RETARDATION (BASIC..MR) Part A & B

BEHAVIOUgjj, ASSESSMENT SCALES FOR INDIAN CHILDREN WITH MENTAL RETARDATION

(BASIC..MR) Part A & B

RECORD BOOKLET

National Institute for the Mentally Handicapped

(Ministry of Welfare, Govt. of India) Manovilcas Nagar, Secunderabad - 500 009.

:7751741 -745

CHAPTER XE!

Behavioural Assessment Scales For Indian Children (

^Authors:

with Mental Retardation, (BASIC-MR) Part A eetaFesMwarta, S. VenkatesanJ

RECORD BOOKLZF

Nsmeotthestudent ^-. .. Age

Level/Class Sex

Dates:

Baseline Assessment Evaluated by ..

FirstQuarter Assessment Evaluated by

Second Quaster Assessment Evaluated by

Third Quarter Assessment Evaluated by

Instructions

1. Each item should be scored based on the 6 levels of performance, I.e., lndependent—5 Clueing—4; Verbal prompting—3; Physical prompting—2; Totally dependent—i; Not applicable=O.

2. The score for each item should be entered In the appropriate boxes given on the right side. Baseline assessment, first quarter,second quarter and third quarter assessment.

8. For some Items examples are given in the record booklet. Theteacher can use other examples during assessment, and note them in the blank spates given.

4. Wherever space Is insufficient, use extra sheets and attach them to the record booklet.

S To score independent (5), the child should pass all the required number of items/trials given In the brackets. For example, In NT-iO, if a child is able to complete only 4 out of 5 required sums Independently, and does the fifth sum with clues the score lagiven as "clueing" (4) and not independently (5).

6. Refer to the Glossary for the administration procedure about specific items.

Item

DOMAINS/ITEMS

Assessments

146. $selin lstQr 2ndQr SrdQii

MOTOR (M)

i.

Retains two one inch cubes in one hand for 30 seconds 2. Claps hands

&

Crawlsadistanceof5feetorniore H H [1i

4. When made to stand, stands without_supportfor

H LIII] LII] LII

5. Puts small objects into a container

H LII] [II] H

6. Uses thumb and index finger to pick up objects

JI] fl LI] LII

7. From sitting position is able to stand

[III] H H H

8. From standing position, bends knees to squatting position

LII LI] H Eli

9. Throws ball in any direction

H H H H

10. Walks for minimum 5-10 steps

LII H H LII]

11. Kicks ball in any direction

[II H LI] Eli

12. Runs for minimum ten steps

LII H H H

13. Climbs up chair

H H H H

Sizeoftherecord booklet reduced to include in the book.

NIMH.Secunderabad¹⁹⁹²

No\\ N

BHUu lsQr 8MQI, _Sr&Qr 14. Climbs upstairs using alternate feet

15. Pours liquid from one giss to another without spilling 16. Climbs down the stairs using alternate feet

1'7. Turns pages singly from a book 18. Jumps off the ground with both feet 19. Opens the door

20. Does simple physical exercises

[Ill E

21. Throws ball atieast five metres away before first bounce

22. Cathhes ball ^I

23. Swings for at least 2-3 minutes

LII fl

24. Wipes blackboard clean using duster

25. Pushes a cycle tyre (male)/ plays 5 stones (female)

26. Climbs atleast eight to ten steps of a slide or ladder LIII

E LII] LI]

27. Stands on one foot for minimum 30 seconds

LII fl E [II]

28. Jumps from a height of 2 feet

LI LIII LII] LI

29. Folds paperand inserts into an envelope LIII

LI LI LII]

30. Walks on straight line for atleast 5-jo_steps

[II LI LIII LI

31. Plays marbles (male)/hopscoteh (female)

fl

32. Tears off a perforated sheet 33. Throws ball into a basket

LII LI LI LI

34, Cuts along a straight line using scissors

fl [J [II]

35. Hops on one foot for minimum 30 seconds 36. Plays ring games

LIII LI LI LI

3t

Threads amedium sized needle

fl LII LI LI

38. Strikes and lights a match stick within two attempts

39. Rides a bicycle

fl [II fl

40. Skips

LI LI LI LI

Total Raw Score Baseline

1st Quarter find Quarter TUrd Quarter Motor

0

Item

DOMAINS/ITEMS

Assessments

No.

^Buflas ltQr 2nJQi 3rIQt

ACTIVITIESOF DAILY LIVING (ADL)

Eating

1. Swallows liquid or semi-solid foods

E LIII E

2. Drinksfromcup or glass

E LI] [III]

3. Discriminates eatables and non-eatables

4. Chews solid foods LII]

LI LI LI

5. Picks up food with fingers and puts in mouth

LI LI LI LI

6. Peels banana/orange skin

LI LI [III] LI

7. Sucks water/liquid through a straw

LI LI LI

8. Mixes rice, dal and eats with hand/spoon

LI LI [III] [III

Toiletting

9. Indicates need to go to toilet

LI El LI LIT

10. Reaches the toilet

LI El LII LI]

11. Removes underware/pant before sitting on toilet seat

LI LI LI LI

12. Washes self after use of the toilet

LI LII LI [III

13. Flushes toilet after use

LI LI LI LII

Brushing

-

[ILILILI

14. Wipes hands with towel/cloth 15. Washes hands with soap and water 16. Brushes teeth

17. Spits paste

LI LI LI LI

18. Cleans the tongue LIII

LI LI LI

19. Applies paste on the tooth brush

LI LI LI LI

Bathing

20. Pours water on self for bathing

LI LI LII LI

21. Wipes face with towel/cloth

LI LI LI LI

22. Washes face with soap and water

LI LIII LII] LI

23. Uses towel for drying body

LI [1111 LI LI

3

:.:::H. Assessments.

