>BASC3 Cecil Reynolds, PhO. = Randy W. Kamphaus, PAO Chile's Name a Date Birth Date School Grade Child's Gender Dale Oremale Age Instructions ‘This forrn contains phrases that describe how children mey act. Please read each phrase and select the response that describes how ths child has behaved recently (inthe last several months). Select Nif the behavior never occurs Select $i the behavior sometimes occurs. Select O ifthe behavior often occurs Select Aif the behavior almost always occurs, Please mark every item. Ifyou don't know or are unsure of your response to an item, give your best estimate. A"Never"response does rot mean that the child “never” engages in a behavior, only that you have no knowledge oft occuring, 11 1ZABCOE Copyright © 2035 NCS Pearson, Ine. Allright reserved, Portions ofthis work cig Rating Scales Your Name Your Gender CiMale Female Your Relationship to Chiid Mother Cirather Ccuardian Dother Do you have concems about this child's (Vision? YN (b) Hearing? YN (© Eating habits? YN How to Mark Your Responses 2e certain to circle completely the letter you choot Ns@a If you wish to change a response, mark an X through itand circle your new choice, ike this NO@A Before starting, be sure to complete the information above these Instructions. @PsychCorp Previously published. Product Number 30820Sen ee ee) 1 Pays attention. NSOA 46, Iscateless with belongings NSOA 2. Makes postive comments about others... N-S.0.A 47, Adjusts wellto changes in family plans. NSOA 3. Disobeys. NSA 48. Isshywith other children NSOA 4, Iseasly upset. NSA 49. Complains of pain NSOA 5. Responds appropriately when asked a question NSO A 50, Teasesothers NSOA 6. Gatssick NSOA_ “51, fatsthings that are not food NSOR 7. Getsinto rouble NS.0.A 52, SaysTwanttodie" orl wish I were dead NSOA 8, Has good coping sil NSO A 53. Shows interest in others'ideas NSOA 9. Worries NSO A 54, Worries about what other children think NSOA 10._Avoids eye contact NS 0 A__ 55, Hurtsothers on purpose. NSOA T1. Has ashort attention span. NSO A "56, Tracks down information when needed NSOA 12, Acts confused, NSOA 57. Vomits. NSOA 13, Isa picky eater. NS.O.A 58, Confuses real with make-believe. NSOA 14, Says "please“and “thank your NSO A 59, Manipulates others, NSOA 15, Complains about health NSOA 60. sad NSOA TE Plans Wel ncn con NS OA 61, Answers telephone propery NSOA 17. Seems odd N-$.0.A 62, 1s qood a getting people to work together NSOA 18, Isa"selstarter: NSO A 63, Expresses fear of getting sick NSOA 18. Has tolleting accidents N-S.0.A 64, Has trouble fastening buttons on clothing. NSOA 20._Says."Ithink ti sick” NSOA_ 65. Iscrueltoanimals NSOA 21. Is fearful NSO A 66, Needs tobe reminded to brush teeth NSOA 22, Makes healthy food choices. NSO. A 67, Worries about what parents think. NSOA 23, Lies. NSO A 68, Breaks the ules. NSOA 24, Acts without thinking NSO.A 69, Hasdificuty explaining rules of games to others... NSO A 25, Finds faut with everything NS OA _ 70, Getsangry easly. NSOA 26, Loves control when angry NS OA 71, Takesa step-by-step approach to work NSOA 27. Has rouble following regular routines. NS.0.A 72, Fallsdown or trips over things easily NSOA 28, Listens to directions N-S.O.A 73, Has poor self-control, NSOA 29. Is usually chosen asa leader. N-S.0.A 74, Breaks the rules ust to see what wil happen. NSOA 30, Engages in repetitive movements NS OA _75. Sleepswith parents NSOA 31. Appears tense NSO A 76, Communicates clearly NSOR 32. Isoverty active. NSA 77. Compliments others. NSOA 33. Accurately takes down messages NSA 78, Hasheadaches. NSOAR 34, ties easly NSOA 79, Reacts negative, NSOA 35, Threatens to hurt others. NS 0 A__ 80, Says,"Idonit have any friends". NSOA 136, Avoids exercise or other physical activity WS OA ~ 61, Seems out of touch with