Abstract
Overview: This chapter covers Step A of the COMPASS Consultation Action Plan, which is conducted prior to the consultation. This information will inform the framework for the student’s personalized COMPASS profile.
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Authors and Affiliations
Appendices
Appendix A Consultant Assessment Checklist
It is necessary for the consultant to obtain information directly or indirectly about the child. Activities that are necessary and those that are recommended but not required are as follows:
Necessary Activities
-
A.
Gather most recent assessment information and provide the following details:
Area evaluated
Date of evaluation
Findings
Medical
Psychological
Receptive and expressive language
Fine and gross motor
Adaptive behavior
-
B.
Review current IEP for social, communication, and learning skill objectives and measurability of objectives (see Chap. 8 for more information on IEPs).
Domain
IEP objective
Social
Communication
Learning skills
Other
-
C.
Review videotape or conduct observation of student during a structured work activity in the classroom or with the consultant, observe how the student initiates and responds, communicates, and works independently.
Activity
Description and length
Observations
-
D.
Review videotape or conduct observation of the student during unstructured activities, such as free play, recess, and lunch and observe how the student initiates and responds, communicates with adults and peers and how they respond to him/her.
Activity
Description and length
Observations
Recommended But Not Required
-
A.
Conduct direct assessment of child’s developmental, adaptive behavior, and cognitive skills using standardized measures.
Assessment tool
Skills evaluated
Results and observations
-
B.
Conduct direct assessment of child’s social, communication, and learning skills from criterion-referenced measures or observation.
Assessment tool
Skills evaluated
Results and observations
Appendix B COMPASS Challenges and Supports Form for Caregivers and Teachers/Service Providers
Child’s/Student’s Name: _____________________________________________ Date: ______________
Your Name: _________________________________
Your Relationship to Child: _____________________
Likes, Strengths, Frustrations and Fears
The information you provide is vital in understanding how to build a competency model for your child/student.
Directions: Please list all the activities, objects, events, people, food, topics, or anything that is preferred by your child/student. These help identify ways to motivate and skills on which to build.
Directions: Please list and describe the fears and frustrations of your child/student. Please be specific about the situations in which these occur and the behavior your child/student shows.
Adaptive Skills
Directions: Please answer each item using the scale as it presently applies to your child/student, with “1” meaning “not at all a problem” and “4” meaning “very much a problem.” Add examples and notes as desired.
Self-management | Not at all | Very much | ||
Performing basic self-care independently (such as toileting, dressing, eating, using utensils) | 1 | 2 | 3 | 4 |
Entertaining self in free time | 1 | 2 | 3 | 4 |
Changing activities—transitioning | 1 | 2 | 3 | 4 |
Sleeping | 1 | 2 | 3 | 4 |
Responding to others | ||||
Following 1 or 2 step direction | 1 | 2 | 3 | 4 |
Accepting “no” | 1 | 2 | 3 | 4 |
Answering questions | 1 | 2 | 3 | 4 |
Accepting help | 1 | 2 | 3 | 4 |
Accepting correction | 1 | 2 | 3 | 4 |
Being quiet when required | 1 | 2 | 3 | 4 |
Understanding group behaviors | ||||
Coming when called to group | 1 | 2 | 3 | 4 |
Staying within certain places—lines, circles, chairs, desks | 1 | 2 | 3 | 4 |
Participating with the group | 1 | 2 | 3 | 4 |
Talking one at a time | 1 | 2 | 3 | 4 |
Picking up, cleaning up, straightening up, putting away | 1 | 2 | 3 | 4 |
Understanding community expectations | ||||
Understanding who is a stranger | 1 | 2 | 3 | 4 |
Going to places in the community (place of worship, stores, restaurants, malls, homes) | 1 | 2 | 3 | 4 |
Understanding safety (such as streets, seat belts) | 1 | 2 | 3 | 4 |
Managing transportation (Cars/buses) | 1 | 2 | 3 | 4 |
Problem Behaviors*
Directions: Please answer each item on the scale of 1–4 as it presently applies to your child/student, with “1” meaning “not at all a problem” and “4” meaning “very much a problem.”