Banhn. lstqr 2ndQr ardqr

24. Removes soap from body with water

Li LIII Li LIII]

25. Applies soap on body

[Ii Li Li [11111

Dressing

26. Takes off clothes when unbuttoned

LIII [Ii LIII [Ii

27. Puts on underpants or elastic knickers

Li Li LII Li

28. Unbuttons clothing

Li Li LIII LIII

29. Puts on shirt/frock (need not button)

LIII LIII Li [II

30. Puts slippers on correct feet

LII LII Li LIII

Si. Buttons own clothing

LIII LIII Li LII

32. Puts on pullover shirt/skirt and blouse

[III LII Li Li

33. laces shoes or buckles saudles

LII [11111 Li Li

34. Ties knots

[Ii Li [II Li

Grooming

35. Applies powder on face/body

LI.] Li Li Li

36. Oils hair

Li Li Li Li

37. Cuts nails with nailcutter/scissors

Li Li Li Li

38. Puts on wHit watch

Li Li LI Li

39. Plaits hair (female)/Combs hair with parting (males)

Li Li Li Li

40. Looks after menstural hygiene(Female)/Shaves (male)

Li Li Li Li

Total Raw Score Baseline

1st Quarter find Quarter ifird Qvarter

Activities of F

DailyLiving

_____________

LANGUAGE (L)

NOTE: For a child who is unable to speak, identification or gestural indication is sufficient to pass the items in this domain

1. Locates items/persons on command by looking at them

[III Li [III LII]

2. Responds to verbal or gestural commands. (any five)

a) "Come" b) "Go"

:

"Look"

d) "give"

Li LIII LU

4

DOMAiNS/ITEMS

Assessment. 1

No

Bimmilne 1dQr. SndQ,.

3. Follows simple commands that call for action. (any five)

a) "Get me the bail"

b) "Give me the book"

c) "Close the door"

d) 'Wipe your face"

[J

4. Points to body parts (any flue)

a) Eyes b) Ears

c) Nose d) Hair

e) Lips

1) Legs

g) Head Ii) Hands [ LII [I

5. Points to familiar objects (any ten)

a) Chair b) Frock

c) Pen d) Pencil

e) Fan o

_Book

g) Doll h) Light

i) Shirt

j)

^Plate

k) Tumbler

_I)

6. Points to pictures in a book (any ten)

a) ₁₎

b) _&

7. Follows "WHOSE" questions (any five)

DEED

(a) Whose bag is this?

(b) Whose book is this?

(c) Whose pencil is this?

(d) Whose tiffin box is this?

[11 [ILl LI

8. Follows postpositions (any ten)

8.1 On a) Putthetoyonthetable

(any 3) b) Put the book on the table c)

d)

8.2

In

a) Put the tiffin box in the bag (any 3) b) Put the bead in the box/container

c) d)

5

DOMAINS/FFES

^.

..

Assessments.

No ^Baseline letQr 2adQr $rtQr

8.3 Under

a) Put the doll under the table (any 4) b) Put the paper under the book

DDDD

9. Follows two step directions (any flue) a) Close the door and bring the book

b) Keep the book in the bag and get the chalkpiece

DEED

10. Follows "Which" questions (any five)

a) Which book have you written your home work?

b) Which teacher did you talk to?

e) Whichwater bOttle is yours?

d) Which is your drawing?

DEED

11. Follows 'Why" questions (any five)

a) Why do we wear warm clothes in winter?

b) Why do we carry an umbrella?

c) Why do we go to school?

EDDD

12. Follows adjectives (any ten)

12.1 Big-srnallaj Show we which of these two

(any 5) pentils-isbigger?

b) Get me the smaller of the iwaballs

C,

12.2

Up-down a) Throw the ball up

(any 5) b) Put your hands up/

Put your hands down c)

13. Follows concept of whole/part (any five) a) This is a whole •chappati,this is a part of it b) This is a whole chalkpiece, this is a part of it

c)

DEED

6

Item

DOMAINS/ItEMS ^.

.• .:..

LNo

BssieUne 1SQr 2ndQr

3tdJ

14. Follows three step directions (anyfive)

a) Keep the pen on the table, close the door and bring your book.

b) Open your book, keep the pencil in your bag and stand in with folded hands.

DEED

15. Identifies first middle and last in a group (any ten)

15.1 First

a) Keep the book in the middle (any 3) of the pen and erazer.

b) Who is standing first in the lihe.

c)

15.2 Middle

a) Go and sit in the middle of

(any 3) and

b) c)

15.3 Last

a) Go and sit in the last chair.

