Brigance IED III

Brigance IED III

DAILY LIVING SKILLS

Student: ______

Date: ______

Person Completing Form: ______

Directions: Check off the item if the child is performing it most of the time. You may provide additional information in the “Comments” section, if needed.

Feeding/Eating:

___ takes spoon from plate to mouth, with some spilling

___ uses straw to drink

___ holds cup or glass with one hand and drinks

___ chews with ease and rotary motion

___ inserts spoon in mouth without turning it upside down, moderate

Spilling

___ inserts spoon in mouth without turning it upside down, little or no

Spilling

___uses a fork for eating

___ spoon feeds without spilling

___ uses side of fork for cutting soft food

___ uses napkin

___ holds fork in fingers (not in fist)

___ uses knife for spreading

___ uses knife for cutting soft foods

Comments: ______

Undressing:

___ cooperates in undressing

___ removes socks

___ assists in undressing

___ removes shoes

___ removes coat

___ removes shirt

___removes pull-down clothing

___undresses self, but may need help with pull-over clothing

___ removes some “pull over” garments

___ removes more difficult “pull over” clothing

Comments: ______

Dressing:

___cooperates in dressing

___ assists in dressing

___ puts on front-opening sleeved garment, if it is positioned so that

arms can be placed in the correct sleeves

___ puts on short- sleeved garment with opening in the

front (shirt)

___puts on long-sleeved garment with opening in front (coat or shirt)

___ puts on front opening, pull up garment if it is positioned so that feet

can be placed in the correct legs

___ puts on short-legged garment with opening in front (shorts)

___ puts on long-legged garment with opening in front (pants)

___ puts on shoes (may be on the wrong feet)

___ puts on pull-up garment with elastic waistband

___ puts on socks

___ puts on “pullover” garment

___ dresses with little supervision except for help with difficult

fasteners (sometimes clothes may be on backward)

___ dresses without supervision (independently) except for help with

difficult fasteners(sometimes clothes may be on backward)

___ puts on shoes (on correct feet)

___ dresses self, putting all clothes on correctly and fastening all

fasteners

___ dresses self completely, including tying shoelaces, and fastening

all fasteners

Comments: ______

Unfastening:

___ unzipsfront nonseparating zipper

___ unbuttons front buttons

___ unties bow

___ unsnaps front snaps
___ unzips front separating zipper

Comments: ______

Fastening:

___ buttons large front buttons

___ snaps front snaps

___ zips front nonseparating zipper

___ buttons small front buttons

___ buckles belt or shoes

___ attempts to tie shoes

___ zips front separating zipper

___ ties shoes

Comments: ______

Toileting:

___ indicates wet or soiled diaper or pants

___ has regular bowel movements

___ begins to anticipate & communicate toileting needs

___ anticipates & verbalizes/communicates toileting needs fairly

consistently

___ gets on potty by self, but may need help with clothing

___ has bowel control (occasional accident)

___ has bladder control (occasional accident)

___ distinguishes between urinating and having a bowel movement and

communicates each need differently

___ climbs on toilet seat

___ has firmly established toileting skills (rarely has accident)

___ pulls down pants when needs toileting

___ urinates without toileting assistance

___stays dry at night if toileted in the evening

___ attempts to wipe self

___ cares for toileting needs, but may need help wiping

___ flushes toilet

___ manages clothes on own adequately when toileting

___ wipes self independently

___ totally cares for toileting needs, including flushing toilet & washing and

drying hands

Comments: ______

Bathing:

___ cooperates in drying hands

___ cooperates in washing hands

___ dries hands, may need assistance

___ washes hands, but may need assistance using soap efficiently

___ dries hands without assistance

___ dries face, but may need assistance

___ washes hands with soap without assistance

___ washes face, but may need assistance

___ turns faucet on and off without assistance

___ knows which faucet is for hot water and which is for cold

water

___ adjusts water temperature with adult assistance

___ dries face without assistance

___ washes face without assistance

___ bathes self with assistance

___ dries self without assistance after bathing

___ bathes self without assistance

Comments: ______

Grooming:

___ willingly allows nose to be wiped

___ begins brushing teeth, but may need much assistance

___ wipes nose when asked to do so

___ brushes teeth, but may need assistance

___ rinses mouth and expels water

___ combs hair, but may need assistance

___ brushes hair, but may need assistance

___ brushes teeth without assistance

___ combs hair without assistance

___ wipes nose without verbal cue

___ brushes hair without assistance

___ covers mouth/nose when coughing & sneezing

Comments: ______

Note to teacher: Subtests G-9, G-10, and G-11 may be administered directly to the student if needed.