Not at all | Very much | ||||
1. | Acting impulsively, without thinking | 1 | 2 | 3 | 4 |
2. | Hitting or hurting others | 1 | 2 | 3 | 4 |
3. | Damaging or breaking things that belong to others | 1 | 2 | 3 | 4 |
4. | Screaming or yelling | 1 | 2 | 3 | 4 |
5. | Having sudden mood changes | 1 | 2 | 3 | 4 |
6. | Having temper tantrums | 1 | 2 | 3 | 4 |
7. | Having a low frustration tolerance; becoming easily angered or upset | 1 | 2 | 3 | 4 |
8. | Crying easily | 1 | 2 | 3 | 4 |
9. | Being overly quiet, shy, or withdrawn | 1 | 2 | 3 | 4 |
10. | Acting sulky or sad | 1 | 2 | 3 | 4 |
11. | Being underactive or lacking in energy | 1 | 2 | 3 | 4 |
12. | Engaging in behaviors that may be distasteful to others, such as nose-picking or spitting | 1 | 2 | 3 | 4 |
13. | Touching him/herself inappropriately | 1 | 2 | 3 | 4 |
14. | Engaging in compulsive behaviors; repeating certain acts over and over | 1 | 2 | 3 | 4 |
15. | Hitting or hurting him/herself | 1 | 2 | 3 | 4 |
16. | Becoming overly upset when others touch or move his/her belongings | 1 | 2 | 3 | 4 |
17. | Laughing/giggling at inappropriate times | 1 | 2 | 3 | 4 |
18. | Ignoring or walking away from others during interactions or play | 1 | 2 | 3 | 4 |
19. | Touching others inappropriately | 1 | 2 | 3 | 4 |
20. | Engaging in unusual mannerisms such as hand-flapping or spinning | 1 | 2 | 3 | 4 |
21. | Having to play or do things in the same exact way each time | 1 | 2 | 3 | 4 |
22 | Having difficulty calming him/herself down when upset or excited | 1 | 2 | 3 | 4 |
23. | Other: _______________________________________ | 1 | 2 | 3 | 4 |
*Items are based on the Triad Social Skills Assessment
Add comments:
Social and Play Skills
Directions: Please rate the following statements on a scale of 1–4, with 1 meaning “not very well” and 4 meaning “very well.” Please answer each question first in terms of the child’s interactions with adults, and then with children.
How well does the child/student | With adults | With children | |||||||
Social awareness | Not Very well | Very well | Not Very well | Very well | |||||
1. | Look toward a person who is talking to him/her | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
2. | Accept others being close to him/her | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
3. | Watch people for extended periods of time | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
4. | Respond to another person’s approach by smiling or vocalizing | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
5. | Initiate interactions for social reasons | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
Joint attention skills | |||||||||
6. | Look at something another person points to | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
7. | Show something to a person and look for person’s reaction | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
8. | Point at an object or event to direct another person’s attention to share enjoyment | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
9. | Share smile by looking back and forth between object and person | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
Imitation | |||||||||
10. | Imitate sounds another person makes | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
11. | Imitate what another person does with an object (such as a person makes toy airplane fly, the child repeats action) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
12. | Imitate body movements of others (such as clap when others clap, play Simon Says) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
13. | Imitate and expand upon other’s actions with toys (such as peer beats drum, child beats drum and also starts to march) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
Play | Not Very well | Very well | Not Very well | Very well | |||||
14. | Take turns within familiar routines (such as rolls a ball back and forth) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
15. | Share toys | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
16. | Play interactively around a common theme | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
17. | Repair breakdowns during interactions (such as the child repeats or changes own behavior when other person seems confused or ignores) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
18. | Pretends to do something or be something (such as that a plate is a hat by putting it on, to be a policeman, to have a tea party, that a doll is a teacher) | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
Communication Skills
Directions: Please describe how your child/student lets you know the following communicative messages through words or actions. Indicate any method your child/student uses to indicate the message. For example, if s/he does not use words, but instead takes you by the hand to request juice, you would write that he takes you by the hand. If your child/student uses words, write what s/he says; or if a combination of ways are used, describe all ways.
Making Requests |
1. Food |
2. Objects |
3. An activity |
4. To use the toilet |
5. Attention |
6. Help |
7. To play |
8. Information |
9. A choice |
Expressing Refusals |
1. “Go away” |
2. “No, I won’t do it” or “I don’t want it” |
3. “I want to be finished” or “I want to stop doing this” |
Expressing Thoughts |
1. Greeting to others |
2. Comments about people/environment |
3. Confusion or “I don’t know” |
4. Comments about errors or things wrong |
5. Asks about past or future events |
6. Agreement |
Expressing Feelings |
1. Angry/mad/frustrated |
2. Pain/illness/hurt |
3. Happy/excited |
4. Hurt feelings/upset |
5. Afraid |
6. Sad |
Sensory Challenges
Directions: Please put a check before each statement that describes your child/student.
