Core Skills Assessment

Core Skills Assessment An Educational Prescription for Individuals with Autism Testing Booklet Student Name: Date of Birth: Assessment Start Date: Assessment End Date: Staff: without the express written permission of NECC. 1

Considerations The Core Skills Assessment testing booklet is organized by testing format (i.e., discrete trial sessions, programmed opportunities, task analyses, and teacher report) to help organize implementation of the assessment. If you prefer to view a list of core skills organized by area, use the Index on pages 44 and 45 of this document. The items may be completed in any order, so skills may be chosen for testing depending on allotted time. Matching tasks and task analyses generally require the most time to assess, while discrete trial sessions with no materials tend to take the least amount of time to assess. Skills with programmed opportunities may be assessed 1-trial at a time, so if properly planned for, each trial can be quickly implemented. The teacher report section does not require the learner to be present, and thus can be completed at any time during the assessment period. Table of Contents DISCRETE TRIAL SESSIONS... 4 ATTENDING... 5 SESSION BEHAVIOR... 6 SIMPLE DISCRIMINATION... 7 MATCH IDENTICAL OBJECTS... 8 MATCH IDENTICAL PICTURES... 9 MATCH PICTURE TO OBJECT... 10 MATCH OBJECT TO PICTURE... 11 ACCEPT AND REJECT... 12 FOLLOW 1-STEP DIRECTIONS WITH VISUAL SUPPORT... 13 FOLLOW 1-STEP DIRECTIONS IN GROUP WITH VISUAL SUPPORT... 14 INDICATE NAMED BODY PARTS... 15 INDICATE NAMED OBJECTS... 16 INDICATE NAMED PICTURES... 17 NAME OBJECTS... 18 NAME PICTURES... 19 FOLLOW A POINT... 20 IMITATE ACTIONS WITH OBJECTS... 21 IMITATE GROSS MOTOR ACTIONS... 22 IMITATE ACTIONS WITH OBJECTS FOLLOWING A DELAY... 23 WAIT IN THE CONTEXT OF GROUP INSTRUCTION... 24 EAT WITH UTENSIL... 25 DRINK FROM A CUP... 25 without the express written permission of NECC. 2 CONTENTS

PROGRAMMED OPPORTUNITIES... 26 REQUEST NEEDED OR DESIRED ITEMS... 27 RESPOND TO NAME... 27 RESPOND TO GREETING... 27 REQUEST ATTENTION... 27 REQUEST ASSISTANCE... 27 RESPOND TO STOP... 27 WAIT FOR PREFERRED ITEM... 28 MAINTAIN APPROPRIATE SOCIAL DISTANCE... 28 EAT VARIOUS FOODS... 29 TAKE MEDICATION... 30 PRODUCE PERSONAL IDENTIFICATION... 30 MAINTAIN PRIVACY DURING PERSONAL HYGIENE... 30 TASK ANALYSES... 31 USE PICTURE OR WRITTEN SCHEDULE... 32 SHOWER... 33 BRUSH TEETH... 34 WASH HANDS... 35 DRESS... 36 UNDRESS... 37 WASH FACE... 38 TEACHER REPORT... 39 DEMONSTRATE PREFERENCES... 40 REQUEST TERMINATION... 41 USE CONDITIONED REINFORCERS... 41 BLADDER TRAINED... 41 BOWEL TRAINED... 41 TOLERATE MEDICAL PROCEDURES... 42 EXIT GIVEN A FIRE ALARM... 42 EXERCISE... 42 ENGAGE IN INDEPENDENT TASK... 42 RIDE IN CAR/VAN... 43 WALK IN THE COMMUNITY... 43 without the express written permission of NECC. 3 CONTENTS

Discrete Trial Sessions The discrete trial format is used to assess isolated skills in a highly structured setting through multiple trials. In the discrete trial format, skills are broken down into smaller units of behavior. Each session contains 5-15 trials and is generally conducted in a single sitting. without the express written permission of NECC. 4

DISCRIMINATION Attending: Given teacher orientation towards student, student will sit with feet on floor, hands down, oriented towards teacher or materials with no interfering motor or vocal stereotypy in 80% of opportunities. Attending definition: Within 3-5 seconds of teacher s orientation towards student, student sits with feet on floor, hands down, oriented towards teacher or materials with no interfering motor or vocal stereotypy. Interval begins with teacher orientation and ends with student response or 5 seconds with no response. Establishing attending: 1. Student should be seated at the table, with chair pushed in (or body oriented towards teacher) 2. Sit facing student; demonstrate in-seat behavior and eye contact 3. DO NOT USE ANY VOCAL PROMPTS TO GAIN STUDENT S ATTENTION (do not say student s name, do not say get ready, do not say look at me ) 4. Wait 3-5 sec. for student to orient towards teacher or materials 5. If student orients towards teacher or materials, record + and present trial 6. If student does not attend (as defined above) use physical or gestural prompts to gain attention and record -; then present trial. Indicate named body parts: Follow 1-step directions with visual support Imitate gross motor actions: State instruction Attending +/- State instruction and gesture as indicated below Student Response Attending +/- State do this and model action Attending +/- 1. Touch head 1. Stand up and raise hand Lifts buttocks off chair 1. Clap hands 2. Touch legs 2. Stomp foot and point to feet Stomps foot 2. Tap table 3. Touch arms 3. Get (known item on table) and gesture towards item Grasps item 3. Arms up Match identical pictures: Present Then present 3-picture picture array below Attending +/- Indicate named picture: State item Then present 3-picture name array Left Middle Right Left Middle Right 1. Chips Chips Cracker Candy 1. Chips Chips Cracker Candy Attending +/- 2. Cracker Candy Chips Cracker 2. Cracker Candy Chips Cracker Total Score: /15 3. Candy Cracker Candy Chips 3. Candy Cracker Candy Chips 5 ATTENDING

