AGES

2–5
Teacher/Daycare Provider Form

ABAS-3
TM

Adaptive Behavior Assessment System TM

Third Edition
Patti L. Harrison, PhD Thomas Oakland, PhD

Child Information

Name of child being evaluated (first, middle, last) Sex

Female Male

Today’s date Date of birth Age Grade

Years:   Months:

School/Daycare City State

Race/Ethnicity

Does the child being evaluated have any disabilities or other limitations?

Yes No If yes, please describe:

Teacher/Daycare Provider Information

Teacher/Daycare provider’s name (first, last) Number of years as a teacher or daycare provider

How long have you been this child’s teacher or daycare provider?

Your relationship to the child you are rating

General education kindergarten or preschool teacher General education teacher’s aide

Special education kindergarten or preschool teacher Special education teacher’s aide

Private preschool teacher Daycare center provider In-home child care provider

Other service provider (describe):

 Directions

The Adaptive Behavior Assessment System, Third Edition, measures important behaviors a child displays at
home, school, and in other settings. The behaviors included on this questionnaire range from those suitable
for infants to those suitable for young children. Some items may seem too difficult for infants while others
may seem too easy for young children. Therefore, the individual you are rating is likely to perform some but not
all behaviors included on this questionnaire.

Please read and answer all items.

Please read each item carefully and rate the child’s performance of the behavior. Select only one response
(0, 1, 2, or 3) according to the guidelines below. Please provide a response to every item, even if some items do
not seem to apply to the child’s age group or are difficult to rate.

Record your answer by circling 0, 1, 2, or 3.

If you know that the child is unable to perform the behavior, circle 0 on the rating scale.
0 Is not able to do this behavior
If you know that the child is able to perform the behavior, rate how often he or she performs the behavior when
needed without reminders and without help.
1 Never (or almost never)
2 Sometimes
3 Always (or almost always)
Please circle only one rating of 0, 1, 2, or 3 for each item.

Indicate when your answer is a guess or estimate.

You may not have seen the child perform the specific behavior described in an item. If this is the case, you
may guess if you know how the child performs similar behaviors. If your rating is based on a guess, first circle
0, 1, 2, or 3, then check the box in the “Check only if you guessed” column.
Check the box in this column only if your rating is based on a guess or estimate.

Additional copies of this form (W-621C) may be purchased from WPS. Please contact us at 800.648.8857 or www.wpspublish.com.
Copyright © 2015 by Western Psychological Services. Not to be reproduced, adapted, and/or translated in whole or in part
without prior written permission of WPS (rights@wpspublish.com). All rights reserved. Printed in USA. 9 8 7 6 5 4 3 2 1
 The following examples show how to complete the questionnaire.
BEHAVIOR RATINGS

Ability Frequency
Never (or Sometimes Always (or Check
Is not almost never) when almost always) ONLY if you
able when needed needed when needed GUESSED

4. Uses one or more words to get something he or she wants, even if the word 0 1 2 3
is not said correctly or pronounced well.

5. Points to common items in a room when asked (for example, “Show me 0 1 2 3

the TV”).

6. Looks at other people’s faces when they are talking to him or her. 0 1 2 3

7. Says the names of other people (for example, those of teachers, daycare 0 1 2 3
providers, or friends).

··
Item 4 is rated 3 because this child always (or almost
always) uses one or more words to get something he
··Item 6 is rated 1 because, although this child is able to
look at other people’s faces when they are talking to him
or she wants, even if the word is not said correctly or or her, he or she never (or almost never) does so when
pronounced well, when needed, without reminders and needed.
without help.

··
Item 5 is rated 2 because this child sometimes points to
··Item 7 is rated 0 because this child is not able to say the
names of other people.
common items in a room when asked. In this case, the rater
also checked the box in the “Check only if you guessed”
column because their response was a guess or estimate.