Sound/Auditory
□Has been diagnosed with hearing problem at some time | □Fails to listen or pay attention to what is said to him/her |
□Reacts to unexpected sounds | □Talks a great deal |
□Fears some noises | □Own talking interferes with listening |
□Distracted by certain sounds | □Overly sensitive to some sounds |
□Confused about direction of sounds | □Seeks out certain noises or sounds |
□Makes self-induced noises | □Other: _____________________________ |
Taste
□Has an eating problem | □Explores environment by tasting |
□Dislikes certain foods and textures | □Puts most things in his/her mouth |
□Will only eat a small variety of foods | □Constant chewing on something |
□Tastes/eats nonedibles | □Other:_____________________________ |
Sight/Vision
□Has trouble discriminating shapes, colors | □Excited by vistas and open spaces |
□Is sensitive to light—squints, wants to wear hats or sunglasses | □Hesitates going up or down stairs, curbs, or climbing equipment |
□Has trouble following with eyes | □Upset by things looking different (spills, spots) |
□Does not make much eye contact | □Makes decisions about food, clothing, objects by sight |
□Is distracted by some/too much visual stimuli | □Closely examines objects or hands |
□Becomes excited when confronted with a variety of visual stimuli | □Wants environment in certain order |
□Dislikes having eyes covered | □Other:_____________________________ |
Touch/Tactile
□Has to know someone is going to touch ahead of time | □Does not like showers or rain on self |
□Dislikes being held or cuddled | □Mouths objects or clothing |
□Seems irritated when touched or bumped by peers | □Refuses to walk on certain surfaces |
□Explores environment by touching objects | □Dislikes having hair, face, or mouth touched |
□Dislikes the feel of certain clothing | □Upset by sticky, gooey hands |
□Refuses to touch certain things | □Touches items with feet before hands |
□Over- or underdresses for the temperature or is unaware of temperature | □Does not like to hold hands |
□Pinches, bites, or hurts her- or himself |
Smell/Olfactory
□Sensitive to smells | □Ignores strong odors |
□Smells objects, food, people, toys more than usual | □Seeks out certain odors |
□Xplores environment by smelling | □Other:____________________________ |
□Reacts defensively to some smells |
Movement/Vestibular
□Seems fearful in space (teeter-totter, climbing) | □Appears clumsy, bumping into things and falling |
□Arches back when held or moved | □Avoids balance activities |
□Spins or whirls self around | □Does not like to be around people in motion |
□Moves parts of body a great deal | □Bumps into things and/or people |
□Walks on toes | □Other:____________________________ |
Visual/Perceptual Motor
□Has trouble with paper/pencil activities | □Has problems with use of some tools |
□Has difficulty with time perception | □Has problems organizing materials and moving them appropriately |
□Has difficulty with body in space, moving appropriately | □Is distracted by doors and cupboards being open, holes, or motion |
□Other:____________________________ |
Sensory Supports
Directions: Please put a check next to the item that pertains to your child/student.
Sound/Auditory
□Likes music | □Other: ______________________________ |
□Likes to sing and/or dance |
Taste
□Has definite eating preferences | □Other: ___________________________ |
Sight/Vision
□Enjoys watching moving things/bright objects | □Likes TV, VCR, videos |
□Enjoys patterns or shiny surfaces | □Likes the computer |
□Other: ___________________________ |
Touch/Tactile
□Likes to be touched | □Prefers certain textures of clothing |
□Likes hugs and cuddling when he/she initiates it | □Likes being rolled or sandwiched between blankets/cushions |
□Likes to play in water | □Likes rough and tumble play |
□Likes baths or swimming pools | □Other: ___________________________ |
□Seeks out mud, sand, clay to touch | |
□Prefers deep touching rather than soft |
Movement/Vestibular
□Enjoys rocking, swinging, spinning | □Likes to climb, seldom falls |
□Likes being tossed in the air | □Other: ___________________________ |
□Likes to run | |
□Likes and needs to move |
Visual/Perceptual Motor
□Relies on knowing location of furniture, stationary objects | □Other:___________________________ |
□Likes to draw and reproduce figures |
Learning Skills*
Directions: Please answer each item on the scale of 1–4 as it presently applies to your child/student’s level of independence, with “1” meaning “not at all” and “4” meaning “very much.”
