OBJECTIVE: To assess the child self-help skills in home setting.

Rating Scale
Self-help Skills Mastery/ Performance
With With minimal With very Without
Support Support minimal Support Support
Opens a lunch box
Uses spoon and fork to feed
him/herself
Drink water in a glass
Drink water in a bottle
Opens lunch boxes, zip lock
bags, food packaging
Button his/her dress
Unbutton his/her dress
Takes bath or shower
Brushes teeth
Wears clothes
Ties shoes
Trims fingernails / toenails
Folds clothes neatly

Anecdotal Record
Description Interpretation
OBJECTIVE: To evaluate whether one child has the social skill needed to interact appropriately with adults.

Checklist
Social skills with without
smiles spontaneously
Say “Please”
Say “Hello’
Say “Thank You”
Say “goodbye”
Use fleeting eye contacts
Responds appropriately when asked to change their behavior
ask for clarification if they are confused or if the situation is unclear to them.
able to understand different tones of voice or read facial cues.
Talk with unusual speed, stress, rhythm, intonation, pitch and/or tone of voice.
Respond to jokes
ask appropriate questions.
understand the consequences of their actions.
adjust or modify their language appropriately according to the communication
situation.
able to imagine what it is like to be somebody else or in their situation
Show interest in what the other person has to say.
Use eye contact or stares at fixedly.

Anecdotal Record
Description Interpretation
OBJECTIVE: To analyze the types of play of a particular child and which type are most common with.

Time Sampling Record

Time Duration Types of play Description
0-5 minutes
5-10 minutes
10-15 minutes
15-20 minutes
20-25 minutes
25-30 minutes

Anecdotal Record
Description Interpretation
OBJECTIVE: To identify and interpret behaviors that are link to emotions.

TIME SAMPLING
Time Emotions Behavior Description
0-5 mins. Ex: happy Punches anyone
around
5-10 mins. Ex: sad Cry out loud
10-15 mins. Ex: anger Eat the lunch of
others
15-20 mins.
25-30 mins.
35-40 mins.

Anecdotal Record
Description Interpretation
OBJECTIVE: To identify which people one child interacts with and how often.

SOCIOGRAM:

father
mother brother

Child
Aunt sister

crush friend
Anecdotal:

Anecdotal record
Description Interpretation
Child & Father
EXAMPLES: EXAMPLES:
The child asked questions to his father while his He is very curious in many tings and always like to
father was reading a newspaper at that time. have answers coming from his father
He tells about the movie that he watched last
Monday with his friends.
Then his father talks to him after reading the
newspaper.
Child & mother

Child & crush They both comfortable in talking with each other,
they can tell everything even secrets.
Child & aunt
Child & brother
OBJECTIVE: To identify signs of a child’s self-concept and factors that affects it.

Time Sampling Record

Time Duration Behavior Description
0-5 minutes
5-10 minutes
10-15 minutes
15-20 minutes
20-25 minutes
25-30 minutes

Anecdotal Record
Description Interpretation