Clinical Assessment of Behavior) Child’s name or number Classroom or teacher ‘Examiner's Notes: an Gender_! Race: Date of birth. Mt Date of test. M, i.Qtest and scores: Achievement test and scores: Other test and scores: Spacial curriculum needs: Notes on family status: ” other Date = as CABS Scores: 1) Lo 2) IF 3) FRP Z ae ee ees ") EVA ee * Score 1980 by Humanics Limited ISBN 0-89334-055-3 Bert O. Richmond and Richard H. Kicklighter Language Developrnent‘ofpehayio”) linica « J Assessinont taal e i eer itinaméige number, oor glassroomorteacher val: q \ Examiiner’s'Notes: cae Gender_t_ Race: ___.— MMe, Date of test 0. M. I.Qtest and scores: Achievement test and scores: 1980 by.HHumanics Limited ISBN 0-89334-055-3 ; » Bert Q. Richmond ade Rl ick : ‘Language Developr ent|e lan “ y 4 Las Development see / store Questions 0 1 1, Hewold are your 9 1 2 How manyis tha? (Hold up two fingers) gs fi if 3 SaY this, 1am a big boy/girl and like to play with my friend repeat exactly.) Name something that AL Youcan gat B. You can drink © You can ride in or on D. Is round. Ask the child to identify these colors a) yehiows 922345, a) Blue b) Green ©) Red (Present exit) © 12 3-4 6 Name 3 Kinds of animals that have four legs. { Do not prompt) © 2.23 4 7 Tellme what this letter is. (Point to each letter one at a ti (present card B) 4 ©).C Hh b).o Show card B and ask child to write or print each letter Ask the child to write or print first and last names. a).A i — © 12 3 4 10. Read these vords out loud tome. ( present cari C) A. Boy * B, Dog C. Good 6, (Ask the child to write or print each word from card <) ——____ Tell me what's happening in this yvict 0 1 12. (Present card'D) © 1 13, Uses two or more complex sentences in describing pict O23 4) Ty grammar not necessary, What do these words mean? 8. Tfouble C. Elevator coe 0123 4.1 A, Automobile A Tellme a short Slory and I'll write it down ( Piot, char: O Lals, eter ae necessary) 9 1916.4 Present Card € Ask child to read these words a) Huge b) Future —¢) Kind d) Clean j Total Scoreindepen Preset a) Knife b. Wi “ BA Give ask Ask Picture: a. Which one do you ntcard A of and bv) Fork ¢ of fork, knife, nich one do you Which one do You pair of scissors ra square child to cut oW child to butt "5 own oF ON fon shirt, ZIP 19 questions ask child to c) Spoon spoon, eat soup with cut meat with drink out of? nd paper: ASK evitd to cot plate and él dent functioning fame it gy Plate ot ass 2 h? out a cite! Glas Je. or tie sh" adicinee 25. What number do you dial to call the operator 26. If the temperature were 90 degree F, Which would you be likely to do? a) Go swimming b) Wear.a'coat cc) Turn up the heat 27. Name the town you live in. 28, Name the country you liveiin 29. Name the current month. 30. Name the current Year.Score 0 0 O12 3 0 1 1 7 Family Role performance \ Questions 1. Present card A, Which one is sister? 2 How many people are in your family? t 3. Give three directions to follow in order, whatever i Foom, such as, “Take this pencil, touch door, jd then purty appropriate in on table.” 4, Present card B what is this? 5. A father is a man a. Amotheris. b. Abrother isa ©. Asisteris a 4 Tell mea story about something that happened in your family la. week. (If no response ~ today, or sometime. Credit if mentions one person other than sclf'in family. story may have wseful clinic! content.) Do you have a dog (cat) athome? What is its nam? (if “no”, wivat Is the name of neighbor's Dog or cat? 8. Do you have any jobs or chores that you usually ds et lua 9! Which one do you use-to:make bread? (Name, carvt, jelly, flour cheese.) 10, Present card C, What do you use this (or? a, Broom ib. Towel ¢. Clock d, Telephone 11." Tell me two ways to:cock an egg. $12.F What do you? i ‘A. Cook beans or peas in? 8. Do to learn about the news 13. What would you do if your house caught on fire ans! nburly wes home but you? (If response is.put it out- suppose you coublu’s ther what? 14, Present card D In A. Which room do you cook a haniburger? 8. Which room do you sleep? : C. Which room do you keep your tooth brush? D. Which room do you sit and watch T.V or sit sia talk ts , parents? E, What do you do in this room? ( Point To dln 10m) $15. Present Card E Ask which is the better house *Tell me how to fix any foot for yourself (eacept If correct answer, ask fOr 4 things that you could dot Ifyou came home from school, found no one clon at Fe window was broken out and you noticed that your TY yf you ty What do you do if you see a car wreck in front oe one better. 