Not at all | Very much | ||||
1. | Child clearly understands the end goal of an activity, recognizes what he/she must do to be finished, and persists on the task to completion | 1 | 2 | 3 | 4 |
2. | Child realizes when he/she is running into difficulty and has some way of letting the adult know he/she needs help | 1 | 2 | 3 | 4 |
3. | Once an activity is under way, the adult can walk away from the child and he/she will keep working until finished, maintaining at least fairly good attention to what he/she is doing | 1 | 2 | 3 | 4 |
4. | Child finishes work and remembers on his/her own to let the adult know (e.g., by bringing work to adult, calling adult, raising his/her hand) | 1 | 2 | 3 | 4 |
5. | Child looks forward to earning a reward, knows it’s next, works toward it, may ask for it or go get it on his/her own when work is finished | 1 | 2 | 3 | 4 |
6. | Child is able to wait briefly for a direction (anticipates that he/she is about to be asked to do something), is able to wait briefly for his/her turn with a toy (anticipating that it’s about to return him/her), and / or wait for something to happen | 1 | 2 | 3 | 4 |
7. | Child may be distracted by outside sights and sounds or inner distractions (evident perhaps in singing to him/herself, gazing off, lining up materials) but is able to refocus attention to work on his/her own after a short time and without a prompt or reminder from the adult | 1 | 2 | 3 | 4 |
8. | When one activity is finished, child will look for another to complete | 1 | 2 | 3 | 4 |
9. | Child can organize his/her responses to perform tasks when multiple materials are in front of him/her (e.g., a stack of cards for sorting) | 1 | 2 | 3 | 4 |
10. | Child recognizes when one strategy is not working and tries another way | 1 | 2 | 3 | 4 |
11. | Child recognizes his/her own mistakes and goes back and corrects them (e.g., takes little peg out of big hole to make room for correct peg) |
*From TRIAD, adapted from Division TEACCH
Environmental Challenges
Describe environmental challenges of the child/student. Environmental challenges are factors that interfere with the child’s learning. Examples are loud or confusing environments, lack of communication system or lack of sociable peers.
□Behavioral/Knowledge/Attitude of Other People Variables (such as inability to communicate clearly to the student, teach skills necessary for the activity, establish positive work or play routines).
□Procedural/Organizational (such as noisy environments, lack of visual supports, lack of effective transition routines).
□Temporal (such as lack or ineffective use of visual supports to understand passage of time or when activity is finished).
□Spatial (such as lack of personal space or clear boundaries).
Environmental Supports
Describe environmental supports of the child/student. Environmental supports are factors that facilitate learning. Examples are positive routines, use of rewards, and use of visuals supports.
□Behavioral/Knowledge/Attitude of Other People Variables (such as is able to communicate clearly to the student, teach skills necessary for the activity, establish positive work or play routines).
□Procedural/Organizational (such as uncluttered environments, visual supports for understanding work routines, positive transition routines).
□Temporal (such as visual supports to understand passage of time or when activity is finished).
□Spatial (such as personal space to work and calm down, clear boundaries).
Summary of Concerns
Directions: Please list one or two concerns under each area that you have about your child/student as they pertain to succeeding at home and school and being a competent person.
Social and Play Skills
1. |
2. |
Communication Skills
1. |
2. |
Learning Skills
1. |
2. |
Adaptive Skills
1. |
2. |
List any others on the back of this page.
Appendix C Instructions for Completing COMPASS Challenges and Supports Joint Summary Form
In this section, we provide the COMPASS Challenges and Supports JSF. Using this form, you will summarize the information provided by the COMPASS Challenges and Supports Form for Caregivers and Teachers. The summary that you will compose will ensure that all participants have a common understanding of the child’s personal and environmental challenges as well as the child’s personal and environmental strengths. The COMPASS Challenges and Supports JSF will allow integration of data into an easy-to-read summary. This summary is used to guide the discussion during the COMPASS consultation. Before collating the data, be sure to obtain completed COMPASS Challenges and Supports Form for Caregivers and Teachers from both the caregiver and teacher.