(any4) ^b)

DEED

16. Follows left-right (all correct in 5 trials)

16.1 Left

a) Show your left hand 1) Who i5 sitting left to you

c) Show your left ear

16.2 Right

a) Show your right leg b) Show your right eye c) Who is sitting right to you

17. Follows sight words (any five)

a) DANGER b) TOILET

c) PULL d) EXIT

e) PUSH I) POISON

g) LADIES

h) ENQUIRY

i) GENTS

18. Arranges picture after listening to a story (any flue)

a) Brainy crow

b) Sour grapes c) Golden eggs

DEED

7

L_No

Ba,eline Ut Qr 2nd qr 3rd Qt 19. Follows traffic signs/signals (any flue)

a) What does Red light indicate?

b) What does Yellow light indicate?

c) What does Green light indicate?

d) What is a Speed breaker?

H H H H

20. Follows voting rights (all correct in 5 trials) a) Why do we have elections?

b) When do we have elections?

c) Who can vote in the elections?

d) Where to go for voting?

e) How to vote in the elections?

H fl H [II]

21. Imitates vowel sounds (all flue)

a) a b) e

d)o HHHH

22. Uses Yes/No by nodding of head.

fl H H H

23. Indicates basic needs by pointing or gesturing. (any flue)

Li Li [I I [ I

24. Speaks single words meaningfully (any five)

a) Akka b) Mama

HHHH

25. When asked tells own name.

H H [III H

26. Imitates sounds of animals & inanimate objects (any five)

a) Cat b) Cow

c) Dog d) Train

e) Lion

1) Automobile

H H H H

27. Uses two word phrases (any flue)

a) Mummy milk b) Daddy come

HHHH

28. Tells use of familiar objects (any five)

a) Chair b) Spoon

c) Doll

d) Pencil

HHHH

8

Item

DOMMN$/fl'EMS

Assessments

No. _BaaU. luIQr. 2n4Qy. IrdQr.

29. Describes action pictures (any ten)

a) Eating b) Skipping

c) Playing d) Combing

e) Bathing

1) Brushing

g) Sleeping h) Reading

U Studying j)

_Praying

)

DEED

30. Uses words to indicate commands (any flue)

31. Identifies sex (all correct in 5 trials)

DEED

a) Areyouaboyorgirl(incaseofboy)

Are you a girl or boy (in case of girl)

b) Is________ aboyoragirl(showaboy)

c) Is

_______

agirloraboy(Sliowagirl)

32. Identifies/names vehicles (any five)

DEED

[lIE [II LI

33. Identifies/names animals (any five).

a) _b)

c) d)

34. Identifies/names vegetables (any five).

DEED

ELIDE

35. Identifies/names fruits (any five).

36. Recites rhymes of atleast 3-4 lines.

DEED

37. Uses adjectives: (any ten)

37.1. Long-short a) Who has long hair in the class?

(any 3) b) Show me the shortest person in the class?

c)

9

Item

DOMAINS/ITEMS

Assessments

L._No.

^— Ba..fln.lstQr. 2r,dQr.

37.2. Rough-smooth a) Give me the rough paper out (any 3) ofthe two papers.

b) Which of the piece of cloth is smooth.

c)

37.3. Clean-Dirty a) Show me which of these two

(any 4) handkerchiefs is dirty?

b) Show me which of these two gltsses of water is clean?

c) d)

38. Uses complex sentences (any flue)

DEED

39. Narrates simple jokes (any flue)

LII Li Li LII

40. Genies on simple conversation.

1—i

ri

I I

L

Total Raza Score Baseline !S Quarter HadQuartnr

mrd Crtor

i

Itin..

DOMAINS/ITEMS

. .—

_______________________________ ^BIine

1Qr..2nd:3,dqr.

READING-WRITING (RW)

NOTE :While assessingachildon this domain, theteachersho fidassess inCaptial/Smallletterdependingon what the particular child is more 'fiamitian with or exposed ta

- 1. Matches similar objects (any flue)

a) Akeytoakey b) Apentoapen

2. Matches objects to pictures_(anyflue)

LIED LI

3. Matches colours (any flue)

a) Red b) Blue

c) Green 6) Yellow

e)

4. Recognises his/her name. (correct in all 5trials)

5. Reads own name

DEED

6. Sorts pictures (any five)

DEED

Animals _a) b) c) d) e)

Fruits

a) b) c) 6) e)

Vehicles a) b) c) 6) e)

Vegetables a) b) c) 6) e)

fl Jj

7. Matches words (aay The)

a) Bat b) Mat

c) Cat

6) Rat

a) Hat

0 Mug

g) Rug

h)

11

Itea

DOMAINS/ITEMS

Asessmen$s

No

^{BsUnø aQr.ZudW $rdQt}

8. Identifies colours (any flue)

a)

^b)

LI LI LI] LI

9. Names colours (any flue)

a) b)

LI [1 LII LI

10. Identifies/readsprinted words (any flue)

a) ball bktube

C) plug ⁱⁱ⁾ fire

ELIDE

11. Identifies/eadsnames & parents (all correct in 5 trials)

DEED

12. Reads two-word phrases (any flue)

a) Thecat b) Myball

c)Abat

^d)

DEED

-13. Identifies/reads own address (ailcorrect inS trials)

14. Identifies/reads names of family members/friends (any flue)

DEED

15. Reads short sentences (any flue)

a) Thisisacat.

b) Thecatisonthe mat.

c) Putapeninthebox.

d) The monkey is sitting on the tree

DEED

12

Item DOMAINS/ITEMS

—

4nmeflts

₄

USfilt lEQi. SQ

16. Reads sign boards (any flue)

a) Hospital b) Police Station

c) School f) Hotel

c) Post office

g) Medical shop

d)Bank i0 LILJ[II[I1

17. Reads smell paragraphs (all three correctly with nw.xi mum of 10 errors)

a) Paragraph One

b) Paragraph Two c) Paragraph Three

18. Reads large print from magazines, newspapers, ett

19. Reads medium sized handwritten paragraphs.

DEED

(any three with maximum of 10 enors)

20. Reads short news item from a newspapers.

EDEE

DEED

21. Scribbles.

DEED

DOMAiNS/ITEMS Asesaments

Sit Qr. Qr. 4rd Qr 22. Traeee along a straight line.

DEED

23. Traces slang a circular object (2.3'd)

DEED

24. Traces alphabets of own name

25. Copies alphabets of own name

DEED

EEEE

14

Item

No.

or/ui - -- --

Ik.elin. ISQi.Assessment.!.dQF. 3idQ..i 26. Copies a straight line

27. Copies circle

DEED

28. Draws a line connecting 3 dots

IS

DEED

DEED

.it_...

no!AAPJSIITEMS Assessments I

No.

BQIj

29. Wiltee own name

30. Copies a square

31. Copiesa triangle

DEED

DEED

DEED

16

Na

Bn4Ius isQi 3MQr *dQZ- 32. Copies own address

DEED

33. Writes own address

DEED

34. Copies printed sentences (any five)

a) There are apples, mangoes and bananas in the basket.

b) What is the Capitai of India? Delhi is the Capital of India.

c) Hello! How are you? I am fine, thank you!

d)

17

• Rem

DOMAmSJnZMs

No. ^• _Bwllis laQn 2$Qt Si4Qr

35. Dictation of words (any five)

a)

b)

c)

d)

a)

36. Dictation of sentences (any five)

DEED

a)

b)

c)

d)

e)

37. Wijtes a letter.

DEED

DEED

IE

item

DOMAINS/ITEMS Assessments

Na

^{+ B.SUa. l*Qr.}

3t

Fills in an application.

[11 fl fi

39.. Composition (mini mum 40 words on any one topic maximum 3 errors permitted)

a) MyPet b)MyHome c)MySchool

fiDEL]

40. Writes a leave letter.

Thtal Raw Scan Baseline

let Quarter Iliad Quarter ifird Quarter DEED

Reading

^.

Writing

19

Item

DOMAINS ITEMS

—-

No,

Bu.lat lsQr. S1Qr. ntQn

NUMBERS-TIME (Th

NOTE For some of the Items in this domain, if the child uses his fingem/lines/objects as clues for calculation it should be scored as "dueth'. To score "Independent", the child should pass the required number of items given in the recordbooklet. In case the child is able to complete two sums independently andyet requires clues to complete the third sum, then the score Is given as 4 and not 5.

1. Rate counts 1-5.

E LI] [II] E

2 Separates one object from a group upon request.

& Discriminates between less and more.

[I]] fl

4. Matchesidentical number of concrete objects.

5. _Racogniseswritten numbers from 1-10.

8. Writes numbers one to ten

DEED

7. Picks up specified number of objects upto five.

a) 2 b) 5

d)3 LIDEE

8. Arranges muinber symbols sequentially from 1-5 in an order.

III] fl

9. Follows directions to fill upto half glass.

10. Adds single digit numbers within ten (any five)

a) 3 b) 4

+2 +3

20

..Iten.;..

;:

.DOMAINS/ITD4S..

... _______

c) 3 d) 5

+7 +0

e)

II.

Subtracts singledigitnumbers within ten (any flue)

DEED

a) ³ b)

6

-2 -4

c) 9

d) 4

-2

e)

12. Writesnumerals above ten ondictation (anyten)

DEED

1$. Doestwo digit additionswithout carry over (anyfive)

DEED

a) 44 b) 25

+22 i-62

01

•

Item

DOMAiNS/ITEMS

Assessments

NO.

.—

B...Ifn. 1ztQr 2adQr. SfdQir

c) 57

d) 40

+20 +36

5)

14. Doestwo digit subtractions without borrowing (anyflue)

DEED

a) 75 b) 36

- 23 -

24

c) 56

d) 84

-20 -60

e)

DEED

15. Does two digit additions with cany over (any flue)

a) 27 b) 39

+15 +28

-a-

c) 53

d) 89

+69

^{+ 17}

e)

DEED

16. Does two digit subtractions with borrowing (any flue)

a) 81 b) 64

-

25 - 47

22

::Zm DOMANS/>.:

No.