Brigance IED III

SOCIAL AND EMOTIONAL DEVELOPMENT

Student:______

Date:______

Person Completing Form: ______

Directions: Check off the item if the child is performing it most of the time. You may provide additional information in the “Comments” section, if needed.

Relationships with Adults:

___ watches face for emotional clues

___ is warmly responsive to adults

___ engages with an adult by doing an activity for five minutes

___ demonstrates warmth when interacting with an adult

___ meets and accepts strangers comfortably

___ interacts with you respectfully

___ responds appropriately to directions from an adult

___ shares feelings with adults when sad or upset

___ shares feelings with adults when happy

___ asks adult for guidance when he/she needs help

___ enjoys sharing information about self with adult

___ shares ideas willingly when requested to by an adult

___ responds appropriately to classroom instruction

___ shares thoughts and ideas

Comments: ______

Play and Relationships with Peers:

___ plays alone in the presence of other students (parallel play)

___ identifies self with students of same age and gender

___ watches other students play and joins briefly

___ imitates self doing something, such as crying or eating

___ begins to play with other students with adult supervision

___ uses a doll or other toy to act out a scene

___ is aware of and curious about gender differences

___ engages in domestic, make-believe play, imitating an adult

activity for five minutes

___ engages in domestic, make-believe play, imitating an adult

activity for ten minutes

___engages in domestic, make-believe play, imitating an adult

activity for fifteen minutes

___ engages in domestic, make-believe play, imitating an adult

activity for twenty minutes

___ plays simple group games, such as “Ring Around the Rosy”

___ uses blocks or other objects to build simple enclosures, such as

pens or yards

___ engages in a small-group project or activity for at least five

minutes

___ shows preference for some friends over others

___ forms a temporary attachment to one playmate

___engages in a small-group project or activity for at least twelve

minutes

___ usually plays cooperatively, but may need adult help

___ prefers companionship of peers to that of adults

___ takes turns in play without adult supervision

___ has several friends, but one special friend

___ plays cooperatively with two or three students for five minutes

___ plays cooperatively with two or three students for ten minutes

___ plays cooperatively with two or three students for fifteen minutes

___ plays cooperatively with two or three students for twenty minutes

___ has a best friend

___ plays cooperatively in large-group games

___ values friendship

___ incorporates verbal directions into play activities

___ plays games with rules

___ pretends to have a career/professional role in play

Comments: ______

Motivation and Self-Confidence:

___ shows a sense of self as evidenced by wanting less service and

Independence

___ shows pride in new accomplishments

___ insists upon doing things for himself/herself

___ maintains interest when reading with an adult for at least five

minutes

___ begins to be aware of so-called good and bad behavior in self

___ begins to be aware of so-called good and bad behavior in others

___ seeks detailed explanations with frequent use of why

___ maintains interest when engaged in a small-group activity or

project for ten minutes

___ describes social behavior using a variety of descriptive words,

perhaps due to a good imagination

___ reacts appropriately to change

___ shows pride in showing new accomplishments and skills

___ listens and takes feedback well

___ demonstrates self-confidence

___ demonstrates perseverance

___ is eager to comply with class rules and activities

___ demonstrates satisfaction and comfort with self

___ maintains a positive attitude during activities

___ usually remains at a 10 to 12-minute task until it is time to quit or

transition

___ transitions appropriately from one activity to another

___ demonstrates independence in learning activities and tasks

___ likes to finish what he/she starts

___ pushes for autonomy (wants to be independent like an adult)

___ approaches new tasks with confidence

___ works on a small-group project or activity for at least twenty

minutes

___ remains engaged in an assigned task even when minor

distractions are present

Comments: ______

Prosocial Skills and Behaviors:

___ helps put things away

___ identifies self with students of same age and gender

___ likes to perform for others

___ gives as well as takes

___ discovers satisfaction from doing things with others

___ shows concern that playmates are not hurt

___ performs simple errands

___ establishes eye contact when interacting with peers

___ establishes eye contact when addressed by an adult

___ greets adults and peers appropriately

___ engages appropriately in conversation initiated by others

___ refuses requests or activities inappropriately

___ is truthful when sharing information with others

___ takes turns (with assistance)

___ takes pleasure in doing simple favors for others

___ volunteers to help a peer with an activity without prompting

___ begins to show empathy for others

___ participates well in group activities

___ responds appropriately to criticism

___ understands the need to share and take turns

___ reacts to disappointment and failure in an acceptable manner

___ asks before using another student’s toy or things

___ offers apologies for accidents or mistakes

___ values friendship

___ likes to finish what he/she starts with less dawdling than at an

earlier age

___ follows verbal conversational rules

Comments: ______

Rev. 11-10