Below are instructions on how to complete the COMPASS Challenges and Supports JSF.
-
1.
Enter information on page 1 of the JSF. This includes student’s name, date of birth, and date of consultation. Enter your name, the caregiver’s name, special education teacher’s name, and school name on the respective lines. Then summarize the child’s personal information in the “Student’s Likes, Strengths, Frustrations and Fears” section on the form (pp. 1–2 of the form). List items that both the caregiver and teacher find the student to like or be interested in. Also provide information on the child’s strengths, frustrations, and fears.
-
2.
Identify skills that are challenging for the student by using data that the teacher and caregiver provide on the “Adaptive Skills” section. Ratings of 3 and 4 on this form indicate difficult skills. Any time a caregiver or teacher rates a skill with a 3 or 4, place an “X” in the corresponding column.
-
3.
The next section, “Problem Behaviors,” utilizes the Problem Behavior Rating Scale. If a caregiver or teacher has marked any of these behaviors with a 3 or 4, place an “X” beside the behavior in the JSF.
-
4.
In the “Social / Play Skills” section, place an “S”—indicating strength—in the corresponding box on the form for answers of 3 and 4. Place a “W”—indicating weakness—in the corresponding box on the form for answers of 1 and 2. Note: Be careful to place the “S” or “W” in appropriate box; placing an “S” or “W” in the incorrect box is easy to do and will result in an inaccurate depiction of the student’s social abilities.
-
5.
In the “Communication Skills” section, either write or type the examples provided by the caregiver and teacher. Another option is to photocopy the corresponding section of the COMPASS Challenges and Supports Form for Caregivers and Teachers and attach the copies to the JSF.
-
6.
In the “Sensory Challenges” section, place a check mark in the corresponding box. Only items that are challenging are of interest in this section.
-
7.
Summarize the student’s “Sensory Supports.” Place a check mark in the corresponding box that are supports or motivators for the student. Only items that are strengths or interests are of relevance in this section.
-
8.
In the “Learning Skills” section, place an “S”—indicating strength—in the corresponding box on the form for answers of 3 and 4. Place a “W”—indicating weakness—in the corresponding box on the form for answers of 1 and 2. Note: Be careful to place the “S” or “W” in appropriate box; placing an “S” or “W” in the incorrect box is easy to do and will result in an inaccurate depiction of the student’s social abilities.
-
9.
The “Environmental Challenges” section can be used to make note of problems that are indicated on the forms or during the consultation.
-
10.
The “Environmental Supports” section can be used to note any supports described in the forms or during consultation.
-
11.
Finally, in the “Summary of Concerns” list the three concerns for each area as indicated by the caregiver and the teacher.
Appendix D COMPASS Challenges and Supports Joint Summary Form
Child’s/Student’s Name: _______________________ Date of Birth: ___________
Given by:
_________________________________ _______________________________
Consultant Special Ed. Teacher
_________________________________ _______________________________
Caregiver School
Date of Consultation:_____________
Student’s Likes, Strengths, Frustrations and Fears
Likes/Preferences/Interests:
Strengths or Abilities:
Frustrations:
Fears:
Personal Management/Adaptive Skills
These skills were marked as very difficult.