____

c) 70

d) 40

-27 -18

e)

17. identifies/names math symbols (any five)

c) .. b)-

^d)

x

e) = DEED

18. Measures liquid using measuring cups (all correct in three trials)

a) ^{1 litre}

b) 1/2 litre

c) 3/4 litre

d) 1/4 litre

[J fl [I]

19. Weighs objects using weighing scale (all correct in three trials)

a) 50gms b) lOOgms

c) 200 gins

20. Uses calculator for basic arithmetic operations.

E [II] E LI

21. Associates time/events to routine school activities

LI E LI]

22. Associates watch/clock with time

LI LI LI LI

23. Follows 'now', 'later', 'hurry', 'wait' (any ten)

23.1 Now a)

(any two) b)

23.2 Later a)

(any two) b)

23.3 Hurry a) (any three) b)

c)

23.4 Wait

a)

(any three) b)

24. Tells correctly if it is day or night (correct iii all 5 trials) a) Is it day or night?

b) Isitnightorday?

_LIII

LI LI LI

23

VIta

DoMAINsI1'flalS

Assessments

fln.rne letQr. zndQr.

25. Tells correctly if it is morning or evening (correct in all 5 trials) a) Is it morning or evening?

b) Is it evening or morning?

fl

^LIII!

[III] E

26. Follows yesterday, today and tomorrow (any^ten) 28.1 Yesterday a) What did you eat yesterday?

(any3) b)

c)

26.2

'1 sy a)Whatdidyoueattoday?

(anyS) b)

c)

26.3 Tommorow a)

(any4) b)

DEED

27. Tells horr and minute handA on the clock

[11 E E LIII

28. Names/i mtifies days of week (all coned)

a) Rote recitation

b) What comes after Thesday c) What comes after Saturday d) What comes before Wednesday a) What comes before Sunday 29. Counts by five's

DEED

30. Tells time by the hour (all correct)

a) 3'O (flock b) 12'O Clock

c) 9'O Clock d) 7'O Clock

a) O'O Clock fl

^1,0Clock

31. Tells own age in years

fl E fl

24

• Item

DOMAINS/ITEMS

Asseisment.

Ni.

^Badin. lMQr. 2ndqr. ISQr.

32. Names/identifies mouths of year (all correct)

a) Rote recitation

b) What comes after March c) What comes after December

d) What comes before September e) What comes before Januazy

33. Associates time with work routine (any flue) a) What time do you go to school?

b) What lime do you have your breakfast?

c) Wbattimedoyougotobed?

d) What time do you have your dinner?

34. Tells lime by quarter hour (all correct)

a) 2.30 b) 6.30

c) 12.15 d) 3.15

e) ^12.45 f) 9.45

[] [I] fl [J

35. Tells date of birth

II] fl

86. Tells day, date, month and year (all correct)

a) What day is today?

b) What is the date today?

c) What is the present month?

d) Whichyearlsgoingon?

37. Reads and uses a calender (correct in ailS thai.)

[J J] fl

38. Tells time to the minutes on the clock (any flue)

a) 11.12 b) 12.22.

c) 7.16

d) 4.25

39. Reminds on prefixed time

40. Sets watch to correct time (any flue)

a) 9.35 b) 2.18

c) 12.20 d) .7.12

e) 1.50

f) 3.48

E LI] [II]

Total Raw Score Baseline

lit Quarter llnd Quarter TUrd Quarter Numb en-

Time

25

:Me.!.n:. I ^1:1:

: I.DOMAJNS/ITEMa

::,.I

II:.

^::...

No. _Baseilne htQr 2ndQr SrdQr

DOMESTIC-SOCIAL (DS)

1. Keeps things at places when asked to LII)

H LII H

2. Collects waste and puts away in the waste paper basket

J) H [11111 H

3. Dusts/wipes table, chairs etc.

[

4. Waters plants

[I] [ J] [III

5. Folds own clothing

H H LII H

6. Sweeps floor using a broom

Li H [III LII]

7. Wets/mops floor

H LII [ii H

8. Serves eatables 9. Washes utensils

fl

H H U

10. Washes clothes

H H H H

11. Cuts vegetables

[ [II]

12. Lights a kerosene/gas stove 13. Prepares tea or coffee

J} [II

14. Prepares dough for chapati/puris

LII H H H

15. Prepares simple breakfast items

H H H H

16. Sews buttons

H LIII H H

17. Cooks rice or other food items

H [II H H

18. Prepares a cuny or sabji

H H H H

19. Irons own cotton clothes

H H H LII

20. Prepares a complete meal

H H H H

21. Responds with correct gesture when said ta-ta

H H H LIII]

22. Responds to own name by turning his/her head

H H H H

23. Identifies teacher by her name

H H H H

24. Goes inside school yard and comes back

H H H H

25. Shares food/toys with other children

H H H H

26. Greets others

H H H H

27. Seeks permission to go out

H H H H

F'.,

Item -

DOMAiNS/ITEMS

Asseasmenta

Na. . 8.ieia.e

in r. 2nd Qr. 3rj

28. Sings/dances with music

29. Offers help to teachers in classroom/school chores

U LI LII LI

30. Knows duties of various occupations (any flue)

a) Postman b) Milkman

c) Newspaper boy d) Policeman e) Doctor

31.

