Handouts

OVERHEAD/HANDOUT F6
Page 1 of 5
BURKS' BEHAVIOR RATING SCALES
PROFILE SHEET
by Harold F'.Burks. Ph.D.
- Age -
Grade
Aelationahip10ChilC
-
IN8TRUCTIONS: Category SCOrH IMUid be ~lcuilCed CCOfdlng to dNca0n8ln m8n~.
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Page2 of 5
HANDOUT F6
BURKS' BEHAVIOR RATING SCALES
ADMINfSTRATION BOOKLET
by HaroldF. Burks,Ph.D.
PI/O/i&~ by
Name
Dale
School
Age -:-
Grade
Ratedby
statementin ~hebox
Plea.. rate each end every item by putting the I1\Jmber
oppositeeach item. The 5 descriptive statements are g:ven below:
Number 1. You have not noticed tnls beheviGrat all.
Number 2. You have noticed the behavior 108 slight degree.
Number3. Youhave
.
Number 4. You have noticed the ~enavlO( 1O a large degre~.
Numbtr5. You have noticed the behavior to 8 v~ry
.."~'"
,."
que$tlons.
ask
not
Does
4.
~. Upset1tmakeS a mistake,
6. PeJl8verates. c."not
"
._-=:~~~::=~:::~~g-'D
~
shin responses. ...
eranC8.
""'
"-""-."""".."
...
".'
'.'.'..'.."
8, Complains he never gets his fair
9. Gives lnapproprllte
-
responses. -"
".."0
0
. '._."'..'.'..'~"." D
Y.~
reward
".0
, 1. Attention
12. Doee nO1
0
0
7, IS eaSily distracted, laCks continuity of
10.
o
0
h
future
behevk>r.
the
pick on him,..
about
acattered
or
worry
a
flighty
indicate
othor children
erratic.
Qucstia1s
Show,
1.
2.
3. Majntai~
-.(;,~
13. WiD not forgive others. ,...,.
~-'-'.._"
do.
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not
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did
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othere do not like him.
"..,
tnlngs
lheyactually
,
$hOr1.
is
remernberlng
thing!
'.'."'.-'
poor
Con'C)lalns
of
vocabulary.
span
trouble
Attcnti~
Has
5.
18,
'9.
Shows
,
18.
, 7. Accusesothers
,.,
14. Is upset if things do not turn oUt
~.O
,
0
,
else.
something
,...,
to
jumps
sense.
wrong.
doing;
is
he
thinoa
it
what
finish
t'limself
Cannot
Does not show common
Blames
~.
21,
22.
go
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HANUUU"."
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In !tit boa
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Conllaerat»e
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!\lYe
YOU
a.
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,... ... ~ 8Y8fy ~ by PJIIIIIg ",. n~ber or 1118
mOlt IPr-'OPIflle descripli
0PP0IiI8tach item. T~ 5 deSCrlctlvelIaIemenll are a~n below;
Number 1. Vou have not noIIcodIhit Dell8viorat III.
N~r
2. You 1\1118
no~Ced"" bthiYior to a slightdegree.
N~r
4. You hew ~
ml belWvIor\0 a lar~ degree.
Numb8f I. You haw noticedtne btha~or to a very I8fge degree.
--0
23.snowsmany'Mra.--24. TellsblzerreSIOfIM.
poorreading~
26. B8comft
0'Ier8adt8d~.
Q/8
,
.t~«
1anguIQI.
a don"
UNnt"~8
DlSplaYI
Utes
27.
28.
M--dOM
what
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37. W--
~tI8Viof.
promII-.
ana
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8XpI~1v1
folbw
Do8
34.
Showl
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35.
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42. ~u,h., ...ily
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i1yperactve.nd
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Shows
1aiIOh00d8.
Appe8ra
II
31.
32,
33.
Tels
St'IOws
29.
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Plea.. rate 88Ch and -,.,
Ilem by ~utl,"g the nunber or the 1nO8Iappropriale descripti~
swtemenl In 1M bOx
opposite each it.m. TM 5 deacrl~V8 st.tem~
arc given below:
Number 1. You h8119 not noll*
Inl. b811avior al aI.
Number 2. You have noticed \1'8 behavior \0 a sI:g"I oegree.
