Behavior Checklist

Student Name: __Harper_________Teacher _Allison Gerlach________

Please list positive behaviors or behavior strengths that the student displays:
- Confident: Is not afraid to be herself or voice her opinion
- Friendly: Will talk to anyone around her.
- Independent: Is happy playing on her own.
- Helpful: Is always willing to help the teacher or anyone in the class
who needs something.
- Thoughtful: Brings things that someone forgot outside to them.

Please select frequency in which the following behaviors are displayed in

your classroom:

Almost Never

Frequently
Occasionally
X First Observation
X Second Observation

Hyperactive:
Out of seat…………………………………………………………. X X
Constant movement in desk……………………………………….. XX
Can’t remain in line to and from classes…………………………... X X
Constant verbal behavior………………………………………….. XX
Has nervous muscle twitches, eye-blinking, nail-biting, etc. …….. X X

Withdrawn
Listless, tired………………………………………………………. XX
Seems generally unhappy…………………………………………. XX
Stares blankly into space…………………………………………... X X
Rarely asks for assistance even when work is too difficult……….. XX
Does not attempt work……………………………………………. XX
Apprehensive about committing self to a response……………….. XX
Weeps or cries without provocation………………………………. XX
Avoids calling attention to self……………………………………. XX
Almost Never

Frequently
Occasionally

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Poor Attention/Concentration
Does not follow oral lessons………………………………………. XX
Does not follow lessons on board or visual materials…………….. XX
Rarely completes any assignments………………………………... XX
Daydreams………………………………………………………… XX
Demands individual explanation of assignments…………………. XX
Easily distracted from task by ordinary classroom stimuli (minor XX
movement, noises)…………………………………………………

Aggressive
Attacks other children by hitting, shoving, etc……………………. XX
Verbally attacks and provokes other children…………………….. XX
Steals………………………………………………………………. XX
Explosive or angry when things do not go own way……………… XX
Argues with the teacher over behavior……………………………. XX
Destructive of others’ belongings and schoolwork……………….. XX
Strikes back with angry behavior to teasing………………………. XX

Disruptive
Demands attention of any sort from teacher and peers……………. XX
Doesn’t follow class or school rules (quiet, on time, etc)…………. X X
Interrupts lessons by antics (verbal or physical)…………………... XX
Tells bizarre stories……………………………………………….. XX
Does not conform to limits on own without control from others…. XX

Uncooperative
Blames other for own mistakes……………………………………. XX
Will not follow routine……………………………………………. XX
Works only when threatened with punishment…………………… XX
Defiant of teacher’s requests………………………………………. XX
Argues with peers over minor situations………………………….. XX
Must have last word in arguments………………………………… XX

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 Almost Never

Frequently
Occasionally
Manipulative
Wants excessive visits to nurse……………………………………. XX
Wants excessive visits to the bathroom…………………………… XX
Works only when given individual help…………………………... XX
Blames mistakes on anything but self (size of book, your XX
directions, etc. )…………………………………………………….
Constantly puts self down or criticizes own work………………… XX
Tries to keep you off task by talking about other things, etc……… XX
Approaches new tasks, situation with “I can’t do it”……………… XX

Inappropriate Social Behavior

Comments that no one likes him/her………………………………. XX
Has no friends at school…………………………………………… XX
Does not like to go out for recesses……………………………….. X X
Does not initiate play or talk with peers…………………………... XX
Is avoided by peers at school……………………………………… XX
Personal appearance is lacking in cleanliness, order……………… XX
Does not function in group or class discussions…………………... XX
Ridicules peers, torments younger or smaller students……………. XX
Exhibits inappropriate behaviors in room (nose-picking, XX
masturbation, etc.)………………………………………………….

Comments:

Harper’s behavior was very similar between the two observations. She

displays moderate hyperactivity and disruptive behaviors with poor attention

and concentration. During the second observation, she was really tired so her

hyperactivity was not as extreme as the first observation. These similarities

tell me that it is possible that she has ADHD. She has most trouble with

behavior when she needs to stay still and pay close attention. Most of her

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disruptive behavior can be attributed to her hyperactivity, too. But, Harper is

pretty much never aggressive, uncooperative, manipulative, withdrawn or

inappropriate. She is amiable and loves to please her teachers and her peers.

Something huge that did change between my observations was her

desire to not go to the gym, where everyone plays for free time. The children

from all five of the day care classes go to the gym to run around before

lunch and nap time. It is very crowded and loud and there is seldom a day

where free time does not end with someone crying and someone else being

put in time put. On the first day of my observation, Harper was playing in

the gym happily with the other girls from her class when suddenly, she

became distressed and started yelling and covering her ears. The teacher

took her out of the gym to calm her down and after that she never wanted to

come back in. She says, “I don’t like free time, it hurts my ears” and she puts

up a big fight until one of the teachers concedes and lets her stay in the

classroom to help set up lunch. I think it is a logical conclusion to draw that

Harper does not like being in the gym because of the noise level and this

causes her to display “inappropriate social behavior”. I would not consider

her actions to be a result of social troubles however, more so sensory issues.