0 1 23. p17, Howoldyouhave to be to A, Vote B. Geta full-time job C. Drive a car 01 (18 o12 “a what would you do? 012 20 TOTAL SCORE |o Economical vocational Activity oe Questions ot? Which one is more? ( Show blocks or any similar objects) A.S how 4 block and 2 block B. Show 8 Block and 6 Block 0 1 2 Present card Awhich costs mare? O 1203 3. Present cardB a, Which one is dentist b. Which one is farmer c. Which one is cook? 4. Which do you use to fix a car? Present card C, if hammers 1s “Hose Ojea ask to explain. 20203 4 5, Which cost more? es 4 a) Car-Bicycle, —-b)Candy-watch—€)Coat-shirt A) aes sttenae o 1 8S Where do you get your car worked on? If answer is, "At horn” atch stranger in town has trouble with his car, where could he get itt 17. Where does a nurse, usiially work? 1 8. § What dogs a plumber do? 12.3 4 9. Present card D a. Which one would you usually use to fix your bicycle b. Which one would yourusually use to make a dress ¢. Which one would you usually use to make a breakfast: d. Which one would you usually use if you were a carpenter ? 1 2. 3 4 1044 Show penny, nickel, dime, quarter, ask child to name each 11.) show penny, nickel, dime, quarter, which is worth more 9¢ most? 12, Show me the one that is worthithe smallest amount (then tue: the next, then the'most. 13. Show the coins that add up a dollar (Display 3 quarters, 5 : nickels, 3 pennies.) 0 1 2 @& Askchild to give you the following amount of money 75 Cents 98 Cea» &) Give me the correct change from $1. For a purchase of 2/ Gene 2b 16. About how much does a can of a soft drink ( Pop, seda, ele.) cust About how much doesn’t small candy bar cost? coon ee eee x 18. How much does a stamp cast to mail a letter?0123 49, Who make more moneys Gas station attendant “Teacher-Principle Engineerjaniot doctor 0 2 20. How you ever Bonesto a store and bought things for yourself? What? 0 1 21. Nameone way You have made some Money 22, 2 Total Score Z Y &Score 0123 Socialization 1, Which is our fi pistes ur first and last name? Your mother’s first name? Your father’s first name 2. Ifyou have two dolls (Balls) and your bestfriend hadi nome, what would you de? 3. & What should you say if you bump into someone without muanint: to? 4. What should you say if someone gives you a piece of canily? 5.) What should you fo if your little brother or sister cuts their finger at home and you parents are not there? Inclependent answer: 2, “dependent -1 5 6 Present Card.A, a. Identifyremotion of each face b. Which face.do you use when you fall down and inurt you / knee? ©. Which face do you use when you play a game with your parents? 7. Show me how you'look when your mother (prescuit card A} a. Gives you candy» ‘b. Is angry with you. c.Has a surprise for yuu 8. Present card 0, Say:'let’s pretend you are in the pictures Mun your finger on the one that would be you? 9. Present cards B&A, Say: pretend this is you at a ness "the first time. Which of these three faces show how you woute feel about joining the other children? 10. Present cards C & A’Say: pretend this is your fami*y toyeiher Which of these faces show how you feel when you are with yout family? 11. What'"should” you'doiif'a little kind called you sad nae? 12. What “should” you doiif you found a billfold (purse) on the ground. with two:dollars:init? When you go home'from school do you prefer to play by your 13. or with others? 14. At recess would you rather play with just one friend or switit several friends? 15. What “should” you do if your best friend asked» 24 -ur an ys" during a test? Tell me a joke or something that if funny. Ask wiiat’ Ss i clear.) nny if notName three games you can play with other children on the playground, 18. Which game can you play by yourself? b. Base ball Red rover a. Jumping 19. What could you do to make your father (mother) happy? 20. "A Boy who lost his basketball would feel 21.8 A girl who fouhd a quarter would feel 22. $A boy who got a best grade on'his report card would feel____ What should you do if you lose your reading book? 23. 24. If your class put on a play, would you like a part in it? 25. If you move into'a new neighborhood or school, name threw things you could do to make new friends? 26. Why should we take turns? Why do grownups have to work? Why do we need to have laws?Scanned with CamScannerScanned with CamScannerScanned with CamScanner9 senamairong WOVEN Scanned with CamScannernquoeacnysyoesteezas rac ama nls Comet AlorsHIChuiren bl Asay 2 Caan Unveey L AOASDIYIORGCH Tee © cul Gre # 167 Wak NaSI6l. 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