Number S. YOLI".ve nOti~d the behavior to a considerable degree.
NUfTlber 4. You ha'-8 noIiced me behavior 10 . large degree.
NLlmber 5. You nave mUceO Itw behavior 1o a very large ~gree.
54. Avoids phySical contact In P'8y.
i".
-0
-""",-,""",--:-0
~-
._~'--"-'D
~"'~
'-O
~
'-"-'---
~..~
n
thlngt
to
play.
on
uncooper.11ve
If cf':ipll,.d
physical
and
~
hurt
trouble
stubOom
Is
H..
Gets
58.
59.
57.
Is rebeUloUi
holding
56 Actc ac non.conformisl
60.
.
"c,
qulc:kly.
.ngty
gecOtTWs
55.
:
:
,
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.~~
87. 18 quiC:c!y Iru81(atad .00 loset emotlonaf c~OI.
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,-.
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way
loners.
own
his
with
thir.gS
A8~.led
7'
Does
68.
69. Drawings and peinlings are mealY
0
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"-0
n'..-
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muscle
action-.
~
large
own
in
ttyIe4
for
olothlno
poor.
QOOrdlMtion
Is
rNponeibilily
qulokly
poor
uIIUS.J81
tired
Shows
We.,.
Get8
Handwtiung
Denio.
70.
- =~::.'.'."'~"--:::::~:::=:=::::D-.-o
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stress
\lnder
Explodet
72.
74.
---
'
,
~
.
75.
.7a
'-0
__0
'
0
0
~-~~~_.-
0
moat.~__~.~.~
frcxn
dillere"!
deliberately
benaYing
01
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:==~=--=:o-o
0
";'!
17. Flares up al cla$6malea if te8sed 0# PWlhed....
~
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--".'_.".Od
'.Styl."
62.
53.
65.
66.
73.
64.
61 Becomes angry il aSkedto do &omething.
18.
HANUUU'l'
,.
18
13 15
~
Page 5 of 5
HANDOUT F6
0
"...
,
,
,
~
around
,
him
abilities
trou~le
own
,
lead
in
10
are
know.
distrusts
to
otherS.
others
Qlhers
get
and
10
pushes
when
difficult
or
depende~
IS
Depreciates
Laughs
Sulks
Hits
Is
80.
8'.
82
83.
79
84.
on
f'leeH rate each and every item by pl.rttingthe numberor the most epptopri~lcdescnpt"'o .tatcment n t~ box
o~poslt.each item.The5 descriptive
statements
aregivenbelow:
Number 1. You have n~ noticedthISbehaltlorat all.
Number 2. You have noticedthe beheviO(to 8 spgn\degree.
Number 2. You have n~icecl the heh8Vlorto a considerabledeoree
Number 4. You have noticed t!1eDel\aviorto 8 large degree.
NumDer5. You have no/Icedthe ~".I/IOr 10a very large degree.
0
0
0
..
upset.
are
perfaman~e.
...
Inferior
otherS
.""
when
'.'
~ith
..
Jeefing
.unhappy
overobedient
Appears
Shcws
Stlistied
little
easily
Is
Is
85.
86.
87.
88.
"'
,--,-,~,-,._-,.,
tJ
..-,
'-'"
0
quickly
'0
, 0
acdvities:
... ...
'-'~"-l
~
.._~
~
in OOS1ion 0/ being
,
hlfTlSell
"'."
puts
...
,
others.
led
easily
StIy.
Is
Deliberately
IS
93.
94.
group
competItion.
92. Wanls to toss
95.
from
puniShment
welcome
Avoids
$ceme
91.
e9.
Withdraws
to
0
90.
0
""""""-'--'-""""
.-~...
96. IS sarcastic
0
0
.0
0 0
.--
""'-""""""""'h"'"
97. Is eaailv fruslrated and gives
98. Doesnol ShO\v
feelings... .
",""M'
99. Givespiclure01"poor
silly
0
~,
othcrs.
Acts
Teasos
00.
1
101
~
102.Want.otners:0 ao tningsfor hi'TI
~~..h
,
...
.,.."..-""""
,.