realty. NSOA 237, Sets realistic gals, NSOA a2. Wersbed NSOA 38, Worries about things that cannot be changed, NSOA 43. Listens carefully. NSOA 39. Complains of being sick when nothing is wrong NSOA 64, Isnewvous NSOA 40, Changes moods quicky NS 0 A__ 85, Has touble getting information when needed. NSOA “i, Throws or breaks things when any. NS OA ~86, Accepts things as they re NSOA 42. Interrupt athers when they are speaking NSO. 87, Quicklyjoins group activites. NSOA 43, Deceives others NSOA 88, Staresbianky, NSOA 44, Overteacs to stressful tuations. NSOA 89, Setsfires NSOA 45,_Says,"Lhate myself NSO A _ 90. Cleansup after sel NSOA91. Is easily distracted 136, Has panic attacks NSOA NSOA 92. Recovers quckl after a setback NS.0.A 137, Offershelp to other children, NSoA 93, Fiddles with things while at meals NS.0.A 138. Isoverly emotional NSOA 94, Puts others down, NSO. A 139, Shows basic emotions clear NSOAR 9. Finds ways to solve problems NS OA 140, Hasseiaures NSOA 96. Avoids other chien. WS OA ‘Tat, Lestogetoutor woul NSOR 97. Makes others feel welcome. NSO A 142, Makes decisions cally. NSOA 98. Hits other children, NSO A 143, Adjusts wel to new teachers NSOA 99. 's inconstant motion. NSOA 144, Steals NSOA 100, Seems lonely. NS.0.A_ 145. Does strange things. NSOA TOT. is shy with adults NS OA 146, lsoverly aggresive -NSOR 102. Likes to talk about his or her day. NSOA 147, Iseasily stressed, NSOA 103. Adjusts wellto changes in routine, N50 A 148. Isclearwhen telling about personal experiences... NS OA 104, Says, “t's all my faut NSO. A 149, Organizes chores or other tasks wel -NSOR 105, Has fevers. NSO A150, Tellslies about others. -NSOA 106. Getsbackat others. SOA 151, Isunabletoslow dow: NSOA 107, Worries about what teachers think NSO A 152, Seems unaware of others. NSOA 108, Picks on athers who are diferent from his or herself... NS © A 153, Acts in safe manner NSOA 108. ‘tarts conversations NS.0.A 154, Encourages others to do their best NSOA 0. | negative about things. NSO A 155, Prefersto be leader NSOA TIT. Has trouble making new fends NS OA 156, Avoids making fiends NSOA 112, Says, "Tm not very good at this" NSA 157, Babbles 0 elt NSOA 113, Ties tohelp others be ther best NSA 158, Speech is confused or disorganized. NSOA 114. Disrupts other children activities. N-S.0.A 159, Interrupts parents when they aretalking on the phone, NS O A IS. Acts strangely. NSA 160, Says,Tmafraid | wil make a mistake NSOA 16. Says Tcan't do anything right NS OA 61, fafadof geting sick NSOA 117. Bullies others, NS.0.A 162. Runsaway from home. NSOA 118 Complains of physical problems. NS.0.A 163, Makes fiends easy NSOA 119, Islrtable N-S.0.A 168, Sneaks around. NSOA 120._Gives good suggestions for solving problems. NS.0.A 165. [sable to descibe felings accurately NSOA T21._ Argues wien denied own way, NSO A 166, Actsout of contol NSOR 122. Says things that make no sense. N-S.0.A 167. Shows feelings that do not fit the situation NSOA 123. Overcomes problems. N50 A 168. Isunclear when presenting ides. NSOA 124. Says,"Iwant to kil myst. NSOA 168. Iscesilent NSO 125, Acts a f other children are not there. NS 0A 170, Prefersto play alone, NSOA 126, solate self from others. WSOA W171, Does weird things NSOA 127. Pays attention when being spoken to. NSA 172, Cannot wait to take tun NSOA 128, Worries about making mistakes NSA 173, Ishighly motivated to succeed. NSOA 128, Says,"Nobody likes me! NSO A 174 Congatutesctherswhen good tings BOE" 6 gg 130, Handles winning and losing well MISO ee eereaeeeeea NSOA 137. Throws up after eating 132. Complains f stomach pain 133, 134. Accepts people who ae different from his or herself Iseasy to please, 135,_{s easily calmed when angry z2 2 NSOAR NSOA NSOA Please complete the General Comments on the back page.