Self-management | Caregiver | Teacher |
Performing basic self-care independently (such as toileting, dressing, eating, using utensils) | ||
Entertaining self in free time | ||
Changing activities—transitioning | ||
Sleeping | ||
Responding to Others | Caregiver | Teacher |
Following 1 or 2 step direction | ||
Accepting “no” | ||
Answering questions | ||
Accepting help | ||
Accepting correction | ||
Being quiet when required | ||
Understanding Group Behaviors | Caregiver | Teacher |
Coming when called to group | ||
Staying within certain places—lines, circles, chairs, desks | ||
Participating with the group | ||
Talking one at a time | ||
Picking up, cleaning up, straightening up, putting away | ||
Understanding Community Expectations | Caregiver | Teacher |
Understanding who is a stranger | ||
Going to places in the community (place of worship, stores, restaurants, malls, homes) | ||
Understanding safety (such as streets, seat belts) | ||
Managing transportation (Cars/buses) |
Problem Behaviors*
These behaviors were marked as problematic | Teacher | Caregiver | |
1. | Acting impulsively, without thinking | ||
2. | Hitting or hurting others | ||
3. | Damaging or breaking things that belong to others | ||
4. | Screaming or yelling | ||
5. | Having sudden mood changes | ||
6. | Having temper tantrums | ||
7. | Having a low frustration tolerance; becoming easily angered or upset | ||
8. | Crying easily | ||
9. | Being overly quiet, shy, or withdrawn | ||
10. | Acting sulky or sad | ||
11. | Being underactive or lacking in energy | ||
12. | Engaging in behaviors that may be distasteful to others, such as nose-picking or spitting | ||
13. | Touching him/herself inappropriately | ||
14. | Engaging in compulsive behaviors; repeating certain acts over and over | ||
15. | Hitting or hurting him/herself | ||
16. | Becoming overly upset when others touch or move his/her belongings | ||
17. | Laughing/giggling at inappropriate times | ||
18 | Ignoring or walking away from others during interactions or play | ||
19. | Touching others inappropriately | ||
20. | Engaging in unusual mannerisms such as hand-flapping or spinning | ||
21. | Having to play or do things in the same exact way each time | ||
22 | Having difficulty calming him/herself down when upset or excited | ||
23. | Other: ______________________________________ |
*Items are based on the Triad Social Skills Assessment
Social and Play Skills
How well does the child/student | With adults | With children | |||
Social Awareness | Teacher | Caregiver | Teacher | Caregiver | |
1. | Look toward a person who is talking to him/her | ||||
2. | Accept others being close to him/her | ||||
3. | Watch people for extended periods of time | ||||
4. | Respond to another person’s approach by smiling or vocalizing | ||||
5. | Initiate interactions for social reasons | ||||
Joint Attention Skills | |||||
6. | Look at something another person points to | ||||
7. | Show something to a person and look for person’s reaction | ||||
8. | Point at an object or event to direct another person’s attention to share enjoyment | ||||
9. | Share smile by looking back and forth between object and person | ||||
Imitation | |||||
10. | Imitate sounds another person makes | ||||
11. | Imitate what another person does with an object (e.g., person makes toy airplane fly, child repeats action) | ||||
12. | Imitate body movements of others (such as clap when others clap, play Simon Says) | ||||
13. | Imitate and expand upon other’s actions with toys (e.g., peer beats drum, child beats drum and also starts to march) | ||||
Play | |||||
14. | Take turns within familiar routines (e.g., rolls a ballback and forth) | ||||
15. | Share toys | ||||
16. | Play interactively around a common theme | ||||
17. | Repair breakdowns during interactions (such as the child repeats or changes own behavior when other person seems confused or ignores) | ||||
18. | Pretends to do something or be something (such as that a plate is a hat by putting it on, to be a policeman, to have a tea party, that a doll is a teacher) |
Communication Skills
The following are descriptions of words or actions your child/student uses to communicate:
Making Requests | Teacher | Caregiver |
1. Food | ||
2. Objects | ||
3. An activity | ||
4. To use the toilet | ||
5. Attention | ||
6. Help | ||
7. To play | ||
8. Information | ||
9. A choice | ||
Expressing Refusals | Teacher | Caregiver |
1. “Go away” | ||
2. “No, I won’t do it” or “I don’t want it” | ||
3. “I want to be finished” or “I want to stop doing this” | ||
Expressing Thoughts | Teacher | Caregiver |
1. Greeting to others | ||
2. Comments about people/environment | ||
3. Confusion or “I don’t know” | ||
4. Comments about errors or things wrong | ||
5. Asks about past or future events | ||
6. Agreement | ||
Expressing Feelings | Teacher | Caregiver |
1. Angry/mad/frustrated | ||
2. Pain/illness/hurt | ||
3. Happy/excited | ||
4. Hurt feelings/upset | ||
5. Afraid | ||
6. Sad |
Sensory Challenges
These items were identified as being applicable to your child/student:
Sound/Auditory | Teacher | Caregiver |
Has been diagnosed with hearing problem at some time | □ | □ |
Reacts to unexpected sounds | □ | □ |
Fears some noises | □ | □ |
Distracted by certain sounds | □ | □ |
Confused about direction of sounds | □ | □ |
Makes self-induced noises | □ | □ |
Fails to listen or pay attention to what is said to him/her | □ | □ |
Talks a great deal | □ | □ |
Own talking interferes with listening | □ | □ |
Overly sensitive to some sounds | □ | □ |
Seeks out certain noises or sounds | □ | □ |
Other:__________________________________________________ | □ | □ |
Taste | Teacher | Caregiver |
Has an eating problem | □ | □ |
Dislikes certain foods and textures | □ | □ |
Will only eat a small variety of foods | □ | □ |
Tastes/eats nonedibles | □ | □ |
Explores environment by tasting | □ | □ |
Puts most things in his/her mouth | □ | □ |
Constant chewing on something | □ | □ |
Other:__________________________________________________ | □ | □ |
Sight/Vision | Teacher | Caregiver |
Has trouble discriminating shapes, colors | □ | □ |
Is sensitive to light—squints, wants to wear hats or sunglasses | □ | □ |
Has trouble following with eyes | □ | □ |
Does not make much eye contact | □ | □ |
Is distracted by some or too much visual stimuli | □ | □ |
Becomes excited when confronted with a variety of visual stimuli | □ | □ |
Dislikes having eyes covered | □ | □ |
Excited by vistas and open spaces | □ | □ |
Hesitates going up or down stairs, curbs, or climbing equipment | □ | □ |
Upset by things looking different (spills, spots) | □ | □ |
Makes decisions about food, clothing, objects by sight | □ | □ |
Closely examines objects or hands | □ | □ |
Wants environment in certain order | □ | □ |
Other:__________________________________________________ | □ | □ |
Touch/Tactile | Teacher | Caregiver |
Has to know someone is going to touch ahead of time | □ | □ |
Dislikes being held or cuddled | □ | □ |
Seems irritated when touched or bumped by peers | □ | □ |
Explores environment by touching objects | □ | □ |
Dislikes the feel of certain clothing | □ | □ |
Refuses to touch certain things | □ | □ |
Over or under dresses for the temperature or is unaware of temperature | □ | □ |
Does not like showers or rain on self | □ | □ |
Mouths objects or clothing | □ | □ |
Refuses to walk on certain surfaces | □ | □ |
Dislikes having hair, face, or mouth touched | □ | □ |
Upset by sticky, gooey hands | □ | □ |
Touches items with feet before hands | □ | □ |
Does not like to hold hands | □ | □ |
Pinches, bites, or hurts himself | □ | □ |
Other:__________________________________________________ | □ | □ |
Smell/Olfactory | Teacher | Caregiver |
Sensitive to smells | □ | □ |
Smells objects, food, people, toys more than usual | □ | □ |
Explores environment by smelling | □ | □ |
Reacts defensively to some smells | □ | □ |
Ignores strong odors | □ | □ |
Seeks out certain odors | □ | □ |
Other:__________________________________________________ | □ | □ |
Movement/Vestibular | Teacher | Caregiver |
Seems fearful in space (teeter-totter, climbing) | □ | □ |
Arches back when held or moved | □ | □ |
Spins or whirls self around | □ | □ |
Moves parts of body a great deal | □ | □ |
Walks on toes | □ | □ |
Appears clumsy, bumping into things and falling down | □ | □ |
Avoids balance activities | □ | □ |
Does not like to be around people in motion | □ | □ |
Bumps into things and/or people | □ | □ |
Other:__________________________________________________ | □ | □ |
Visual/Perceptual Motor | Teacher | Caregiver |
Has trouble with paper/pencil activities | □ | □ |
Has difficulty with time perception | □ | □ |
Has difficulty with body in space—moving appropriately | □ | □ |
Has problems with use of some tools | □ | □ |
Has problems organizing materials and moving them appropriately | □ | □ |
Is distracted by doors and cupboards being open, holes, or motion | □ | □ |
Other:__________________________________________________ | □ | □ |
Sensory Supports
These items were identified as being applicable to your child/student:
Sound/Auditory | Teacher | Caregiver |
Likes music | □ | □ |
Likes to sing and dance | □ | □ |
Taste | ||
Has definite eating preferences | □ | □ |
Other:__________________________________________________ | □ | □ |
Sight/Vision | Teacher | Caregiver |
Enjoys watching moving things/bright objects | □ | □ |
Enjoys patterns or shiny surfaces | □ | □ |
Likes TV, videos, video games | □ | □ |
Likes the computer | □ | □ |
Other:__________________________________________________ | □ | □ |
Touch/Tactile | Teacher | Caregiver |
Likes to be touched | □ | □ |
