CHILD'S/STUDENT'S NAME: |
DATE: |
This questionnaire seeks your honest responses to questions about your child's/this student's abilities in the area of social skills. Your answers will help his/her teacher select skills to be taught. Please rate him/her in the following areas.
THIS CHILD. . .
| 1. Describes or names emotions and feelings he/she sees in others and understands them (anger, happiness, fear, sadness) | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 2. Knows his/her own feelings and emotions. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 3. Expresses his/her feelings and emotions appropriately (shows anger, fear, happiness, etc. when appropriate). | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 4. Says "I feel. . ." or "I am. . ." to express feelings. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 5. Uses socially appropriate language for body functions (such as bathrooming, menstruation, gas) and for body parts. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 6. Avoids swearing and use of unacceptable language. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 7. Recognizes the emotions that others are feeling (anger, fear, disappointment, embarrassment, etc.) | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 8. Knows what to do when she/he feels left out or ignored. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 9. Knows what to do when she/he feels afraid. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 10. Shows love and affection to family and friends appropriately. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 11. Behaves appropriately when feeling embarrassed (not angry or belligerent). | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 12. Demonstrates self-control when feeling frustrated. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 13. Handles disappointment and losing a game or contest well for his/her age. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 14. Handles winning and success well (doesn't brag too much or make others feel bad). | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 15. Finds something to do when feeling bored.. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 16. Does not over-react or become violent when feeling angry. Handles anger well. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 17. Is honest and tells the truth. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
| 18. Shares things with others. | |||||
| ( ) Never | ( ) Sometimes | ( ) Usually | ( ) Don't Know | ||
COMMENTS:
RESPONDENT'S SIGNATURE____________________________________________________
Social Skills Curriculum Guide, 1992
Special School District of St. Louis County