Please mark off the boxes that apply the most to your child. This information provides us with more input about what type of group
your child should be placed in and his or her level of functioning.
__ Processes information quickly
__ Delay in response time
__ Has difficulty understanding the concepts and language- requires visual and/or physical prompts to understand Message.
__ Advanced vocabulary and sentence structure
__ Slightly delayed vocabulary and sentence structure
__ Significantly delayed vocabulary and sentence structure
Behaviors:
__ Motivated, focused, attentive
__ Anxious
__ Active and distracted__ Impulsive
__ Rigid
__ Inattentive or aloof (“in own world”)
__ Oppositional
__ Physically aggressive towards peers
__ Verbally aggressive towards peers
__ Physically aggressive towards adults
__ Verbally aggressive towards adults
__ May run away or want to leave situation when upset
__ Other: ___________________________________________________________________________________
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