 66
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. Has a short attention span
Never/rarely true
Sometimes True
Often
2. Behaves inappropriately (e.g. makes inappropriate comments, actions or noises)
Never/rarely true
Sometimes True
Often
3. Does the individual have problems with vision
No
Yes
4. Does the individual have problems with hearing
No
Yes
5. Forgets when their birthday is
Never/rarely true
Sometimes True
Often
6. Needs to do something as soon as they're asked to otherwise they will forget to do it.
Never/rarely true
Sometimes True
Often
7. Finds concentrating on tasks difficult
Never/rarely true
Sometimes True
Often
8. Ignores irrelevant distractions in the environment
Never/rarely true
Sometimes True
Often
9. Takes a long time to start a task
Never/rarely true
Sometimes True
Often
10. Can't communicate simple details about what they're doing
Never/rarely true
Sometimes True
Often
11. Is stubborn
Never/rarely true
Sometimes True
Often
12. Makes an effort to organise items (e.g. socks in one drawer, stores cutlery correctly
Never/rarely true
Sometimes True
Often
13. Understands instructions involving a series of steps
Never/rarely true
Sometimes True
Often
14. Takes care when completing task
Never/rarely true
Sometimes True
Often
15. Finds it easy to switch from one task/activity to another
Never/rarely true
Sometimes True
Often
16. Easily completes tasks that involve more than one step
Never/rarely true
Sometimes True
Often
17. Loses belongings
Never/rarely true
Sometimes True
Often
18. Finds things to do to occupy time by themselves
Never/rarely true
Sometimes True
Often
19. Gets distracted easily
Never/rarely true
Sometimes True
Often
20. Doesn't rush through tasks
Never/rarely true
Sometimes True
Often
21. Finishes tasks they start
Never/rarely true
Sometimes True
Often
22. Misjudges how long something will take
Never/rarely true
Sometimes True
Often
23. Fidgets (e.g. taps fingers or bounces legs)
Never/rarely true
Sometimes True
Often
24. Carries out simple everyday tasks without prompting (e.g. going to the toilet, having a meal)
Never/rarely true
Sometimes True
Often
25. Finds it hard to get over minor problems easily / fixates on minor problems
Never/rarely true
Sometimes True
Often
26. Needs to be prompted to get dressed and ready for the day
Never/rarely true
Sometimes True
Often
27. Loses track of what they are doing in the middle of a task
Never/rarely true
Sometimes True
Often
28. Overreacts to situations or problems (e.g. gets excessively angry or sad
Never/rarely true
Sometimes True
Often
29. Doesn't notice when they make mistakes
Never/rarely true
Sometimes True
Often
30. Is patient when waiting their turn
Never/rarely true
Sometimes True
Often
31. Doesn't plan ahead for tasks (e.g. doesn't leave enough time or have the correct materials)
Never/rarely true
Sometimes True
Often
32. Impulsively acts or speaks without thinking
Never/rarely true
Sometimes True
Often
33. Can communicate the details of an experience (e.g. who was there, what they did
Never/rarely true
Sometimes True
Often
34. Keeps belongings in set place
Never/rarely true
Sometimes True
Often
35. Finds it difficult to keep themselves busy
Never/rarely true
Sometimes True
Often
36. Isn't bothered when their daily routine is changed without warning
Never/rarely true
Sometimes True
Often
37. Completes simple tasks without making mistakes
Never/rarely true
Sometimes True
Often
38. Could decide on their own what to do later that day (e.g. watch a film, paint etc.)
Never/rarely true
Sometimes True
Often
39. Easily concentrates on TV shows/activities
Never/rarely true
Sometimes True
Often
40. Is disorganised (e.g. keeps room/bathroom in a mess)
Never/rarely true
Sometimes True
Often
41. Finds it easy to sit still
Never/rarely true
Sometimes True
Often
42. Starts tasks they need to do without being repeatedly prompted
Never/rarely true
Sometimes True
Often
43. Finds it easy to multi-task (doing more than one thing at a time)
Never/rarely true
Sometimes True
Often
44. Remembers where they put something recently (up to half an hour ago)
Never/rarely true
Sometimes True
Often
45. Wouldn't remember the basic plot of a TV show/film they've seen earlier that day
Never/rarely true
Sometimes True
Often
46. Wouldn't recall an important event from at least 6 months ago (e.g. a trip they'vebeen on)
Never/rarely true
Sometimes True
Often
47. Goes into a room and forgets what for or why
Never/rarely true
Sometimes True
Often
48. Knows basic information about other people (e.g. name, relation to self)
Never/rarely true
Sometimes True
Often
49. Often repeats themselves or asks the same question without noticing
Never/rarely true
Sometimes True
Often
50. Remembers what they did today
Never/rarely true
Sometimes True
Often
51. Remembers if there is something outside of their usual routine planned for the day (e.g. going to the doctors)
Never/rarely true
Sometimes True
Often
52. Doesn't change their mind once they've made a decision
Never/rarely true
Sometimes True
Often
53. Remembers everything they need to do in the morning
Never/rarely true
Sometimes True
Often
54. Wouldn't remember someone they met earlier that day
Never/rarely true
Sometimes True
Often
55. Easily remembers simple instructions
Never/rarely true
Sometimes True
Often
56. Understands questions involving a decision (do you want to do this or that)
Never/rarely true
Sometimes True
Often
57. Tends to use the same words or gestures to describe things (i.e. uses a limited vocabulary)
Never/rarely true
Sometimes True
Often
58. Strays from the topic when communicating
Never/rarely true
Sometimes True
Often
59. Can explain reasoning behind decisions (e.g. why they have chosen one activityover another)
Never/rarely true
Sometimes True
Often
60. Doesn't respond when talked to
Never/rarely true
Sometimes True
Often
61. Tell somebody if they needed help with something (e.g. if they can't find something they're looking for)
Never/rarely true
Sometimes True
Often
62. Doesn't understand sayings that are not meant literally (e.g. chip on the shoulder)
Never/rarely true
Sometimes True
Often
63. Wouldn't be able to give simple instructions (e.g. the rules of a game)
Never/rarely true
Sometimes True
Often
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