0
,0
others
,-,-.,.,-""-",,,.,-,-.,0
~
0
o
,.0
~
~
class
tne
01
clown
the
Plays
0
0
,
110.
0
'.,.
'-"""'"
0
0
0
ot
...""""'..'.'~'~'_'h.'.".".'~rk
plaia..
cia"
depressed...
dCSlnlerested
~on.t8nt
other children.
In
adults
to
Clings
Seek,
Appe~rs
107.
108.
109.
Appe.rs
105
108. Plays tricks on
..,..
e..;ly
&el'.confide~e
."'urt.
little
Shawl
Feelings
103.
104.
.." - . ..
0
17
4
5
4
1.
.1
OVERHEADfflANDOUT Fl7
SOCIAL EMOTIONAL CHARACTERISTICS
OF ADOLESCENTS
ADOLESCENT ACTIONS
1. Often
goes to extremes
2. Is preoccupied with social acceptance
3. May belong to gangs
4. Respondsto group activities
5. Regardsindependencefrom family as a step
toward adult-hood
6. Emotional changesand instability from sexual
maturity .
7. May have a Dknow- it - alID attitude
8. May return to habits of a younger child
9. Strong identification with an admired adult.
10. Concerned over his physical attractiveness
11. Seeks both dependence and independence
12. Needs understanding of sexual relationships
and attitudes.
13. Needs adult guidance which does not threaten
seM~ nf freedom
14. Needs acceptance by and conformity with
others
15. Needs assurance of security
16. May have short outbursts of anger
PARAPROFESSIONALRESPONSE
HANDOUT F16
Da2e2 of 2
A DO L ESC EN TS WITH
mE ADOLESCENT
1. Has an urge for constantmovement
2. Has a severely negative self-image
3. May exhibit learnedhelplessness
to a great
degree
4. Has a short attentionspan,distractibility,
preservation
5. Has poor abstractthinking skills
6. May sufferfrom a sensorydeprivation suchas
mild hearingloss,mild speechirregularities
7. May have impulsivity
8. May suffer from emotional lability
9. May haveperceptualmotor problems
10. May movefar too slowly for productive work
11. May suffer mild to severedefici~ in gross
motor activity
12 May suffer mild to severe deficits in fine
motor activity.
D IS A B ILIT IFS
mE PARAPROFF$lONAL
RESPOND
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Transition ServiceInventory
Name
Date of Birth
Age_Grade
.;'!!;!IC~'-
Date Developed
SchooVSite
EMPLOYMENT /POST-SECONDARY EDUCATION OUTCOMES
1. What do you want to do upon graduation from High School?
2. Whatjob areyou interestedin now?
-
0 Summer 0 Part-time
0 Full-time
0 Vol\U1teer 0 Other
3. Preferred working conditions: 0 With people or
0 With things
0 Indoors
or
0 Outdoors
0 Same tasks or
0 Different tasks
0 Day
or
0 Night
4. Have you had any previous work training? 0 Yes 0 No
If yes, what?
5. What careerareyou interestedin?
6. What type of educationwill you need?
0 Adult Education(GED)
0 College(identify) 0 2 year 0 4 year
0 Technicalmstitution (identify)0 Military (identify)
0 Other(identify) DOMESTIC
SKILLS OUTCOMES
- - --7. Who do you plan to live with? 0 Yourself 0 A roommate 0 Parent(s)/Guardian0 Spouse
8. Do youhaveanysignificantmedicalproblems? 0 Yes 0 No
9. Do you know how to seekassistancefor them?
0 Yes 0 No
COMMUNITY FUNCTIONING OUTCOMES
10. Which of thesepersonalill[]s do you have?
0 SocialSecurityCard 0 DriverDsLicense 0 Stateill
0 Birth Certificate
11. What servicesdo you needto help you becomemore independent?
TRA.~SPORTAnON OUTCOMES
--~
12. Do you currentlyhave supportfor transportation? 0 Yes 0 No
If yes,who? 0 Self 0 Parent 0 Friend 0 Co-worker
13. What kind of transportationwill you needafter graduationto get to and from school/work?
RECREATION OUTCOMES
14. What kinds of activities are you interestedin?
D
Sports D Clubs D Hobbies D Other.
15. What kinds of activities are you currently involved in?