DECA Assessment for 3-5 years
This form describes a number of behaviors seen in some young children. Please mark the box in the category that tells how often you saw the behavior in the past 4 weeks. Answer each question carefully. There are no right or wrong answers. Please answer every item. This form will be automatically sent to your Home Visitor when it is completed.
Child's Name*
Gender
DOB
Age*
Name of person completing this form*
Relationship to Child*
During the past 4 weeks how often did the child.......
1. Act in a way that made adults smile and show interest in him/her?*
Never Rarely Occasionally Frequently Very Frequently
2. Listen to or respect others?*
Never Rarely Occasionally Frequently Very Frequently
3. Control his/her anger?*
Never Rarely Occasionally Frequently Very Frequently
4. Seem sad or unemotional at a happy occasion?*
Never Rarely Occasionally Frequently Very Frequently
5. Show confidence in his/her abilities (saying "I can do it")*
Never Rarely Occasionally Frequently Very Frequently
6. Have a temper tantrum?*
Never Rarely Occasionally Frequently Very Frequently
7. Keep trying when unsuccessful? (Show Persistence)*
Never Rarely Occasionally Frequently Very Frequently
8. Seem un- interested in other children or adults?*
Never Rarely Occasionally Frequently Very Frequently
9. Use obscene gestures or offensive language?*
Never Rarely Occasionally Frequently Very Frequently
10. Try different ways to solve a problem?*
Never Rarely Occasionally Frequently Very Frequently
11.Seem happy or excited to see his/ her parent or guardian?*
Never Rarely Occasionally Frequently Very Frequently
12. Destroy or damage property?*
Never Rarely Occasionally Frequently Very Frequently
13. Try or ask to try new things or activities?*
Never Rarely Occasionally Frequently Very Frequently
14. Show affection for familiar adults?*
Never Rarely Occasionally Frequently Very Frequently
15.Start or organize play with other children?*
Never Rarely Occasionally Frequently Very Frequently
16. Show patience?*
Never Rarely Occasionally Frequently Very Frequently
17. Ask adults to play with or read to him/ her?*
Never Rarely Occasionally Frequently Very Frequently
18.Have a short attention span? ( difficulty concentrating)*
Never Rarely Occasionally Frequently Very Frequently
19. Share with other children?*
Never Rarely Occasionally Frequently Very Frequently
20. Handle frustration well?*
Never Rarely Occasionally Frequently Very Frequently
21. Fight with other children ?*
Never Rarely Occasionally Frequently Very Frequently
22. Become upset or cry easily?*
Never Rarely Occasionally Frequently Very Frequently
23. Show an interest in learning new things?*
Never Rarely Occasionally Frequently Very Frequently
24. Trust familiar adults and believe what they say?*
Never Rarely Occasionally Frequently Very Frequently
25. Accept another choice when his/her first choice was not available?*
Never Rarely Occasionally Frequently Very Frequently
26. Seek help from children/ adults when necessary?*
Never Rarely Occasionally Frequently Very Frequently
27. Hurt others with actions or words?*
Never Rarely Occasionally Frequently Very Frequently
28. Cooperate with others?*
Never Rarely Occasionally Frequently Very Frequently
29.Calm his/herself down?*
Never Rarely Occasionally Frequently Very Frequently
30. Get easily distracted?*
Never Rarely Occasionally Frequently Very Frequently
31. Make decisions for him/herself?*
Never Rarely Occasionally Frequently Very Frequently
32. Appear happy when playing with others?*
Never Rarely Occasionally Frequently Very Frequently
33. Choose to do a task that was hard for him/her?*
Never Rarely Occasionally Frequently Very Frequently
34. Look forward to activities at home or school ( birthdays or trips)?*
Never Rarely Occasionally Frequently Very Frequently
35. Touch children or adults in a way that you thought was inappropriate?*
Never Rarely Occasionally Frequently Very Frequently
36. Show a preference for a certain adult, teacher, or parent?*
Never Rarely Occasionally Frequently Very Frequently
37. Play well with others?*
Never Rarely Occasionally Frequently Very Frequently
38. Remember important information?*
Never Rarely Occasionally Frequently Very Frequently
Should be Empty: