1. Adapted School-age Social and Emotional Checklist
Please quickly rate the student according to the rating scale below. If you are unsure of an answer
please give your best estimate. ALL items should be completed.
1=Never
2= Rarely/not usually
3=Sometimes
4= Often
5=Almost Always/Usually
1. Student is able to ask for what he/she wants and tell a familiar adult about his/her
concerns/troubles.
2. Student is able to follow directions and general expectations of familiar adults.
3. Student is able to express feelings appropriately to peers.
4. Student is able to share and interact cooperatively with peers.
5. Student is able to start and sustain conversations with peers.
6. Student is able to ignore peers when he/she should.
7. Student is appropriately assertive with peers
8. Student thinks about what he/she is doing and demonstrates he/she understands the
consequences of behavior.
9. Student is aware when he/she is having a problem.
10. Student learns from past mistakes and does not repeat them.
11. Student knows when he/she is having a social problem.
12. Student is knowledgeable of how he/she affects others.
13. Student uses appropriate strategies (non-aggressive) to solve disagreements and
interpersonal difficulties with others.
14. Student is aware when he/she is getting angry or frustrated.
15. Student can verbalize several things that help calm him/her when angry (understands
coping skills).
16. Student responds to anger with appropriate coping skills (uses coping skills).
17. Student keeps anger under-control (does not blow up or have anger outbursts).
18. Student can handle minor frustrations without adult assistance.
19. Student acknowledges his/her own feelings and expresses these feelings in appropriate
ways.
20. Student seems to like him/herself (can identify positive self qualities).
21. Student is able to take responsibility for achievements and mistakes.
Social Behavioral Skills= Items 1-7
Social and General Problem Solving Skills = Items 8-13
Ability to Cope with Anger = Items 14-18
Emotional Well Being & Level of Self Esteem = Items 1 and 19-20