AUTISM SOCIAL SKILLS PROFILE - Connecticut

1 AUTISM SOCIAL SKILLS PROFILE . Name: _____. First Middle Last Birthday:_____ Age:_____ Sex: Female Male Today's Date:_____. Mo. Day Year Mo. Day Year Relationship: Mother Father Guardian Other _____. Street Address: _____. City: _____ State: _____ Zip: _____. Phone: ( ) _____. The following phrases describe SKILLS or behaviors that the individual might exhibit during SOCIAL interactions or in SOCIAL situations. Please rate HOW OFTEN the individual exhibits each skill or behavior independently, without assistance from others ( , without reminders, cueing and/or prompting). You should base your judgment on your behavior over the last 3 months. Please use the following guidelines to rate your behavior: Circle N if the individual never or almost never exhibit the skill or behavior.

2 Circle S if the individual sometimes or occasionally exhibit the skill or behavior. Circle O if the individual often or typically exhibit the skill or behavior. Circle V if the individual very often or always exhibit the skill or behavior. Please do not skip any items. If you are unsure of an item, please provide your best estimate. You may use the Brief Description section to provide additional information on the particular skill or behavior. For instance, if the individual exhibits a particular skill or behavior more frequently when cueing or prompting is provided, or when interacting with adults rather than peers, please make a note of this in the Brief Description section. Scott Bellini Page 1 of 5. AUTISM SOCIAL SKILLS PROFILE . Never Sometimes Often Very Often N S O V.

3 Skill Area How Often Brief Description Invites peers to join him/her N S O V. in activities 1 2 3 4. Joins in activities with peers N S O V. 1 2 3 4. Takes turns during games and N S O V. activities 1 2 3 4. Maintains personal hygiene N S O V. 1 2 3 4. Interacts with peers during N S O V. unstructured activities 1 2 3 4. Interacts with peers during N S O V. structured activities 1 2 3 4. Asks questions to request N S O V. information about a person 1 2 3 4. Asks questions to request N S O V. information on a topic 1 2 3 4. Engages in one-on-one SOCIAL N S O V. interactions with peers 1 2 3 4. Interacts with groups of peers N S O V. 1 2 3 4. Maintains the give-and-take N S O V. of conversations 1 2 3 4. Express sympathy for others N S O V. 1 2 3 4. Talks about or acknowledges N S O V.

4 The interests of others 1 2 3 4. Scott Bellini Page 2 of 5. AUTISM SOCIAL SKILLS PROFILE . Never Sometimes Often Very Often N S O V. Skill Area How Often Brief Description Recognizes the facial N S O V. expression of others 1 2 3 4. Recognizes the nonverbal N S O V. cues, or body language of 1 2 3 4. others Requests assistance from N S O V. others 1 2 3 4. Understands the joke or humor N S O V. of others 1 2 3 4. Maintains eye contact during N S O V. conversations 1 2 3 4. Maintains an appropriate N S O V. distance when interacting with 1 2 3 4. peers Speaks with an appropriate N S O V. volume in conversations 1 2 3 4. Considers multiple viewpoints N S O V. 1 2 3 4. Offers assistance to others N S O V. 1 2 3 4. Verbally expressed how he/she N S O V. is feeling 1 2 3 4.

5 Responds to greetings of N S O V. others 1 2 3 4. Joins in a conversation with N S O V. two or more people without 1 2 3 4. interrupting Initiates greetings with others N S O V. 1 2 3 4. Scott Bellini Page 3 of 5. AUTISM SOCIAL SKILLS PROFILE . Never Sometimes Often Very Often N S O V. Skill Area How Often Brief Description Provides compliments to N S O V. others 1 2 3 4. Introduces self to others N S O V. 1 2 3 4. Politely/asks others to move N S O V. our of his/her way 1 2 3 4. Acknowledges the N S O V. compliments directed at 1 2 3 4. him/her by others Allows peers to join him/her in N S O V. activities 1 2 3 4. Responds to the invitations of N S O V. peers to join them in activities 1 2 3 4. Allows others to assist him/her N S O V. with tasks 1 2 3 4. Responds to questions directed N S O V.

6 At him/her by others 1 2 3 4. Experiences positive peer N S O V. interactions 1 2 3 4. Compromises during N S O V. disagreements with others 1 2 3 4. Responds slowly in N S O V. conversations 1 2 3 4. Changes the topic of N S O V. conversation to fit self- 1 2 3 4. interests Misinterprets the intentions of N S O V. others 1 2 3 4. Scott Bellini Page 4 of 5. AUTISM SOCIAL SKILLS PROFILE . Never Sometimes Often Very Often N S O V. Skill Area How Often Brief Description Makes inappropriate N S O V. comments 1 2 3 4. Engages in solitary interests N S O V. and hobbies 1 2 3 4. Ends conversations abruptly N S O V. 1 2 3 4. Fails to read cues to terminate N S O V. conversations 1 2 3 4. Exhibits fear or anxiety N S O V. regarding SOCIAL interactions 1 2 3 4. Experiences negative peer N S O V.

7 Interactions 1 2 3 4. Engages in socially N S O V. inappropriate behaviors 1 2 3 4. Exhibits poor timing with N S O V. his/her SOCIAL initiations 1 2 3 4. Is manipulated by peers N S O V. 1 2 3 4. Engages in solitary activities N S O V. in the presence of peers 1 2 3 4. N S O V. 1 2 3 4. N S O V. 1 2 3 4. N S O V. 1 2 3 4. Scott Bellini Page 5 of 5.