Special Education

Teaching Students with Fetal Alcohol Syndrome

Appendix 4: Adaptive Skills Checklist

Appendix 4: Adaptive Skills Checklist
Name: ________________________ Date of Birth: ________________________
School: ________________________ Grade: ________________________

Attentional Abilities Mostly Sometimes Never
Completes classroom assignments during class time _______ _______ _______
Prepares for assigned activities (test, quiz, reading assignment) _______ _______ _______
Uses age appropriate organizational skills _______ _______ _______
Is able to give specific details when asked for an explanation or description _______ _______ _______
Understands nonverbal cues _______ _______ _______
Follows the course of a conversation _______ _______ _______
Follows directions from teachers and other school personnel _______ _______ _______
Thinks before acting _______ _______ _______
Knows how and when to initiate appropriate actions _______ _______ _______
Responds appropriately to the stimulation of the classroom _______ _______ _______
Able to stay on topic during a discussion _______ _______ _______
Can self-regulate behaviour in a classroom setting _______ _______ _______


Cause/Effect Linking _______ _______ _______
Demonstrates concern about classroom performance _______ _______ _______
Demonstrates age-appropriate ability to take another’s point of view _______ _______ _______
Can articulate the implications of an action before undertaking it _______ _______ _______
Understands consequences and what they are for _______ _______ _______
Is able to change behaviour as result of consequences _______ _______ _______
Is able to generalize from the behaviour in one setting to the same or similar behaviour in another setting _______ _______ _______


Social Skills Mostly Sometimes Never
Follows the school’s rules _______ _______ _______
Follows the classroom’s rules _______ _______ _______
Demonstrates age-appropriate self-control _______ _______ _______
Exercises good judgment in decision-making and behaviour _______ _______ _______
Can take responsibility for actions _______ _______ _______
Is able to wait for a turn to speak or to do something _______ _______ _______
Is able to share possessions or materials appropriately _______ _______ _______
Able to make and keep friendships _______ _______ _______
Normally associates with age-appropriate peers _______ _______ _______
Responds appropriately to redirection in an academic situation _______ _______ _______
Responds appropriately to redirection in a social situation _______ _______ _______
Demonstrates appropriate emotional response to a given situation _______ _______ _______


Personal Skills _______ _______ _______
Interacts appropriately with the teacher on an instructional level _______ _______ _______
Reacts appropriately to praise and recognition _______ _______ _______
Reacts appropriately to constructive criticism _______ _______ _______
Responds appropriately to environmental cues _______ _______ _______
Takes responsibility for own actions _______ _______ _______
Adapts to increases in noise and stress _______ _______ _______
Appropriately responds to pressure _______ _______ _______
Responds appropriately to changes in task or assignment _______ _______ _______
Is able to accept changes in established routines _______ _______ _______
Adaptable to changes in physical environment, routines, transitions _______ _______ _______
Adaptable to changes in emotional environment, routines, transitions _______ _______ _______

Comments
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Completed by: __________________________________________________________
Relationship to student: __________________________________________________________
Date: __________________________________________________________