Waitsforhisturnwith4to5othercbildren LII LI LIII LI]

32. Plays with 4-5 children

LI LI LI LI

33. Comes and goes to school unattended when the

school is within the same neighbourhood

LI LI LI LI

34. Says 'please', and 'thank you'

LI LI LI LI

35. Introduces himself to others (any flue) a) What is you name?

b) How old are you?

c) Where do you stay?

d) What is your father\rnother's name?

e) What is the name of your school?

LI LI LI LI

36. Plays with children for 20 minutes in cooperative play/activity

LI LI LI LI

37. Can cross road

LI LI LI LI

38. Goes to home from school or vice versa outside his neighbourhood

LI LI LI LI

39. Receives and gives message taken on phone or in person

LI LI LI LI

40. Travels in a bus on own

LILILILI

Total Raw Score Baseline

1st Quarter Ibid Quarter ilIrd Quarter

Domestic-

Social

27

a

alias 1*Qi ZadQt *4Q) PRE-VOCATIONAL-MONEY (PIT)

1. Carries notice/messages from one classroom to another

[II] fl [II] U

2. Bnish paints

U LI LI] LI]

8. Uses a pencil sharpener

[II] LI fl [II]

4.

Sticks usinggumorglue [I] fl

5. Cuts simple shapes

U

6. Rings school bell on time

fl [I] fl LI

7. Clips using sappier

LI] LI] L] LI

8. Makes holes using punching machine

LI] LI [II LI

9. Stacks objects into groups

[II] LI] LI LI

10. Putsaway things in appropriate places after use

LI [II] [II] LI

11. Assemblessimilar objects of three to four sizes [III]

LI LI LI]

12. Nails and hangs a calender

13. Usesa screw driver to insert or remove screws

LI] LI] LI LI

no

NO.

Haste JM 2M*! IS

it

Tells date of National festivals (all correct)

a) Independence day

b) Republic day

c) Children's day

d) Gandhi Jayanthi fl LI

15.

8kesagarlandoffiOWer5us11lgth [] fl fl [III

16. Applies medicine on a cut

[1 fl [II] LI

17. Does simple hemming work

fl LI LI LI

18. Plants a sapling

LI fl [J fl

19. Tells names of impurtant people (all correct)

a) President b) Vice-Presidint c) Prime minister d) Governor

e) Chief minister

20. Wraps a gift box

LI LII [III [I]

21. Sorts coins from other similar metal objects

LI LI LI] LI

22. Aware that money can buy things

LI LI [I] LI

23. Keeps money safely

fl LI [1] LI

24. Selects a rupee note from other paper objects

fl [I] LI LI

25. Sorts out mixed coins (all correct) a) Isolates five 5 ps.coins b) Isolates five 10 pa coins

c) Isolates five 20 ps.coins d) Isolates five 25 pa coins e) Isolates five 50 ps. coins

1) isolates five 1.00 Re. coins

LI LI LI LI

26. Identifies/nameS all denominations of coins (all correct)

a) 5ps b) lOps

c) 2Ops d) 25ps

e) 5Ops 0 iRe LI LI LI LI

21. Identifies/names currency notes upto ten (all correct)

a) Re.1 b) Rs.2

c) Rs.5 d) is.1o LI LI LI LI

28. Rank orders coins

LI LI LI LI

29. Adds collects coins to make a rupee

LI LI LI LI

30. Makes purchases within 1 Re

LI LI LI LI

liens

DOMA1NS/rrEMS Asseasments

No. Balm. imQr- 2ndQr artQr.

31. Makes purchases within 1 Re. with correct change

32. Makes purchases upto Bs.2with correct change

fl

33. Knows transactional value for items below Rs.1O/-(anyflue)

a) Whatisthecostofapencil?

b) Whatisthecostofanotebook?

c)

d) a)

34. Calculates change upto 10 nipees

35. Makes purchases upto Rs.5 with correct change 38. Makes purchases upto RalO with correct change

DEED DEED DEED EEEE

37. Knows transactional value of items above Rs.1O/- (any flue)

38.

89.

40.

a) b) c) d) e)

Maintains account of money in a piggy bank Deposits money in a hank

Withdraws money from bank

EEEE DEED EEEE EEEE

Cumulative

Score

(All Domains) Totol Raw Score Baseline 1st Quarter find Quarter TUrd Quarter

Pr. vocational.

Money

Tots! Raw Score Baseline 1st Quarter

llnd Quarter Ilird Quarter

[Cumulative

Score

(All Domains)

30

Behavioural Assessment Scales for Indian Children r

^AuitIors:

with Mental Retardation, (BASIC-Mit) Part B UeetaFesMwarja, £ Venkatesanj

RECORD BOOKLET

Name of the student Age

Level/Class Sex

Dates:

Baseline Assessment Evaluated by

First Quarter Assessment Evaluated by Second Quarter Assessment Evaluated by Third Quarter Assement Evaluated by

Instructions

1. Eact item should be scored based on three levels of severity/frequencey of problem behaviours, i.e., Never (N), Occasionally (0) and Frequently (F). Score 0 for "Never", I for "Occasionally" and 2 for "Frequently".

2. Enter the appropriate numerical score against each item for the child, depending on the severity/frequency of the problem behaviourin question, and inthe appropriate box, i.e., baseline, first quarter assessment, second quarter assessment and/or third quarter assessment

3. Add the total problem behaviour raw score and enter it in the profile sheet of BASIC-MB, Part-B.

Item No.

DOMAINS/ITEMS

Assessments

BgseIb,. 1*Qr 2tdQr idQr

Violent

and Destructive Behaviour

1. Kicks others 2. Pushes others

3. Pinches others

fl [11 fl

4. Pulls hair, ear, body parts of others

5. Slaps others

fl [II] fl

6. Hits others

[III fl [11 [1

7. Spits on others LII]

fl LI LI

8. Bangsobjects

LI LI LI [III]

9. Slamsdoors

fl [II]

10. Bitesothers

Ii.

^Attacksor pokes others with weapon (blade, stick, pencil)

12. Throws objects at others

•

NIMLI. Secunderabad 1922

51

13. Tears/pulls threads from own or others

clothing

LILII[I]LJ

14. Tears up own or others books, papers, magazines

15. Breaks objects/glass/toys

fl LII] LII E

16. Damages furniture

[I] fl

Temper

Tantrums

17. Cries excessively

E [III

1& Screams

19. Stamps feet

fl [j fl

20. Rolls on floor

fl [J fl [III]

Misbehaves

with others

21. Pulls objects from others

E LI] fl

22. Interruptsin between when others are

tsThing

[IEEE

23. Makes loud noise when others are working or reading

24. Makes face to tease others

[I [I [I [III

25. Uses abusive/vulgar language

[I [I [I] [I

26. Takes others possession without their permission openly

27. Tells others what to do and wants

his/herway (bossy)

[I [I LII [I

Self

Injurious behaviours

28. Bangs head

[I [I LI] [I

29. Bites self

[I [I [I [I

30. Cuts or mutilates self

31.

Pullsownhair

[III]

[I [III [I

32. Scratches self _[III]

[I LI] [I

33.

Eteseff [IEEE

34. Puts objects into eyes/nose/ear

[I [I [I LI]

35. Eats inedible things

[I [I [I [I

32

L

^Saudis. 1MQr 2ndRr SrdQk

36. Peels skin/wounds

[1 fl

37. Bites nail

Repetitive behaviours

3t

Rocisbody

DEED

39. Nods head

E LII] [II] E

40. Sucks thumb

E [III E E

41. Makes peculiar sounds

LII E LI LI

42. Bites ends of pen/pencil

LII LI LII LII

43. Shakes parts of the body repeatedly

fl LIII LII LI

44. Grinds teeth

[II] LII LI LI

45. Swings round and round

LII LI LIII LI

Odd

behaviours

46. Laughs to self

[II LI LI LI

47. Laughs inappropriately

LI LI] LI [III]

48. Talks to self

[J fl LII]

49. Hoards unwanted objects (sticks, thread,

pieces of old clothes)

LI LII [III] LI

50. Picks nose

LI [II] LI LI

51. Plays with unwanted objects like chappal, strings, faeces and dirt excessively 52. Kisses, hugs, and licks people

unnecessarily

53. Smells objects

LII [III LII [1111]

Hyperactivity

54. Does not sit at one place for required time

fl LII LI

55. Does not pay attention to what is told

fl LII LI

56. Does not continue with the task at hand

for required time

[ LI

Rebellious

behaviours

57. Refuses to obey commands

[II LII LI LII

58. Does opposite of what is requested

[J

33

item No. DOl%fAfNs/rm Assessments

HM.**1*QI pidQr. SMQn

59. Takes very long time intentionally to complete a task

60. Wanders outside school 61. Runs away from school 62. Argues without purpose

Antisocial behaviours

63.

advantage or blames otters

64. Cheats in games or no sense of ir play 65. Steals

66. Makes obscene gestures

DEED

fl LI]

67. Exposes body parts inappropriately 68. Makes sexual advances towards

members of opposite sex

69. Touches own private parts in public 70. Touches others private parts in public

fl [I]

71. Gambles

Fears

72. Fear of objects

fl fl

73. Fear of animals

74. Fear of places

fl J] fl

75. Fear of persons

fl [I] fl

Anyothers:

LII]

E E [III]

Tota!Rczw Score Baseline

Ist Quarter find Quarter Ifird Quarter [Cumulative

Score

Domains)

34

Appendir BEHAVIOURAL PROFILE ON BASIC-MR. PART -

^A

Name of the student V.5. F?AV/ Level/Class Date/s Evaluatedby Date/s ^Evaluatedby

Age ^:

Ja E ARS

Baseline Assessment Second Quarter Assessment

Sex

rstQuarterAssessmeni

ThirdQuarterAssessment

t.33.

^MrSARQtJ

ItemNo. 12 4 5 6 7 8 91011121314151617181920

^ItemNo.

2l2z23iiz62728293O313233343536338394O

Motor

scS5cscsssS333aSi

^{1 I Motor I I}

AD!.

5 3

^C

(S 5 5

³

5 S 5 5 ' 3

^{S S S ADL}

S

^5'

52 S 5

^S

rs

^{. S S}

4ç

^{/ .3}

i

^2.

/ o

Language:

Receptive

! i I PI ! ! £ I I I E

^.

2

^.

1 £ L L

^{Language:Expressive}

.f I I I !