DISCRIMINATION Session behavior: Given a 3-comparison visual array, and an immediate point prompt to the correct comparison, the student sits, scans, and points in 89% of opportunities. Materials: 2 dimensional stimuli: 1 form, 2 blank stimuli A = form B = blank Instructions: Sit across from student. Present form and 2 blanks. Wait 3-5 sec for student to perform each skill in sequence (sit, scan, follow a point prompt to point to the form). If any skill is not demonstrated, use immediate full manual guidance. Record a + for each trial in which the skill sequence is demonstrated independently, or a if any component is not. Definitions: Sit: Prior to presentation of stimuli, student sits at table with buttocks on chair pushed into table, face oriented toward teacher work area; no interfering stereotypy. Scan: Student s face is oriented toward comparison stimuli; no interfering stereotypy. Point: Student points to correct stimulus with isolated finger, then releases contact and does not touch a second stimulus in that trial. L M R Sit Scan Point + = all session skills independent 1 B B A 2 A B B 3 B A B 4 B A B 5 B B A 6 B A B 7 A B B 8 B B A 9 A B B Score: /9 6 SESSION BEHAVIOR

DISCRIMINATION Simple discrimination: Student touches the correct comparison when given a simple discrimination task with a static sample and 2 incorrect comparisons in 89% of opportunities. Materials: 3 form comparison cards (green square, red circle, yellow triangle) with 1 matching sample card Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Run 3 demonstration trials and provide immediate prompt (by pointing to the correct comparison). DO NOT take data on demonstration trials. For remaining trials, present sample, present comparisons, and wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a - for any other response, and an NR for no response. A = Green square, B = Red circle, C = Yellow triangle S L M R +/ - /NR 1 A B C A 2 A A C B 3 A C A B 4 A C A B 5 A A B C 6 A B C A 7 A C B A 8 A B A C 9 A A B C Score: /9 7 SIMPLE DISCRIMINATION

DISCRIMINATION Match identical objects: Given an object (sample) and an array of 3 objects (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 15 objects (5 sets). Materials: Object set 1: chips, cracker, candy (can be changed to student s preferred edibles) Object set 2: brush, book, spoon Object set 3: fork, ball, cup Object set 4: toothbrush, paper, marker Object set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 8 MATCH IDENTICAL OBJECTS

DISCRIMINATION Match identical pictures: Given a picture (sample) and an array of 3 pictures (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 15 pictures (5 sets). Materials: Picture set 1: chips, cracker, candy (can be changed to student s preferred edibles) Picture set 2: brush, book, spoon Picture set 3: fork, ball, cup Picture set 4: toothbrush, paper, marker Picture set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 9 MATCH IDENTICAL PICTURES

DISCRIMINATION Match picture to object: Given a picture (sample) and an array of 3 objects (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 5 stimulus sets. Materials: Pictures and objects of the following sets: Set 1: chips, cracker, candy (can be changed to student s preferred edibles) Set 2: brush, book, spoon Set 3: fork, ball, cup Set 4: toothbrush, paper, marker Set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 10 MATCH PICTURE TO OBJECT

DISCRIMINATION Match object to picture: Given an object (sample) and an array of 3 pictures (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 5 stimulus sets. Materials: Objects and pictures of the following sets: Set 1: chips, cracker, candy (can be changed to student s preferred edibles) Set 2: brush, book, spoon Set 3: fork, ball, cup Set 4: toothbrush, paper, marker Set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 11 MATCH OBJECT TO PICTURE

COMMUNICATION Accept and reject: When presented with a preferred and non-preferred item the student will accept or reject the item (take, push away, nod, shake head, yes, no ) in 4/5 opportunities. Materials: 2 highly preferred items 3 non-preferred items Instructions: Present 1 item at a time. Ask, Do you want this? Record a + if student takes the preferred item or pushes away the non-preferred items. Record a - if student takes the non-preferred item or pushes away the preferred item. Record NR for no response. Date: Setting: +/- Staff: 1. Non-preferred item 2. Preferred item 3. Non-preferred item 4. Preferred item 5. Non-preferred item Score: /5 12 ACCEPT AND REJECT

COMMUNICATION Follow 1-step directions with visual support: Given a verbal instruction paired with a gestural cue, the student demonstrates the action in 8/9 opportunities for at least 9 instructions. Instructions: State the direction, gesture, and wait 3-5 seconds for the student to respond. Record + for correct responses, - for incorrect responses and NR for no response. Spoken Instruction & Gesture Student Response Data +/- 1. stand up and raise hand upward Lifts buttocks off chair 2. sit down and gesture towards chair buttocks on chair, feet on floor 3. get (known item on table) and gesture toward item Grasps item 4. Walk to (known item) and gesture towards item Walks to item 5. Come here and curl finger Moves towards speaker 6. Throw away (known item) and gesture Throws item away towards trash 7. Give me 5 (while holding palm up) and hold up hand with palm facing outward Slaps speaker s hand 8. Stomp feet and point to feet Pounds feet on floor 9. Arms up with palms facing up and raise Raises arms in air slightly Score: /9 13 1-STEP DIRECTIONS

