Adaptive Behavior Assessment Form
Please complete this form to assess the individual's adaptive behavior skills across various domains.
Respondent's Full Name
*
First Name
Last Name
Relationship to the Individual Being Assessed
*
Please Select
Parent
Teacher
Caregiver
Self
Other
Individual's Full Name
*
First Name
Last Name
Individual's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Communication Skills Assessment
*
Rows
Never
Sometimes
Often
Always
Understands verbal instructions
1
2
3
4
Expresses needs clearly
5
6
7
8
Engages in conversation
9
10
11
12
Follows multi-step directions
13
14
15
16
Socialization Skills Assessment
*
Rows
Never
Sometimes
Often
Always
Initiates social interactions
17
18
19
20
Maintains friendships
21
22
23
24
Shares with others
25
26
27
28
Responds appropriately to social cues
29
30
31
32
Daily Living Skills Assessment
*
Rows
Never
Sometimes
Often
Always
Dresses independently
33
34
35
36
Prepares simple meals
37
38
39
40
Manages personal hygiene
41
42
43
44
Manages money or allowance
45
46
47
48
Self-Direction
*
Rows
Never
Sometimes
Often
Always
Completes tasks without reminders
49
50
51
52
Makes decisions independently
53
54
55
56
Adapts to changes in routine
57
58
59
60
Motor Skills Assessment
*
Rows
Never
Sometimes
Often
Always
Uses utensils when eating
61
62
63
64
Ties shoelaces
65
66
67
68
Writes legibly
69
70
71
72
Engages in physical play
73
74
75
76
Overall Adaptive Behavior Rating
*
1
2
3
4
5
Describe any strengths or challenges observed in adaptive behavior.
Additional Comments or Observations
Submit Assessment
Should be Empty: