X Data Sheet Date: _______ 1.1.

X will maintain appropriate reciprocal play (goal 5 minutes): reciprocal play opportunity minutes appropriate reciprocal play Non-Preferred (N) or Preferred (P) maintained after 2 prompts: Activity: 1 2 3 4 5

1.2. X will initiate interactions with others: # observed during session: ______________________________________ 2.1. X is able to string words together (goal 5-7): X # of words spoken together per Encourage by caretaker and staff with: exchange: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Verbal Aggression: __________________________________________ Where What Safety: C C C C C I I I I I C C C C I I I I C I

2.2. X is able to increase receptive language skills:

X will follow 2 step directions. List # of prompts 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Yes/ No: Was X able to complete task?

2.3. X will communicate his wants and needs (Functional Language): # observed during session: ______________________________________ 3.1. X will comply with directives given by caretakers and staff: Directive given for specific task # of prompts required for task 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 3.3. X displayed physical aggression towards others: # observed during session: ______________________________________ 4.1. X displayed self-stimulatory behaviors (flapping, whirling in circles, high pitched noises, chewing on clothing, etc.): # observed during session: ______________________________________ 4.2. X displayed hypersensitivities (sensitive to noise): # observed during session: _____________________________________

4.3. X displayed unsafe behaviors: # observed during session: ______________________________________ 4.4 X will reduce perseverations: ____________________________________

What objects: Game, Ceiling Fan, Mirror, etc. ______________________ 4.5 X will display eye contact: 1. C I NR 2. C I NR 3. C I NR 4. C I NR 5. C I NR 6. C I NR 7. C I NR 8. C I NR 9. C I NR 10. C I NR

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

C C C C C C C C C C

I I I I I I I I I I

NR NR NR NR NR NR NR NR NR NR

4.6 Toileting: X was prompted to use the restroom: (# of times) ___________ X initiated using the restroom: (#of times) __________________ X had an accident: (# of times) __________c__________________