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About
Elements
Affiliates
Soul Spin
Social
February Behavior Rating
Please rate the child's behavior during the month of February. Thanks for your time!
Child Name
*
First Name
Last Name
Your Name (Adult)
*
First Name
Last Name
Overall Behavior
Change over past month? (Overall Behavior)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Overall Behavior)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Physical Aggression
Fighting, hitting, pulling, grabbing
Change over past month? (Physical Aggression)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Physical Aggression)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Verbal Aggression
Yelling, calling names, arguing, teasing
Change over past month? (Verbal Aggression)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Verbal Aggression)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Noncompliance
Not folloing directions, ignoring distractions, refusing, talking his/her way out of something
Change over past month? (Noncompliance)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Noncompliance)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Social Interaction
Making & keeping friends, getting along, sharing, playing nicely, able to have conversation with others
Change over past month? (Social Interaction)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Social Interaction)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Emotional Health & Regulation
Happy, can express feelings, can calm self down, can manage anger
Change over past month? (Emotional Health & Regulation)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Emotional Health & Regulation)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Classroom/Home Expectations
Following routines & procedures, paying attention, leaving things organized
Note: Only rate behavior in the environments you directly observe. For example, if you are a teacher, rate behavior at school. If you are a family member, rate behavior at home.
Change over past month? (Classroom/Home Expectations)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Classroom/Home Expectations)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Self-Management & Self-Control
Thinks things through before acting, sets goals, makes plans & follows through
Change over past month? (Self-Management & Self-Control)
*
Much better
Better
Same
Worse
Much Worse
How often did problems occur? (Self-Management & Self-Control)
*
Never
Infrequently
Sometimes
Often
Always/Almost Always
Are there any new problem behaviors or concerns? (optional)
Is there anything else you'd like us to know? (optional)
Thank you!