Likes hugs and cuddling when he/she initiates it | □ | □ |
Likes to play in water | □ | □ |
Likes baths or swimming pools | □ | □ |
Seeks out mud, sand, clay to touch | □ | □ |
Prefers deep touching rather than soft | □ | □ |
Prefers certain textures of clothing | □ | □ |
Likes being rolled or sandwiched between blankets/cushions | □ | □ |
Likes rough and tumble play | □ | □ |
Other:__________________________________________________ | □ | □ |
Movement/Vestibular | Teacher | Caregiver |
Enjoys rocking, swinging, spinning | □ | □ |
Likes being tossed in the air | □ | □ |
Likes to run | □ | □ |
Likes and needs to move | □ | □ |
Likes to climb; seldom falls | □ | □ |
Other:__________________________________________________ | □ | □ |
Visual/Perceptual Motor | Teacher | Caregiver |
Relies on knowing location of furniture, stationary objects | □ | □ |
Likes to draw and reproduce figures | □ | □ |
Other:__________________________________________________ | □ | □ |
Learning Skills
Learning/Work Skill | Caregiver | Teacher | |
1. | Child clearly understands the end goal of an activity, recognizes what he/she must do to be finished, and persists on the task to completion | ||
2. | Child realizes when he/she is running into difficulty and has some way of letting the adult know he/she needs help | ||
3. | Once an activity is under way, the adult can walk away from the child and he/she will keep working until finished, maintaining at least fairly good attention to what he/she is doing | ||
4. | Child finishes work and remembers on his/her own to let the adult know (e.g., by bringing work to adult, calling adult, raising his/her hand) | ||
5. | Child looks forward to earning a reward, knows it’s next, work toward it, may ask for it or go get it on his/her own when work is finished | ||
6. | Child is able to wait briefly for a direction (anticipates that he/she is about to be asked to do something), is able to wait briefly for his/her turn with a toy (anticipating that it’s about to return him/her), and / or wait for something to happen | ||
7. | Child may be distracted by outside sights and sounds or inner distractions (evident perhaps in singing to him/herself, gazing off, lining up materials) but is able to refocus attention to work on his/her own after a short time and without a prompt or reminder from the adult | ||
8. | Child shows interest in and curiosity about materials, handles them without prompting or nudging from the adult to get started. When one activity is finished he/she will look for another | ||
9. | Child can organize his/her responses to perform tasks when multiple materials are in front of him/her (e.g., a stack of cards for sorting) | ||
10. | Child recognizes when one strategy is not working and tries another way | ||
11. | Child recognizes his/her own mistakes and goes back and corrects them (e.g., takes little peg out of big hole to make room for correct peg) |
Environmental Challenges
Describe challenges noted in the Forms or reported during the consultation:
□Behavioral/Knowledge/Attitude of Other People Variables (such as inability to communicate clearly to the student, teach skills necessary for the activity, establish positive work or play routines).
□Procedural/Organizational (such as noisy environments, lack of visual supports, lack of effective transition routines).
□Temporal (such as lack or ineffective use of visual supports to understand passage of time or when activity is finished).
□Spatial (such as lack of personal space or clear boundaries).
Environmental Supports
Describe supports noted in the Forms or reported during the consultation:
□Behavioral/Knowledge/Attitude of Other People Variables (such as is able to communicate clearly to the student, teach skills necessary for the activity, establish positive work or play routines).
□Procedural/Organizational (such as uncluttered environments, visual supports for understanding work routines, positive transition routines).
□Temporal (such as visual supports to understand passage of time or when activity is finished).
□Spatial (such as personal space to work and calm down, clear boundaries).
Summary of Concerns
Social and Play Skills
Teacher | Caregiver |
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1. | 1. |
2. | 2. |
Communication Skills
Teacher | Caregiver |
---|---|
1. | 1. |
2. | 2. |
Learning Skills
Teacher | Caregiver |
---|---|
1. | 1. |
2. | 2. |
Adaptive Skills
Teacher | Caregiver |
---|---|
1. | 1. |
2. | 2. |
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Ruble, L.A., Dalrymple, N.J., McGrew, J.H. (2012). COMPASS Consultation Action Plan: Step A. In: Collaborative Model for Promoting Competence and Success for Students with ASD. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2332-4_6
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