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AberrantBehaviorChecklist

Pleaseratethechildsbehaviorforthelast4weeksaccordingtothescalebelow. 0= 1= 2= 3=

Notatallaproblem Thebehavioris aproblem, but slight indegree Theproblem is moderately serious Theproblem is severe indegree

Pleasekeepthefollowingpointsinmind: a. Takerelativefrequencyintoaccountforeachbehaviorspecified.Forexample,ifthechildaveragesmore temperoutburststhanmostotherchildren,itsprobablymoderatelyseriousorsevere,evenifitoccursonly onceortwiceaweek.Otherbehaviors,suchasnoncompliance,wouldprobablyhavetooccurmoreoftento meritanextremerating. b. Considerhowthechildbehaveswithothers,notjustwithyou.Trytotakethewholepictureintoaccount. c. Trytoconsiderwhetheragivenbehaviorinterfereswiththechildsdevelopment,functioningorrelationships. Forexamplebodyrockingorsocialwithdrawalmightnotdisruptotherpeople,butitprobablyhinders individualdevelopmentorfunctioning.

Donotspendtoomuchtimeoneachitemyourfirstreactionisusuallythecorrectone.

1.Excessivelyactiveathome, school,work,or elsewhere 2.Injuresselfonpurpose 3.Listless,sluggish,inactive 4.Aggressivetootherchildrenoradults(verbally or physically) 5.Seeksisolationfromothers 6.Meaningless,recurringbodymovements 7.Boisterous(inappropriatelynoisyandrough) 8.Screamsinappropriately 9.Talksexcessively 10.Tempertantrums/outbursts

0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

11.Stereotypedbehavior;abnormal,repetitive movements 12.Preoccupied,statesintospace 13.Impulsive(actswithoutthinking) 14.Irritableandwhiny 15.Restless,unabletositstill 16.Withdrawn;preferssolitaryactivities 17.Odd,bizarreinbehavior 18.Disobedient,difficulttocontrol 19.Yellsatinappropriatetimes 20.Fixedfacialexpression;lacksemotionalresponsiveness

0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

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Version103/15/2012

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21. 22. 23. 24. 25. 26. 27. 28. 29. 30.

Disturbsothers Repetitivespeech Doesnothingbutsitandwatchothers Uncooperative Depressedmood Resistsanyformofphysicalcontact Movesorrollsheadbackandforthrepetitively Doesnotpayattentiontoinstructions Demandsmustbemet immediately Isolateshimself/herselffromotherchildren oradults

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

31. 32. 33. 34. 35. 36. 37.

Disruptsgroupactivities Sitsorstandsinonepositionforalongtime Talktoselfloudly Criesoverminorannoyancesandhurts Repetitivehand,body,orheadmovements Moodchangesquickly Unresponsivetostructuredactivities(does not react) Doesnotstayinseat(duringlesson,trainingsession,meals, 38. etc.) 39. Willnotsitstillforanylengthoftime 40. Isdifficulttoreach,contact,orgetthroughto

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

41. 42. 43. 44. 45. 46. 47. 48. 49. 50.

Criesandscreamsinappropriately Preferstobealone Doesnottrytocommunicatebywords orgestures Easilydistractible Wavesorshakestheextremitiesrepeatedly Repeatsawordorphraseoverandover Stampsfeetorbangsobjectsorslamsdoors Constantlyrunsorjumpsaroundtheroom Rocksbodybackandforthrepeatedly Deliberatelyhurtshimself/herself

51. 52. 53. 54. 55. 56.

Paysnoattentionwhenspokento Doesphysicalviolencetoself Inactive,nevermovesspontaneously Tendstobeexcessivelyactive Respondsnegativelytoaffection Deliberatelyignoresdirections Hastemperoutburstsortantrumswhendoesnotgetown 57. way 58. Showsfewsocialreactionstoothers

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Unless otherwise indicated, all materials on these pages are copyrighted. All rights reserved. No part of these pages, either text or image may be used for any purpose other than personal use.

Version103/15/2012

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