The following table is provided to further assist you in filling out this questionnaire.
Rating The child:

0 ····cannot perform the behavior;

····
Is not able is too young to have tried the behavior;
does not have the skill to perform the behavior;

··
has not been taught to perform the behavior; or
has some limitation that prevents performing the behavior.

is able to perform the behavior, but

····
1
Never never or almost never does it when needed;

····
(or almost never) never or almost never does it without being reminded;
when needed another person does it for the child instead of the child doing it; or
refuses to perform the behavior.

is able to perform the behavior, but

····
2
Sometimes only does it sometimes when needed;

··
when needed sometimes does it without help, but sometimes needs help; or
sometimes does it on his or her own, but sometimes needs to be reminded.

is able to perform the behavior, and

····
3
Always does it most or all of the time without help and without being reminded; or
(or almost always) displayed the behavior at a younger age but has now outgrown it.
when needed

Check ONLY if
After you rate an item 0, 1, 2, or 3, fill in the square in this column if:
you GUESSED

····your rating was a guess or estimate;

you have not had the opportunity to see the child perform this behavior; or

·· you have seen the child perform similar behaviors, but not this one.

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 3

 BEHAVIOR RATINGS

Ability Frequency

Communication Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Shakes head or says “Yes” or “No” in response to a simple question (for 0 1 2 3

example, “Do you want something to drink?”).

2. Looks up or smiles when someone says his or her name. 0 1 2 3

3. Says phrases with at least two words (for example, “My book”). 0 1 2 3

4. Uses one or more words to get something he or she wants, even if the word 0 1 2 3
is not said correctly or pronounced well.

5. Points to common items in a room when asked (for example, “Show me 0 1 2 3

the TV”).

6. Looks at other people’s faces when they are talking to him or her. 0 1 2 3

7. Says the names of other people (for example, those of teachers, daycare 0 1 2 3
providers, or friends).

8. Says the name of an object clearly enough that others recognize it (for 0 1 2 3
example, “ball,” “dog,” “cup”).

9. Laughs when another person laughs. 0 1 2 3

10. Follows simple commands (for example, “No” or “Come here”). 0 1 2 3

11. Names 20 or more familiar objects. 0 1 2 3

12. Speaks clearly enough that others who do not know him or her can 0 1 2 3
understand most of what is said.

13. Follows simple, one-step directions that include “over” or “under” (for 0 1 2 3
example, “Put your hands over your head”).

14. Listens closely for at least 1 minute when people talk. 0 1 2 3

15. Raises and lowers voice to express different feelings or needs. 0 1 2 3

16. Uses simple sentences with a noun and verb. 0 1 2 3

17. Refrains from repeating what he or she says over and over again. 0 1 2 3

18. Sings all or part of the words to songs. 0 1 2 3

19. Makes plurals of words by adding an -s (for example, “shoes,” “socks,” “dogs”). 0 1 2 3

20. Speaks in sentences of six or more words. 0 1 2 3

21. Tells teacher, daycare provider, friends, or others about his or her favorite 0 1 2 3
activities.

22. Asks questions such as “Will you play with me?” 0 1 2 3

23. Uses past tense to talk about prior events (for example, “I stayed inside”). 0 1 2 3

24. Has a conversation with another person for at least 3 minutes. 0 1 2 3

25. Says irregular plural nouns correctly (for example, says “feet” instead of 0 1 2 3
“foots” and “men” instead of “mans”).

26. Waits for others to finish what they are saying, without interrupting. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 78

Total guessed

4 ABAS-3 Teacher/Daycare Provider Form Ages 2 –5

 BEHAVIOR RATINGS

Ability Frequency

Functional Pre-Academics Is not

able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Points to at least one body part when asked (for example, “head” or “leg”). 0 1 2 3

2. Points to pictures in books when asked (for example, points to a horse 0 1 2 3

or cow).