COMMUNICATION Follow 1-step directions in group with visual support: Given a verbal instruction paired with a gestural cue in a group of two, the student demonstrates the action in 8/9 opportunities for at least 9 instructions. Environmental Arrangement: 2 students sit beside each other across from the teacher (with or without a table). Instructions: While the student is grouped with at least 1 other student, state the direction to both students, gesture, and wait 3-5 seconds for the target student to respond. Record + for correct unprompted responses, - for incorrect responses and NR for no response (record data for the target student only). Spoken Instruction & Gesture Student Response Data +/- 1. stand up and raise hand upward Lifts buttocks off chair 2. sit down and gesture towards chair buttocks on chair, feet on floor 3. get (known item on table) and gesture toward item Grasps item 4. Walk to (known item) and gesture towards item Walks to item 5. Come here and curl finger Moves towards speaker 6. Throw away (known item) and gesture Throws item away towards trash 7. Give me 5 (while holding palm up) and hold up hand with palm facing outward Slaps speaker s hand 8. Stomp feet and point to feet Pounds feet on floor 9. Arms up with palms facing up and raise Raises arms in air slightly Score: /9 14 1-STEP DIRECTIONS IN GROUP

COMMUNICATION Indicate named body parts: Given a verbal instruction, the student touches the named body part on self in 80% of opportunities for a minimum of 5 body parts. Instructions: State, "Touch X", for each body part. Wait 3-5 seconds. Record + for correct responses, - for incorrect responses and NR for no response. Date +/- Staff: 1. Touch head 2. Touch legs 3. Touch arms 4. Touch stomach 5. Touch feet Score: /5 15 INDICATE NAMED BODY PARTS

COMMUNICATION Indicate named objects: Given a spoken word (sample) and an array of 3 objects (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 15 objects (5 sets). Materials: Object set 1: chips, cracker, candy (set 1 can be changed to student s preferred edibles) Object set 2: brush, book, spoon Object set 3: fork, ball, cup Object set 4: toothbrush, paper, marker Object set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a - for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 16 INDICATE NAMED OBJECTS

COMMUNICATION Indicate named pictures: Given a spoken word (sample) and an array of 3 pictures (comparisons), the student touches the correct comparison in 89% of opportunities, for a minimum of 15 pictures (5 sets). Materials: Picture set 1: chips, cracker, candy (set 1 can be changed to student s preferred edibles) Picture set 2: brush, book, spoon Picture set 3: fork, ball, cup Picture set 4: toothbrush, paper, marker Picture set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Present sample. Present comparisons. Wait 3-5 sec for student to respond. Record a + if the student points to correct comparison. Record a - for any other response, and an NR for no response. A = chips, B= cracker C = candy A = brush, B= book C = spoon A = fork, B= ball C = cup S L M R +/- NR S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 1 C A B C 2 B C A B 2 C C A B 2 A C A B 3 C B C A 3 A B C A 3 B B C A 4 B A B C 4 C A B C 4 A A B C 5 C C A B 5 A C A B 5 B C A B 6 A B C A 6 B B C A 6 C B C A 7 C A B C 7 A A B C 7 B A B C 8 A C A B 8 B C A B 8 C C A B 9 B B C A 9 C B C A 9 A B C A Score: /9 Score: /9 Score: /9 DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. A = toothbrush, B= paper C = marker A = soap, B= towel C = shoe S L M R +/- NR S L M R +/- NR 1 A A B C 1 B A B C 2 B C A B 2 C C A B 3 C B C A 3 A B C A 4 B A B C 4 C A B C 5 C C A B 5 A C A B 6 A B C A 6 B B C A 7 C A B C 7 A A B C 8 A C A B 8 B C A B 9 B B C A 9 C B C A Score: /9 Score: /9 17 INDICATE NAMED PICTURES

COMMUNICATION Name objects: The student names an object presented individually in 8/9 opportunities for 15 objects (5 sets). Materials: Object set 1: chips, cracker, candy (can be changed to student s preferred edibles) Object set 2: brush, book, spoon Object set 3: fork, ball, cup Object set 4: toothbrush, paper, marker Object set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Hold up visual stimulus in front of student and wait 3-5 sec with an expectant look for student to respond. Record a + if student correctly names stimulus. Record a - for any other response, and NR for no response. A = chips, B = cracker, C = candy A = brush, B = book, C = spoon A = fork, B = ball, C = cup # S +/- NR # S +/- NR # S +/- NR 1 A 1 A 1 A 2 C 2 C 2 C 3 B 3 B 3 B 4 C 4 C 4 C 5 B 5 B 5 B 6 A 6 A 6 A 7 A 7 A 7 A 8 B 8 B 8 B 9 C 9 C 9 C Score: /9 Score: /9 Score: /9 A = toothbrush, B = paper, C = marker A = soap, B = towel, C = shoe # S +/- NR # S +/- NR 1 A 1 A 2 C 2 C 3 B 3 B 4 C 4 C 5 B 5 B 6 A 6 A 7 A 7 A 8 B 8 B 9 C 9 C Score: /9 Score: /9 If the student is nonspeaking and does not have all stimuli from the CSA included in their augmentative communication device Do not assess this item. Record NA for all sets in the measurement column on the ACE. Use the comments section to explain why the item was not directly assessed. DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. 18 NAME OBJECTS

COMMUNICATION Name pictures: The student names a picture presented individually in 8/9 opportunities for 15 pictures (5 sets). Materials: Picture set 1: chips, cracker, candy (can be changed to student s preferred edibles) Picture set 2: brush, book, spoon Picture set 3: fork, ball, cup Picture set 4: toothbrush, paper, marker Picture set 5: soap, towel, shoe Instructions: Sit across from student. Establish attending. Hold up visual stimulus in front of student and wait 3-5 sec with an expectant look for student to respond. Record a + if student correctly names stimulus. Record a - for any other response, and NR for no response. A = chips, B = cracker, C = candy A = brush, B = book, C = spoon A = fork, B = ball, C = cup # S +/- NR # S +/- NR # S +/- NR 1 A 1 A 1 A 2 C 2 C 2 C 3 B 3 B 3 B 4 C 4 C 4 C 5 B 5 B 5 B 6 A 6 A 6 A 7 A 7 A 7 A 8 B 8 B 8 B 9 C 9 C 9 C Score: /9 Score: /9 Score: /9 A = toothbrush, B = paper, C = marker A = soap, B= towel, C = shoe # S +/- NR # S +/- NR 1 A 1 A 2 C 2 C 3 B 3 B 4 C 4 C 5 B 5 B 6 A 6 A 7 A 7 A 8 B 8 B 9 C 9 C Score: /9 Score: /9 If the student is nonspeaking and does not have all stimuli from the CSA included in their augmentative communication device Do not assess this item. Record NA for all sets in the measurement column on the ACE. Use the comments section to explain why the item was not directly assessed. DISCONTINUE testing any set if the first 3 responses are incorrect; score a 0 for the set and continue testing with next set. 19 NAME PICTURES

