Beruflich Dokumente
Kultur Dokumente
AND
Sara S . Sparrow, David A . Balla, and Domenic V . Cicchetti
A revision of the Vineland Social Maturity Scale by Edgar A . Doll
CLASSROOM EDITION
Questionnaire
Booklet
ABOUT THE CHILD : ABOUT THE TEACHER:
For the Person Scoring and Interpreting : For reference when computing the scores, the highest possible
total is printed in the upper right corner of each subdomain raw score box .
ITEM SCORES
2-Yes, usually
1-Sometimes or partially
0-No, never
OMMUNICATION
OMAIN
ECF
1 . Demonstrates understanding of the 1 . Imitates sounds of adults within a few
meaning of "no" (for example, stops an seconds after hearing them . (For example,
ongoing activity or indicates knowledge the child says "buh-buh," "ma-ma," or
that it should stop) . "wa-wa ." If the child says words,
17 . States telephone number when asked . way, without assistance . (For example, the
(The area code is not required for a child says, "She's a nice person . . . I
mean cheerful, happy, friendly .") 2 1
score of 2 .)
COMMUNICATION
DOMAIN 14 . Uses the index in reading materials .
(The child must have used an index
independently at least twice to score 2 .)
1 . Recites all letters of the alphabet from
memory . (Letters may be in or out of
sequence . If the child sings the "ABC
song" but does not say the alphabet, 16 . Prints or writes at least 10 words
score 1 .) 2
from memory .
11 . Urinates in toilet or potty-chair . (If the 25 . Covers mouth and nose with hand,
child has only partial bladder control, tissue, or handkerchief when coughing or
score 1 .) sneezing .
Sum of 2s, 1 s, Os
26 . States current date (day of the week, The next item is on the following page .
month, date, and year) when asked . 1
Before going on, please determine that you
recorded a score for every item on this
page .
ITEM SCORES
2-Yes, usually
1-Sometimes or partially
Observed Observed
Performance O - No, never Performance
12 . Makes or buys small gifts for 1 . Plays with toy or other object alone or
caregiver, family member, or other familiar with others .
person on major holidays, on own
2 2 . Uses common household objects for
initiative .
play (for example, pots, spoons, or
13 . Remembers birthdays or anniversaries cardboard boxes) .
of immediate family members and special
friends . (The child must keep track of the
occasion and greet the person 4 . Plays very simple interaction games
appropriately on that day, but need not with others (for example, peekaboo or
buy a gift .) 2
shaking hands) .
14 . Shows a relatively consistent 5 . Participates in at least one game or
preference for some friends over others . 2
activity with others (for example, tug-of-
war or ball) .
15 . Has a preferred friend of either sex . (If
the ages of the child and friend are more 6 . Engages in elaborate make-believe
than two years apart, score 0 .) 2
activities, alone or with others (for
example, playing school, or other activities
16 . Uas a best friend of the same sex .
with more than one role and more than
(The relationship must be reciprocal, If the
one step) .
child had such a friend in the past but
does not now, score 2 .) 2
7 . Plays more than one board or card
game requiring skill and decision making
17 . Has a fairly regular group of friends .
(for example, Rummy, Monopoly, checkers,
(If the child interacts with others only in a
or electronic games requiring skill) .
group arranged by another person,
score 0 .) 2
8 . Follows rules in simple games without
being reminded .
s
to score 2 .) 2 i0
14
Summary Observations to be Completed by the Teacher
What are the child's strengths?
Describe the child's performance (or lack of performance) of activities that were not included in the
questionnaire items .
List any activities included in questionnaire items that you believe the child can perform but does not
perform . If possible, give the reason the child does not perform the activity .
Additional comments
15
Vineland Adaptive Behavior Scales: Child's name
Position Sex
Standard Score
X=100, Band of Error Adaptive
SD= 15 % Nat'l Level Age
Raw Tables B .1 and Confidence %ile Rank Stanine Tables 8 .5 Equivalent
SUBDOMAIN Score B .2 Table B.3 Table 8 .4 Table 8 .4 and B.6 Tables B .7 and B .8
Receptive
Expressive
Written
Personal
Domestic
Communit
DAILY LIVING SKILLS DOMAIN SUM
Interpersonal Relationships
Play and Leisure Time
Coping Skills
COMMUNICATION
_ DOMAIN
DAILY LIVING SKILLS
DOMAIN
SOCIALIZATION 1111111111111111111111111111111111111111111111111111111111111111111111111111111 ~11111111111111111111111111111111111111111111 X1111111111111
DOMAIN
^MOTOR SKILLS -. 1111111111111111111111 1111111 11111 III 11 -~E of o n nu om uu
DOMAIN
BEEN
ADAPTIVE BEHAVIOR-
COMPOSITE
percentile rank: 1 2 5 9 16 25 37 50 63 75 84 91 95 98 99
n n
-5SD -4SD -3SD -2SD -1SD 1 MEAN ' ' +1SD ' +2SD ' +3SD +4SD
Recommendations
® ©1985, American Guidance Service, Inc ., 4201 Woodland Road, Circle Pines, Minnesota 55014-1796
All rights reserved . No part of this booklet may be photocopied or otherwise reproduced. Printed in the U.S .A.
For additional forms, call or write ACS, toll-free 1-800-328-2560 . Ask for item 3085 Vineland Record forms (25 per package) .
B 0 9 8 7 6 5 4
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Printed on
recycled paper