3. Turns book pages one by one. 0 1 2 3

4. States his or her age in years when asked. 0 1 2 3

5. Counts three or more objects. 0 1 2 3

6. Attempts to imitate simple drawings (for example, copying a line or circle). 0 1 2 3

7. Sorts three or more objects by color. 0 1 2 3

8. Sings the alphabet song. 0 1 2 3

9. Names six or more colors, including red, blue, and yellow. 0 1 2 3

10. Names four or more shapes (for example, circle, square, rectangle, 0 1 2 3
triangle).

11. Sorts three or more objects by size (for example, from largest to smallest). 0 1 2 3

12. Names at least two letters when shown his or her name. 0 1 2 3

13. Recites nursery rhymes from memory. 0 1 2 3

14. Reads his or her name when printed. 0 1 2 3

15. Answers simple questions about a story read to him or her. 0 1 2 3

16. Draws a recognizable face that includes two eyes, a nose, a mouth, and hair. 0 1 2 3

17. Prints at least two letters in his or her name. 0 1 2 3

18. Counts 10 or more objects without using fingers. 0 1 2 3

19. Names most letters when shown the alphabet. 0 1 2 3

20. Counts from 1 to 20. 0 1 2 3

21. States the days of the week in order. 0 1 2 3

22. Reads and obeys common signs (for example, Do Not Enter, Exit, Stop). 0 1 2 3

23. Tells which day comes before another (for example, “Wednesday comes 0 1 2 3
before Thursday”).

24. Writes numbers 1 through 10 correctly. 0 1 2 3

25. Writes or prints his or her first and last name. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 75

Total guessed

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 5

 BEHAVIOR RATINGS

Ability Frequency

School Living Is not

able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Selects and uses a toy or book from a shelf in daycare or classroom. 0 1 2 3

2. Points to the place where his or her belongings are stored in the classroom 0 1 2 3
or daycare.

3. Removes cookies, chips, or other food from a box or bag. 0 1 2 3

4. Shows concern when he or she spills something (for example, says “Oh no” 0 1 2 3
or tells an adult).

5. Goes to his or her assigned chair or place in the room when arriving at 0 1 2 3
daycare or school.

6. Does a simple errand when asked (for example, runs to get a towel for a 0 1 2 3
spill).

7. Refrains from breaking or tearing toys or books in the classroom or 0 1 2 3

daycare.

8. Assists others with putting away toys, games, and other items. 0 1 2 3

9. Picks up and throws away trash. 0 1 2 3

10. Refrains from throwing food or paper on the floor. 0 1 2 3

11. Washes hands without splashing water on the floor. 0 1 2 3

12. Hangs coat or sweater in the proper place. 0 1 2 3

13. Transitions easily from one school activity to the next. 0 1 2 3

14. Helps keep classroom or daycare neat and clean. 0 1 2 3

15. Removes tray or plate and other items from the table when finished eating 0 1 2 3
at school or daycare.

16. Puts things in their proper places when finished using them. 0 1 2 3

17. Places dirty trays, plates, forks, and other items in correct disposal bins in 0 1 2 3
the school or daycare lunchroom.

18. Assists teacher or daycare provider with moving chairs, distributing 0 1 2 3

supplies, or other tasks, when asked.

19. Keeps toys, games, and other belongings neat and clean. 0 1 2 3

20. Wipes up spills at school or daycare. 0 1 2 3

21. Informs a teacher or other adult if someone is bullying or hurting him or her 0 1 2 3
or others.

22. Works quietly in the classroom without disturbing others. 0 1 2 3

23. Remains focused and working, even in noisy school settings. 0 1 2 3

24. Brings needed books and supplies. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 72

Total guessed

6 ABAS-3 Teacher/Daycare Provider Form Ages 2 –5

 BEHAVIOR RATINGS

Ability Frequency

Health and Safety Is not

able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Avoids bumping into walls or objects when crawling or walking. 0 1 2 3

2. Shows, points to, or tells another person about a cut, bruise, or other minor 0 1 2 3
injury.

3. Acts startled or surprised when he or she hears a very loud sound. 0 1 2 3

4. Cries or whimpers when he or she does not feel well or is injured. 0 1 2 3

5. Points to the body part that hurts when he or she is sick or injured. 0 1 2 3

6. Follows another person’s direction to “stop” when near danger, such as fire 0 1 2 3
or broken glass.

7. Refrains from putting non-edible objects in mouth (for example, crayons, 0 1 2 3

blocks, sand).