^.E

11 1 1 IS I I 1±

Reading

I ! II 1 .1 5 1 5 1 ! L .. I L L L

^{Wrifing S}

511

⁵

if cc

^{5' 5'}

L A I

Numbcr

s c .c cs s s r 5 5 '1 S

^I

I

^I I I

-

^—

-

_Time

.r

^5' 5_S 5'

3. 3• 5'!

¹

/ 33

^"

'

^'

i - -

Domestic 3

3

3

S'I

^I

I

I F Social S

c gs

^{g .c}

s .'s'

^{.c 5'}

c' c

^s'

ci f /

^I

Pre-VocationalS 5'

32 /

^..

/ , -

Scoring Key:lndependent:5 -Clueing:4 - Verbal prompting:3 GRAPHIC-PROFILE

BASELINE TRAINING

C ₁₀₀

m e 80

:—=°

I 20

-

^—

v

S

IQr. jlQr. ^lIlQr.

(Key:RS-Riw Score:Qr.-Quarter)

Money

55' g5ç 3.

-Phyuical pronting:2 - Totally dependent:I - Not

DOMIAN

KS %

Motor

37j.(

ADL

IS'17?.g —

ifing iJoS

Number-Time

— '8

L17

Domestic-Social

7 3.5'

Pre vocational-Money

5q. 2.7

TOTAL

82 S%Z/

31 1 / / / -

applic.ble:0

Second

Qr. rdQ

KS %

^{KS %}

KS %

/907o 14O 70 '47Z.

/O

^ab

Ut 8, /63 RIS

loS

52S

107

;;fH 11± a..

Ia i1S 3. 9 iS"

£L 31 S 32.g 77 385

Qj .f flo 2$ V&

_\

35

Appendix i

BEHAVIOURAL PROFILE ON BASIC-MR. PART - A

Date/s Evaluated by

kenNo.

Motor ADL Language:

Writini Time

Social Name ofthe student

Age Sex

56

Level/Class Baseline Assessment First Quarter Assessment

Date/s Second Quarter Assessment ________

Third Quarter

Assessment ______

27

Evaluated by

BASELINE

Scoring Key : Independent:5 - Ctueing:4 - Verbal prompting:3 - Physical prompting:2 -Totsity dependent:1 - Not .pplicable:0 Baseline First Qr.

GRAPHIC PROFILE

— —

RS %

RS %

TRAINING

C ₁₀₀

m a 80 uP

7oo • ° 40

t ^ri

I t ²⁰

VI

₀

a

S I Qr. llQr. IIIQr.

ItS - Raw Score : Qr.

36

Appendix ii

BEHAVIOURAL PROFILE ON BASIC-MR. FART - B

Nameof the student

V £'-

KM/) Level/Class ^CEeZJ%JtØ(SI _Date/s Evaluated by ^Date/s Evaluated by

Age ^ii. ?t..v ^{BaselineAssessment} Second Quarter Assessment

Sex MALE FirstQuarterAssessment Third QuarterAssessment

2.3.

^¶).

ir .-Qv"a

blent and Destructive Behaviours Temper Tantrums Misbehaves with others Self injurious Behaviours Repetitive Behaviours

1 2 3 4 5 6 7 8 9

Oovooo

^ô

00

10 11

oa

12

O

13 0

14 15

Oc

16 17

C' 18

0

19 2O21 22f23 0

cIa oiv

24

0 25

0

26 27 282

0 0 00

930

0

31 3233

00 b

343 3839404142434445

coijJoo oool cO

J II!

H

Odd Behaviours Hyperactive 4748

00

49

C'

50

ty

5152 53 0

54 0

55

0

56

Scring K : Never (N) :0; Occasionally (0): 1; Frequen4ly (F) : 2

GRAPHIC PROFILE CUMULATIVE SCORES

C

:

p

C

ioo so

BASELINE TRAINING

ASSESSMENT RAW SCORES CUMULATIV1

PERCENTAGES

!t-67

BASELINE

lb

60

— —

.

IIlQr.

• I

t ri 40

FIASTQUARTER H-f

9-3

• 9

:

20

SECOND QUARTER 0 0

0_

BASELINE

.

IQr.

Ilir.

THIRD OUARTER

3-30

37

Appegdfr II

JAVIOURAL PROFILE ON BASIC-MR.

PART

- B

Name

of

thestudent Level/Class Date/s Evaluated by Date/s Evaluated by

Age Baseline Assessmern cond Quartet Assessment

Sex FirstQuarter Assessment Third_QuarterAssessment

iolent

and Destructive Behaviour Temper Tantrums ^Misbehaves with others Self injurious Behaviours Repetitive Behaviours

I

23

45 67 8 9lOl1

1213 141516 17 18 19 2021 22 23 24 25 26

27 28293O3132333435 36

373839h0'4142434445

I

—

I —

— — — — —

GRAPHIC PROFILE CUMULATIVE SCORES

C

: :

p

• .

n

•O

S

,

BASELINE too

60 20 o

BASEUNC _{11 Qr.}

TRAININD

Ill Qr.

I ASSESSMENT _{RAW SCORES} CUMULATIVE

PERCENTAGES BASELINE

FIRST QUARTER SECOND QUARTER

I Qr. THIRD QUARTER

38