SOCIAL SKILLS Follow a point: Given a verbal cue "Look" paired with a point, the student will shift gaze from the speaker to look at the item being indicated in 4 out of 5 opportunities. Materials: 5 items (pictures/objects) likely to be of interest to the student Instructions: a. Arrange all items as described below (see also diagram to right). b. Sit at table diagonal from student. c. Prompt attending and establish eye contact before beginning each trial. d. Say, Look! and then clearly point to one item while also orienting your head to the item. Then immediately watch for student s response. e. If the student turns head and eyes towards the item to which you are pointing, deliver reinforcer and record +. f. If the student does not turn head and eyes towards the item, or does not respond within 5 seconds, remove eye contact for 2 seconds and record -. 4 Student 1 Table Teacher 3 5 Response Definition: Student orients head and eyes to item teacher is touching, pointing towards, or looking at within 5 seconds of examiner s cue Look. Note: item 2 is above the student Date: Staff: Setting: For each trial, say, Look!, point, and turn your head to: Additional Response Data: +/- 1. Picture (1) on wall to SIDE of student, approximately 3 feet from student 2. Item in the room located ABOVE the student (e.g., light, clock, ceiling fan) Noticeably tilts head and/or eyes upward 3. Object (3) in FRONT of the student, approximately 5 feet from student 4. Picture (4) on wall BEHIND student Turns head sufficient degrees to indicate looking in the general vicinity behind student 5. Object (5) on FLOOR to side of student, approximately 4 feet from student It may help to have a 2 nd person observe this trial to determine if the student looks at the object Score: /5 20 FOLLOW A POINT

SOCIAL SKILLS Imitate actions with objects: Given a model from the teacher of an action with an object, the student imitates the model in 8/9 opportunities. Materials: Fork, plate, box of crayons, cup Instructions: State, "Do this" and model an action with an object. Present the same object(s) to the student and wait 3-5 seconds for student to respond. Record + for correct performance, - for incorrect performance and NR for no response. Date: Setting: Staff: 1. box (of crayons) on plate +/- NR 2. fork on top of box 3. cup next to plate 4. cup on top of box 5. fork in cup 6. plate on top of fork 7. cup on plate 8. fork and cup on plate 9. plate upside down and box on top Score: /9 21 IMITATE ACTIONS WITH OBJECTS

SOCIAL SKILLS Imitate gross motor actions: Given a model of a physical action, the student imitates the model in 8/9 opportunities. Materials: None Instructions: State, Do this and model a gross motor physical action. Wait 3-5 seconds for the student to respond. Record + for correct performance, - for incorrect performance and NR for no response. Date: Staff: Setting: Data +/- NR 1. clap hands 2. tap table 3. arms up 4. cover ears with hands 5. stand up 6. stomp feet 7. pat stomach 8. arms out to side 9. tap shoulders Score: /9 22 IMITATE GROSS MOTOR ACTIONS

SOCIAL SKILLS Imitate actions with objects following a delay: Given a model from the teacher of an action with an object, the student imitates the model following a 3 second delay in 8/9 opportunities. Materials: Fork, plate, 2 cups, ball, book, spoon Instructions: State, "Do this" and model an action with an object. Remove objects (place out of student s view). Wait 3 s. Present the same object(s) to the student and wait 3-5 seconds for student to respond. Record + for correct performance, - for incorrect performance and NR for no response. Date: Setting: Staff: 1. stack 2 cups +/- NR 2. put ball in cup 3. put spoon on book 4. turn cup upside down 5. cup on book 6. ball on plate 7. fork on book 8. spoon on plate 9. cup next to book Score: /9 23 IMITATE ACTIONS WITH OBJECTS - DELAYED

SOCIAL SKILLS Wait in the context of group instruction: Student will wait appropriately while teacher attention is directed toward another student in 4 out of 5 opportunities across 2 consecutive sessions. Response Definition: While teacher is oriented towards another student, the target student maintains sitting with feet on floor, hands to self, with no interfering behavior (e.g., bids for attention, vocalizations at or above conversational level, distracting motor movements, etc.). Instructions: Sit at table across from or between 2 students. There should be no materials on the table other than those required for implementing the maintenance and/or acquisition programs. Both students should be seated with their chairs pushed into the desk or table. Orient to target student and establish attending (use least-to-most physical assistance for student to attend). Then, present 5 maintenance trials to target student. Turn away from target student and present 5 maintenance trials to the other student. Continue to work with the other student regardless of the target student s response (unless there is an immediate safety concern). If target student WAITS appropriately, reinforce waiting, then implement 5 maintenance trials and reinforce according to student-specific guidelines. Begin next trial, turning to again present maintenance trials with the other student. If target student DID NOT WAIT appropriately, continue to work with the other student until the 5 trials have been implemented, then turn to target student and establish attending using least-to-most intrusive prompting. Do not implement any maintenance trials. Begin next trial, turning to other student to present 5 maintenance trials. For each trial, record + if target student waits appropriately while teacher attention is directed towards the other student. Date: Staff: Date: Staff: Waiting +/- 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Score: /5 Score: /5 Waiting +/- Scoring: Number of correct responses/total # of opportunities (10). Total Score: /10 24 WAITING IN GROUP