8. Sits still in high chair, booster seat, or chair without climbing or sliding off. 0 1 2 3

9. Acts uncomfortable or fusses when too hot or too cold. 0 1 2 3

10. Refrains from putting toys in his or her mouth. 0 1 2 3

11. Tells an adult if he or she has a stomachache or other illness. 0 1 2 3

12. Stays within sight of teacher, daycare provider, or other familiar adults in a 0 1 2 3
public place without wandering off.

13. Tells an adult if someone else is in trouble (for example, if another child has 0 1 2 3
fallen down).

14. Puts on a coat or sweater when cold. 0 1 2 3

15. Follows safety rules for fire or weather alarms at school or daycare. 0 1 2 3

16. Follows safety rules at a park or playground. 0 1 2 3

17. Carries breakable objects safely and carefully. 0 1 2 3

18. Asks a teacher or daycare provider before going near something that might 0 1 2 3
be dangerous (for example, animals or playground equipment).

19. Carries scissors safely. 0 1 2 3

20. Cares for own minor injuries (for example, paper cuts, knee scrapes, 0 1 2 3
nosebleeds).

FOR EXAMINER USE ONLY Raw total 60

Total guessed

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 7

 BEHAVIOR RATINGS

Ability Frequency

Leisure Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Smiles or shows interest when he or she sees a favorite toy. 0 1 2 3

2. Shows interest in a toy or other object by pointing to it. 0 1 2 3

3. Chooses a game or toy during playtime. 0 1 2 3

4. Crawls or walks after a ball or other toy. 0 1 2 3

5. Plays with a single toy or game for at least 1 minute. 0 1 2 3

6. Looks with an adult at pictures in books or magazines. 0 1 2 3

7. Plays with a variety of toys instead of only one or two. 0 1 2 3

8. Plays on playground equipment with adult supervision. 0 1 2 3

9. Watches for a few minutes as people play with toys or games. 0 1 2 3

10. Plays alone with toys and games, or does other fun activities. 0 1 2 3

11. Plays with toys, games, or other fun items with others. 0 1 2 3

12. Plays simple games like “peek-a-boo” or rolls a ball to others. 0 1 2 3

13. Plays with a single toy or game for more than 5 minutes. 0 1 2 3

14. Engages in imaginary or make-believe play with others. 0 1 2 3

15. Joins a group of children in games or on the playground when encouraged 0 1 2 3

by an adult.

16. Participates regularly in a specific fun activity (for example, listening to a 0 1 2 3

certain type of music or playing a favorite computer game).

17. Plays simple group games with other children (for example, “tag” or “hide- 0 1 2 3
and-seek”).

18. Invites others to join him or her in playing games and other fun activities. 0 1 2 3

19. Waits for his or her turn in games and other fun activities. 0 1 2 3

20. Follows the rules in games and other fun activities. 0 1 2 3

21. Asks classmates what they would like to do during free time at daycare or 0 1 2 3
school (for example, games or activities).

22. Plays simple board games. 0 1 2 3

23. Invites others to go first in games, play, or other activities. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 69

Total guessed

8 ABAS-3 Teacher/Daycare Provider Form Ages 2 –5

 BEHAVIOR RATINGS

Ability Frequency

Self-Care Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Swallows liquids without difficulty. 0 1 2 3

2. Nurses, drinks, or eats willingly, with little encouragement. 0 1 2 3

3. Opens mouth when offered food on a spoon. 0 1 2 3

4. Feeds himself or herself crackers, cookies, dry cereal, or other finger foods. 0 1 2 3

5. Chews semisolid or solid food before swallowing. 0 1 2 3

6. Drinks from a cup or glass, even if another person must hold it. 0 1 2 3

7. Eats firm foods that require biting and chewing (for example, steamed 0 1 2 3
vegetables).

8. Lifts arms as needed when another person is dressing or undressing him 0 1 2 3

or her.

