Tip Sheet for ADAPTIVE Domain
Self-Care
SC 14: Removes his or her shoes without assistance. (Structured or Interview)
- The child must use their hands to remove the footwear; not just kick off shoes.
- Parent must observe untying and/or unfastening straps, Velcro, or laces.
- *flip flops are not considered for scoring.
Scoring: 90% of the time or more = Score 2; Sometimes = Score 1; <10% (rarely or never) Score = 0. Self Care
SC 26: Chooses the appropriate utensil for the food he or she is eating. (Structured)
- This is a “STRUCTURED” item and must be administered as per manual to the child.
Scoring: 6 situations = 2; 4 or 5 situations = 1; 3 or fewer = 0
Personal Responsibility
PR 1: Moves independently around the house, requiring only occasional supervision. (Observation or Interview)
- If you have to physically assist your child’s movement from room-to-room, then Score=0.
- If your child moves independently, THEN how much supervision/checking required? (Examples: Does caregiver cook, vacuum, or use the bathroom without taking child with them or confining child to a safe place.)
- If “occasional” supervision Score = 2.
- If “moderate” supervision = 1.
- If “constant” supervision required Score = 0.
PR 2: Understands that hot is dangerous. (Structured or Interview)
- Evaluator may use the interview mode as a communication delay may impede child’s ability to “express” his/her knowledge and many children may not have exposure to matches.
- If child’s access to hot items is restricted by parent/caregiver, then Score=0
PR 5: Indicates or describes an illness or ailment to an adult. (Interview)
- Child initiated WORDS or ACTIONS.
Scoring: 90% of the time or more = Score 2; Sometimes = Score 1; <10% (rarely or never) Score = 0.
PR 9: Continues to work on a learning task with minimal guidance. (Observation or Interview)
- Child must be engaged in a learning activity for at least 15 minutes or time allotted with 2 or fewer contacts with an adult; not just playing.
Scoring: 90% of the time or more = Score 2; Sometimes = Score 1; <10% (rarely or never) Score = 0.
PR 10: Initiates and organizes his own activities. (Observation or Interview)
- Child must organize the activity: gather/find the materials, and work in an appropriate place.
- Score on frequency
- Examples might include an art activity (creating a card), setting up a race car and race track
- Parent may get items out of reach at child’s request
Scoring: 90% of the time or more = Score 2; Sometimes = Score 1; <10% (rarely or never) Score = 0.
PR 12: Follows rules when playing simple games. (Observation or Interview)
- MUST have established rules, and play with other children or adults (2+ individuals – not Video or Phone games played by themselves.)
- Score on frequency.
Scoring: 90% of the time or more = Score 2; Sometimes = Score 1; <10% (rarely or never) Score = 0.
PR 18: Goes to bed without assistance. (Interview)
- Only source = parent/caregiver in home. Contact for reliable response. (Nighttime routines, excludes naptime)
Scoring: Without Assistance = 2. With some assistance = 1. With a great deal of assistance