SELF HELP Eat with utensil: Throughout a meal, the student eats with a utensil in 80% of opportunities. Drink from a cup: Throughout a meal, the student drinks from a cup in 80% of opportunities. Instructions: Present 5 pre-cut (no larger than three quarters of an inch) food items on a plate. Say "eat with a fork." Record a + if student pierces item with the fork. Record a - for any other response. Instructions: Present 1 oz. of liquid in a plastic cup and say, "Take a drink." Allow student to attempt to drink liquid independently. If student does not drink liquid, or if liquid is released from mouth, record -. Record + if student drinks all or part of the liquid from the cup. Date: Staff: Date: Staff: Trial +/- Trial +/- 1 1 2 2 3 3 4 4 5 5 Score: /5 Score: /5 25 MEAL SKILLS

Programmed Opportunities The programmed opportunities format uses naturally occurring events to assess skills in the context of their actual motivational conditions or typical circumstances. While these skills require 5 data points, do not collect all data at one time. Set up opportunities to assess these skills across the entire testing period. Some skills require testing in a specific context or setting. Keep this in mind as you arrange testing sessions. 26

COMMUNICATION Date: Staff : Date: Staff: Date: Staff: Request needed or desired items: Across 2 people and 2 settings (at minimum), the student initiates requests for items/actions in 4/5 programmed opportunities with or without a teacher cue (e.g., What do you want? ). Respond to name: In response to name, the student turns to look at the speaker in 4/5 programmed opportunities. Respond to greeting: Given a greeting, the student will orient body, face, and eyes to the speaker and wave or state hello in 4/5 programmed opportunities. Instructions: Place 2-3 high preference items out of reach of student. Direct attention to items. Record + if student points to/asks for item, and if student grabs/takes item without requesting. Instructions: Say student s name. Record + if student looks in the direction of teacher, and for any other response. Instructions: Say Hi, (name). Record + if student looks in the direction of teacher and for any other response. Trial +/- Trial +/- Trial +/- 1 1. sitting in a chair across from teacher 1. sitting in a chair across from teacher 2 2. working independently on a task 2. working independently on a task 3 3. watching TV 3. watching TV 4 4. during a meal 4. during a meal 5 5. walking in hall 5. walking in hall Score: /5 Score: /5 Score: /5 Date: Staff: Date: Staff: Date: Staff: Request attention: The student will obtain attention from another person in 4/5 programmed opportunities. Request assistance: The student will request assistance when presented with a difficult to complete task in 4/5 programmed opportunities. Respond to stop: When given the instruction, Stop, student demonstrates the action in 4/5 programmed opportunities from a distance of 5 feet or more. Materials: 2-3 high preference items Instructions: Sit across from student. Show or play with reinforcing item, then turn so head and body are oriented away from student. Record + if student taps shoulder, states, excuse me, or requests item vocally. Instructions: Present tasks that student is unable to complete. (Opening a jar with a tight lid, tying a shoe, unwrapping a piece of candy). Record NA if student completes task independently, + if student requests help, -if student grabs/takes item without requesting. Instructions: Walk through environment beside the student. Allow student to move 1 ahead. Say Name, stop. If student stops walking within 5 sec, record +. Trial +/- Trial +/- Trial +/- 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Score: /5 Score: /5 Score: /5 27 PROGRAMMED OPPORTUNITIES

SOCIAL SKILLS Wait for preferred item: Given an instruction from a teacher to wait, the student waits appropriately in 4/5 programmed opportunities for at least 2 minutes. Materials: Preferred items or activities Instructions: When a student makes a request for an item, activity or person, say Wait. If the student waits appropriately record +. Record if disruptive behavior occurs. Maintain appropriate social distance: When interacting with another person, student maintains social distance at arm s length in 5/5 programmed opportunities. Materials: None Instructions: Prompt student to interact with another person for 3-5 seconds (greet, ask for help, deliver a message). Score + if the student is oriented toward the listener and maintains social distance at arm s length for duration of interaction. Score if the student does not orient towards the listener or does not maintain appropriate distance. Date: Staff: Date: Staff: Trial +/- Trial +/- 1 1 2 2 3 3 4 4 5 5 Score: /5 Score: /5 28 PROGRAMMED OPPORTUNITIES

SELF HELP Eat various foods: Student eats at least 3 foods from each of the 4 food categories. Instructions: List 3 foods that the student will eat from each of the following food groups. Score the number of foods eaten out of a possible 12 foods (3 in each food group). EXAMPLES of foods in each category: Vegetables: broccoli, spinach, carrots, green beans, zucchini Protein: meat, poultry, fish, tofu, dry beans, eggs, nuts Starch: bread, cereal, rice, pasta, crackers Fruit: apples, bananas, berries, melon, oranges, grapes Vegetables Protein Starch Fruit Scoring: Number of foods eaten across categories (do not count more than 3 foods from each category) Score: /12 29 PROGRAMMED OPPORTUNITIES

HEALTH AND SAFETY Take medication: Student swallows medication in any form delivered by a teacher, medical professional or parent in 100% of opportunities with no physical assistance. Note: This skill is not generally tested in public school settings. Medication can be modified in any way, including disguising liquid medication in juice, or crushing a pill and mixing it in pudding. If student currently takes no medication, use placebo obtained from nursing staff. Produce personal identification: Student produces identification when asked by an unfamiliar person in 4/5 opportunities. Materials: Identification card (if using) Instructions: Set up 5 opportunities for an unfamiliar person to say, What s your name? to the student. Record + if student hands a personal ID card, or responds vocally. Maintain privacy during personal hygiene: Across all settings, student seeks privacy by closing the door when engaging in personal hygiene routines in 100% of opportunities. Note: Do not assess children under 5 (score NA on the ACE ). Instructions: Record data when student initiates a bathroom request OR moves toward the bathroom. Record a + if student closes the bathroom door after entering the bathroom. Record a - for any other response. Instructions: Using chosen method, present medication. Record + if student ingests medication, - for any other response. Date: Staff: Date: Staff: Date: Staff: Trial +/- Trial +/- Trial +/- 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Score: /5 Score: /5 Score: /5 30 PROGRAMMED OPPORTUNITIES

Task Analysis The task analysis format is used to teach skills that involve chains of behaviors. In order to assess all behaviors in the chain, prompting is used during the assessment of task analysis core skills (this is different from all other testing formats). Full physical assistance is provided if the learner does not respond within 3-5 seconds or begins to complete a step which disrupts the routine, making completion impossible (e.g., putting on shoes before socks). If a learner completes a step using a different type of response, but functionally accomplishes the same goal, then that step may be scored as correct (+). For example, with undressing, if the learner does not sit down and place ankle on knee to remove socks and shoes, but is able to remove socks and shoes while standing, these steps should be considered correct. 31

RECREATION AND PHYSICAL EDUCATION Use picture or written schedule: Student completes the steps of a 3 item (minimum) activity schedule independently for two consecutive sessions. Materials: Picture or written activity schedule that the student is using currently. If student does not have a Schedule, assess with a schedule that is appropriate to the student s functioning level. Instructions: Present student s current schedule book with the 3 activities and the materials placed where they are usually kept for that student. Teacher stands behind student. Say, "Follow your schedule." If student does not initiate a response, manually guide the response. Record I for any step completed independently. Activity 1 Activity 2 Activity 3 Open Book/Turn Page Point to picture Obtain Materials Manipulate Materials Return Materials (consume if edible) Activity 1 Activity 2 Activity 3 Score: /15 List the names of the specific activities used in the comments section on the ACE. *Rearrange the order of the pictures before the schedule is presented the second time. Activity Open Book/Turn Page Point to picture Obtain Materials Manipulate Materials Return Materials (consume if edible) Activity 2 Activity 3 Activity 1 Score: /15 Scoring: Number of independent responses /total # of opportunities (30). Total Score: /30 32 USE PICTURE OR WRITTEN SCHEDULE

SELF HELP Shower: Given an initial instruction to take a shower, the student completes the routine independently. Instructions: Give initial cue to take a shower. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response or if the student begins to complete a step which disrupts the routine, making completion impossible (e.g., putting shampoo on dry hair). Record (+) for correct independent responses, (-) for any other response. If student completes task independently, but in a different order, indicate the order in which the steps were completed. Step Description +/- Order This skill is not generally tested in non-residential settings (e.g., public schools). 1 Get head wet 2 Pick up shampoo and squeeze into hand 3 Put shampoo on head 4 Rub top of head 3x 5 Rub sides of head 3x 6 Rub back of head 3x 7 Rinse hair 8 Pick up face cloth 9 Put soap on face cloth 10 Wash face 11 Pick up body sponge 12 Put soap on sponge 13 Wash one arm and underarm 14 Wash other arm and underarm 15 Wash chest 16 Wash groin 17 Wash one leg 18 Wash other leg 19 Wash back 20 Wash buttocks 21 Rinse soap off body Score: /21 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 33 SHOWER

SELF HELP Brush teeth: Given an initial instruction to brush teeth, the student completes the routine independently. Instructions: Give initial cue to brush teeth. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response or if the student begins to complete a step which disrupts the routine, making completion impossible (e.g., brushing teeth before putting on toothpaste). Record (+) for correct independent responses, (-) for any other response. If student completes task independently, but in a different order, indicate the order in which the steps were completed. Step Description +/- Order 1 Pick up toothbrush with one hand 2 Pick up toothpaste with other hand 3 Open toothpaste cap 4 Squeeze toothpaste onto toothbrush 5 Put down toothpaste 6 Turn on water* 7 Run toothbrush under water 8 Turn off water* 9 Put toothbrush in mouth 10 Brush one side bottom 3x 11 Brush other side bottom 3x 12 Brush one side top 3x 13 Brush other side top 3x 14 Brush top front teeth 3x 15 Brush bottom front teeth 3x 16 Turn water on and spit out toothpaste* 17 Rinse brush 18 Turn water off* 19 Put toothbrush down 20 Pick up towel 21 Wipe mouth 22 Put towel down Score: /22 *Note: if using automatic sink, student receives credit for putting toothbrush under faucet to turn on water and removing toothbrush from faucet to turn off water. 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 34 BRUSH TEETH

SELF HELP Wash hands: Given an initial instruction to wash hands, the student completes the routine independently. Instructions: Give initial cue to wash hands. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response, or if the student begins to make an error. Record (+) for correct independent responses, (-) for any other response. Step Description +/- Order 1 Turn water on* 2 Wet both hands 3 Put soap on hands 4 Rub hands together 5 Rub back of one hand 6 Rub back of other hand *Note: if using automatic sink, student receives credit for putting hands under faucet to turn on water and removing hands from faucet to turn off water. 7 Rinse hands 8 Turn water off* 9 Get towel 10 Dry hands 11 Throw towel away Score: /11 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 35 WASH HANDS

SELF HELP Dress: Given an initial instruction to get dressed, the student completes the routine independently. Instructions: Give initial cue to get dressed. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response, or if the student begins to complete a step which disrupts the routine, making completion impossible (e.g., putting on shoes before socks). Record (+) for correct independent responses, (-) for any other response. If student completes task independently, but in a different order, indicate the order in which the steps were completed. Step Description +/- Order 1 Pick up underwear, two hands, backside closest to student 2 Put one leg in hole on same side 3 Put other leg in other hole 4 Pull underwear up to waist 5 Pick up pants, two hands, backside closest to student 6 Put one leg in hole on same side 7 Put other leg in other hole 8 Pull pants up to waist 9 Pick up shirt, two hands, backside closest to student 10 Pull over head 11 Put one arm through hole on same side 12 Put other arm through other hole 13 Pull shirt down 14 Sit down on bed or chair 15 Pick up one sock with two hands 16 Pull sock over 1 foot 17 Pick up other sock with two hands 18 Pull sock on other foot 19 Pick up shoe with two hands 20 Pull onto correct foot 21 Pick up other shoe with two hands 22 Pull onto other foot Score: /22 This skill is not generally tested in nonresidential settings (e.g., public schools). 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 36 DRESS

SELF HELP Undress: Given an initial instruction to get undressed, the student completes the routine independently. Instructions: Give initial cue to get undressed. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response or if the student begins to complete a step which disrupts the routine, making completion impossible (e.g., taking socks off before shoes). Record (+) for correct independent responses, (-) for any other response. If student completes task independently, but in a different order, indicate the order in which the steps were completed. Step Description +/- Order 1 Sit on bed with 1 ankle on opposite knee 2 Pull off shoe and place on floor 3 Pull off sock and place on floor 4 Place other ankle on knee 5 Pull off shoe and place on floor 6 Pull off sock and place on floor 7 Stand and cross arms across stomach This skill is not generally tested in non-residential settings (e.g., public schools). 8 Grasp shirt bottom and pull up and over head 9 Remove arms from sleeves and put shirt on floor 10 Grasp waistband of pants 11 Pull pants down to ankles 12 Grasp waistband of underwear 13 Pull underwear down to ankles 14 Step out of pants and underwear with one foot 15 Step out with other foot 16 Place clothes in laundry bin* Score: /16 *Note: If no laundry bin is present, designate other appropriate location for student to place clothes. 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 37 UNDRESS

SELF HELP Wash face: Given an initial instruction to wash face, the student completes the routine independently. Instructions: Give initial cue to wash face. Wait 3-5 seconds for the student to begin each step. Use hand-over-hand guidance if there is no response or if the student begins to complete a step which disrupts the routine, making completion impossible (e.g., washing face before wetting facecloth). Record (+) for correct independent responses, (-) for any other response. If student completes task independently, but in a different order, indicate the order in which the steps were completed. Step Description +/- Order 1 Turn water on* 2 Wet face cloth 3 Wash face in circular motion 2 times 4 Put face cloth down 5 Turn water off* 6 Dry face with towel Score: /6 *Note: if using automatic sink, student receives credit for putting face cloth under faucet to turn on water and removing face cloth from faucet to turn off water. 2012 The New England Center for Children, Inc. (NECC); All Rights Reserved; No portion of this work is to be reproduced 38 WASH FACE

Teacher Report The teacher report skills are indirectly assessed and do not involve hands-on testing of skills. Because these skills are not directly assessed, they do not require the learner to be present, and thus can be completed at any time during the assessment period. Skills are assigned a score using data already recorded for the learner or seeking input from a teacher or clinician who has known the learner for six months or more. Each skill contains specific instructions regarding what code should be assigned ( always, sometimes, or never ). A score of always indicates that the learner performs the skill to mastery criteria. A score of sometimes indicates that the learner does demonstrate the skill, but the skill is emerging or is demonstrated inconsistently and not to mastery criteria. A score of never indicates that the learner does not perform the skill. 39

SOCIAL SKILLS Demonstrate preferences: Student has identified a minimum of 5 high preference stimuli. Instructions: Conduct a new preference assessment or record the results from an assessment completed within the past 3 months. If you need help selecting which preference assessment to use, see the selection guide in the Preference Assessment module on the ACE. The ACE also contains instructions and data sheets to help you get started. Date of most recent preference assessment: High Preference Items 1 1 2 2 3 3 4 4 5 5 Moderate Preference Items Scoring: Record the total number of high preference items. Total Score: /5 40 TEACHER REPORT

Scoring: Circle the appropriate word (Never, Sometimes, Always) according to the criteria for each of the skills below. SKILL CRITERIA SCORE COMMUNICATION - Request termination Never Sometimes SOCIAL SKILLS - Use conditioned reinforcers The student requests an end to an interaction, environment, event, or other stimuli, through verbalization, sign, picture, or other appropriate mode Student initiates exchange of a conditioned reinforcer to access a tangible item. Over the past month, the student has never requested an end to an interaction, environment, event, or other stimuli. Never Over the past month, the student never initiated an exchange with a conditioned reinforcer. For example, score never if the teacher always prompts the student to exchange tokens, or if the student does not have a token system. Over the past month, the student has requested an end to an interaction, environment, event, or other stimuli, but not to criteria. Sometimes Over the past month, the student initiated an exchange but not to criteria. Always Over the past month, the student has requested an end to an interaction, environment, event, or other stimuli in 80% of opportunities. Always Over the past month, the behavior occurred to the specified criteria. SELF-HELP - Bladder trained Throughout waking hours, the student voids in the toilet 100% of the time. Never Over the past month, during the day, the student has never voided in the toilet. Sometimes Over the past month, the student has voided in the toilet but not to criteria. Always Over the past month, the student has had no urinary accidents: he or she voids in the toilet 100% of the time. SELF-HELP - Bowel trained Throughout waking hours, the student voids in the toilet 100% of the time. Never Over the past month, during the day, the student has never had a bowel movement in the toilet. Sometimes Over the past month, the student has had a bowel movement in the toilet, but not to criteria. Always Over the past month, the student has had no bowel accidents: he or she voids in the toilet 100% of the time. 41 TEACHER REPORT