9. Attempts to use a spoon to eat soft food or soup. 0 1 2 3

10. Points to or asks for food when hungry. 0 1 2 3

11. Takes shoes off. 0 1 2 3

12. Remains relatively still while an adult wipes or washes his or her hands 0 1 2 3
or face.

13. Holds and drinks from a sipping cup. 0 1 2 3

14. Feeds himself or herself for most of a meal, using a spoon or fork, with little 0 1 2 3
spilling.

15. Stays dry and does not wet or soil diaper or underwear for at least 1 hour. 0 1 2 3

16. Washes hands with both soap and water. 0 1 2 3

17. Sits on the toilet or potty seat without being held. 0 1 2 3

18. Remains dry without wetting throughout the day. 0 1 2 3

19. Wipes his or her own face when given a washcloth by an adult. 0 1 2 3

20. Climbs on the toilet or potty seat. 0 1 2 3

21. Tells teacher, daycare provider, or other adult when he or she needs to use 0 1 2 3
the bathroom.

22. Uses bathroom without help. 0 1 2 3

23. Fastens and straightens clothing before leaving restroom. 0 1 2 3

24. Buttons own clothing. 0 1 2 3

25. Ties his or her own shoes. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 75

Total guessed

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 9

 BEHAVIOR RATINGS

Ability Frequency

Self-Direction Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Chooses the food or snack he or she wishes to eat when given a choice. 0 1 2 3

2. Sits quietly for at least 1 minute without demanding attention. 0 1 2 3

3. Stops fussing or crying when picked up or spoken to by a teacher, daycare 0 1 2 3

provider, or other adult.

4. Finds something to do for at least 5 minutes without demanding attention. 0 1 2 3

5. Tries a new activity, even if it is unfamiliar (for example, uses playground 0 1 2 3

equipment that he or she has not used before).

6. Tries to do most things alone without an adult’s help (for example, dressing 0 1 2 3
or feeding self).

7. Follows an adult’s request to “quiet down” or “behave.” 0 1 2 3

8. Resists pushing or hitting another child when angry or upset. 0 1 2 3

9. Chooses a school or daycare activity when given a choice. 0 1 2 3

10. Starts an activity almost immediately when told to do so (for example, 0 1 2 3

putting away toys or books).

11. Asks permission from an adult when needed (for example, “May I go 0 1 2 3
outside to play?”).

12. Works independently and asks for help only when necessary. 0 1 2 3

13. Controls temper when a teacher or daycare provider takes a toy or object 0 1 2 3
away.

14. Stops a fun activity, without complaining, when told that time is up. 0 1 2 3

15. Looks for misplaced toys or games until he or she finds them. 0 1 2 3

16. Stands still when needed, without fidgeting or moving around. 0 1 2 3

17. Controls temper when disagreeing with classmates. 0 1 2 3

18. Follows a routine without being reminded (for example, putting away toys 0 1 2 3
before going to lunch).

19. Refrains from grabbing a toy held by another child. 0 1 2 3

20. Keeps working on hard tasks without becoming discouraged, quitting, or 0 1 2 3

needing reminders.

21. Works on one school activity for at least 15 minutes without reminders. 0 1 2 3

22. Asks for directions, as needed, before beginning school or daycare tasks. 0 1 2 3

23. Discusses ways to solve conflicts with others (for example, “You can have 0 1 2 3
this now if I can have it later”).

FOR EXAMINER USE ONLY Raw total 69

Total guessed

10 ABAS-3 Teacher/Daycare Provider Form Ages 2 –5

 BEHAVIOR RATINGS

Ability Frequency

Social Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Smiles when he or she sees a parent. 0 1 2 3

2. Displays closeness to a parent (for example, is happy when parent arrives 0 1 2 3

at school or daycare).