Scoring: Circle the appropriate word (Never, Sometimes, Always) according to the criteria for each of the skills below. HEALTH & SAFETY - Tolerate medical procedures SKILL CRITERIA SCORE When presented with a routine Never Sometimes medical procedure (blood pressure, temperature, ear Student never complies with check, height, weight) student instructions for any of the complies with instruction in listed procedures without at 100% of opportunities with least two people assisting. minimal physical assistance (no more than 1 extra person to assist) Student either tolerates some procedures with just one person, or sometimes requires two people to comply with instructions. Always Student always complies with instructions for all procedures with no more than one person assisting. HEALTH & SAFETY - Exit given fire alarm Given the sound of the fire alarm, student exits building in 100% of opportunities with minimal physical assistance (no more than 1 extra person to assist). Never Over the most recent fire drills, student never leaves the building without at least 2 people assisting. Sometimes Over the most recent fire drills, student sometimes leave the building with only one person assisting. Always Over the most recent fire drills, student always leaves the building with no more than one person assisting. RECREATION & PHYSICAL ED - Exercise Note: Total duration does NOT have to be 30 consecutive minutes. Includes free play and outdoor activities for young children. RECREATION & PHYSICAL ED Engage in independent task Student engages in cardiovascular exercise for at least 30 minutes per day, 3 times per week. Student engages in an independent play or leisure activity for 15 minutes with teacher or parent in the room Never Over the past month, the student has never engaged in cardiovascular exercise. Never Over the past month, student never engaged in a play or leisure activity for any amount of time. Sometimes Over the past month, the student has engaged in cardiovascular exercise at least once, but not to criteria. Sometimes Over the past month, student engaged in a play or leisure activity, but not to criteria (fewer than fifteen minutes). Always Over the past month, the student has exercised for at least 30 minutes per day, 3 times per week. Always Student engaged in a play or leisure activity at least once for 15 minutes. 42 TEACHER REPORT

Scoring: Circle the appropriate word (Never, Sometimes, Always) according to the criteria for each of the skills below. SKILL CRITERIA SCORE COMMUNITY - Ride in car/van Never Sometimes In the context of a van or car ride, student sits with seat belt and hands to self for the duration of the ride in 100% of opportunities. Over the past month, student never rode in the van with his/her seat belt on and hands to self for any amount of time. Over the past month, student rode in the van with his/her seat belt on and hands to self, but not to criteria (100%) of the time. Always Over the past month, student always rode in the van with his/her seat belt on and hands to self for the duration of the ride. COMMUNITY - Walk in the community While in the community, the student walks beside the teacher, keeps hands to self, and maintains appropriate social distance in 100% of opportunities. Never Over the past month, the student never walked by the teacher, keeping hands to self and maintaining appropriate social distance. Sometimes Over the past month, the student sometimes walked by the teacher, keeping hands to self and maintaining appropriate social distance, but not to criteria. Always Over the past month, the student always walked by the teacher, keeping hands to self and maintaining appropriate social distance 43 TEACHER REPORT

Skills Index DISCRIMINATION ATTENDING... 5 SESSION BEHAVIOR... 6 SIMPLE DISCRIMINATION... 7 MATCH IDENTICAL OBJECTS... 8 MATCH IDENTICAL PICTURES... 9 MATCH PICTURE TO OBJECT... 10 MATCH OBJECT TO PICTURE... 11 COMMUNICATION REQUEST NEEDED OR DESIRED ITEMS... 27 RESPOND TO NAME... 27 RESPOND TO GREETING... 27 REQUEST ATTENTION... 27 REQUEST TERMINATION... 41 REQUEST ASSISTANCE... 27 ACCEPT AND REJECT... 12 RESPOND TO STOP... 27 FOLLOW 1-STEP DIRECTIONS WITH VISUAL SUPPORT... 13 FOLLOW 1-STEP DIRECTIONS IN GROUP WITH VISUAL SUPPORT... 14 INDICATE NAMED BODY PARTS... 15 INDICATE NAMED OBJECTS... 16 INDICATE NAMED PICTURES... 17 NAME OBJECTS... 18 NAME PICTURES... 19 SOCIAL SKILLS DEMONSTRATE PREFERENCES... 40 WAIT FOR PREFERRED ITEM... 28 USE CONDITIONED REINFORCERS... 41 FOLLOW A POINT... 20 IMITATE ACTIONS WITH OBJECTS... 21 IMITATE GROSS MOTOR ACTIONS... 22 IMITATE ACTIONS WITH OBJECTS FOLLOWING A DELAY... 23 MAINTAIN APPROPRIATE SOCIAL DISTANCE... 28 WAIT IN THE CONTEXT OF GROUP INSTRUCTION... 24 44 INDEX

Skills Index SELF HELP BLADDER TRAINED... 41 EAT WITH UTENSIL... 25 DRINK FROM A CUP... 25 SHOWER... 33 BRUSH TEETH... 34 BOWEL TRAINED... 41 WASH HANDS... 35 DRESS... 36 EAT VARIOUS FOODS... 29 UNDRESS... 37 WASH FACE... 38 HEALTH AND SAFETY TAKE MEDICATION... 30 TOLERATE MEDICAL PROCEDURES... 42 EXIT GIVEN A FIRE ALARM... 42 PRODUCE PERSONAL IDENTIFICATION... 30 MAINTAIN PRIVACY DURING PERSONAL HYGIENE... 30 RECREATION AND PHYSICAL EDUCATION USE PICTURE OR WRITTEN SCHEDULE... 32 EXERCISE... 42 ENGAGE IN INDEPENDENT TASK... 42 COMMUNITY RIDE IN CAR/VAN... 43 WALK IN THE COMMUNITY... 43 45 INDEX