3. Goes to a specific family member or other person when directed to do so 0 1 2 3

(for example, “Go to brother” or “Go to teacher”).

4. Squeals or laughs when happy or delighted. 0 1 2 3

5. Shows a sense of humor (for example, laughs when someone acts silly). 0 1 2 3

6. Smiles when he or she sees a teacher or daycare provider. 0 1 2 3

7. Responds differently to familiar and unfamiliar persons (for example, is less 0 1 2 3

warm to an unfamiliar person).

8. Initiates and maintains interaction with adults (for example, initiates and 0 1 2 3
plays peek-a-boo).

9. Imitates actions of adults (for example, pretends to clean house or drive 0 1 2 3

a car).

10. Shows respect for persons in authority by following their rules and 0 1 2 3
directions (for example, parents, teachers, police officers).

11. Greets other children (for example, says “Hi”). 0 1 2 3

12. Seeks friendship with others in his or her age group. 0 1 2 3

13. Says “Thank you” when given a gift. 0 1 2 3

14. Shows sympathy for others when they are sad or upset. 0 1 2 3

15. Shares toys willingly with others. 0 1 2 3

16. Displays good table manners (for example, by using a napkin and 0 1 2 3
remaining at the table until excused).

17. Says “Please” when asking for something. 0 1 2 3

18. Says when he or she feels happy, sad, scared, or angry. 0 1 2 3

19. Moves out of another person’s way without being asked. 0 1 2 3

20. Offers assistance to others (for example, offers to carry packages or put 0 1 2 3
away food).

21. Apologizes if he or she hurts the feelings of others. 0 1 2 3

22. Places reasonable demands on friends (for example, does not become 0 1 2 3
upset when a friend plays with another friend).

23. Refrains from saying or doing things that might embarrass or hurt others. 0 1 2 3

24. Tries to please others by doing something special or giving them a surprise. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 72

Total guessed

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 11

 BEHAVIOR RATINGS

Ability Frequency

Motor Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Lifts head to look around. 0 1 2 3

2. Reaches for objects such as a bottle or toy. 0 1 2 3

3. Follows a moving object by turning head. 0 1 2 3

4. Shakes rattle or other toys. 0 1 2 3

5. Rolls from stomach to side. 0 1 2 3

6. Transfers objects from one hand to the other. 0 1 2 3

7. Sits balanced for 30 seconds or more without support. 0 1 2 3

8. Moves to a sitting position, even if balance is unsteady. 0 1 2 3

9. Crawls for about 10 feet without falling over. 0 1 2 3

10. Rolls ball to others. 0 1 2 3

11. Stands up from a sitting position. 0 1 2 3

12. When standing, bends over to pick up items from the floor. 0 1 2 3

13. Picks up small flat objects from a table (for example, coins or buttons). 0 1 2 3

14. Walks up at least five to six steps without falling (may use handrail). 0 1 2 3

15. Walks without help. 0 1 2 3

16. Runs without falling. 0 1 2 3

17. Throws a small ball overhand. 0 1 2 3

18. Kicks a ball without falling. 0 1 2 3

19. Balances on one foot for 4 or more seconds. 0 1 2 3

20. Hops on one foot for four or more hops. 0 1 2 3

21. Draws straight lines across a piece of paper. 0 1 2 3

22. Bounces a ball for several seconds. 0 1 2 3

23. Catches a ball tossed from 5 to 10 feet away. 0 1 2 3

24. Colors within the lines of a drawing or in a coloring book. 0 1 2 3

25. Uses scissors to cut along a straight line. 0 1 2 3

26. Uses scissors to cut shapes with curved lines. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 78

Total guessed

12 ABAS-3 Teacher/Daycare Provider Form Ages 2 –5

 Comments

ABAS-3 Teacher/Daycare Provider Form Ages 2 –5 13