Social Skills Checklist (Elementary) – 1 –


Name of child: ______________________ Date: _______________________ Birth date: __________________________ Assessor’s name: _______________ Instructions: For each question, check if that particular social skill occurs Almost Always, Often, Sometimes, or Almost Never.

RATING SCALE Almost always- the student consistently displays this skill in many settings and with a variety of people

Often- the student displays this skill on a few occasions, settings and with a few people

Sometimes- the student seldom displays this skill but may demonstrate it on infrequent occasions.

Almost Never- the student never or rarely exhibits this skill. It is uncommon to see this in their daily routine.

SOCIAL PLAY & EMOTIONAL DEVELOPMENT Almost Always Often Sometimes Almost

Never 1.1 Beginning Play Behaviors

1. Maintains proximity to peer within 1 foot

2. Observes peers in play vicinity within 3 feet

3. Parallel play near peers using the same or similar materials (e.g., playing cars near a peer who is also playing cars)

4. Physically imitates peer 5. Verbally imitates peer 6. Takes turns appropriately during simple games

1.2 Intermediate Play Behaviors 1. Shares toys and talks about the activity with peers, even

though the play agenda of the other children is different

2. Physically and verbally responds to interactions from peers (accepts toy from peer, answers questions)

3. Returns and initiates greetings with peers 4. Know appropriate ways of joining in an activity with peers 5. Invites others to play 6. Takes turns during structured activities 7. Obeys game rules 8. Requests toys, food, and materials from peers

1.3 Advanced Play Behavior 1. Plays cooperatively with peers during imaginative play 2. Makes comments about what he/she is playing to peers 3. Organizes play (suggests ideas to peers on how to play) 4. Follows peer play plans 5. Takes turns during unstructured activities without a time


6. Offers toys, food, and materials to peers

Social Skills Checklist (Elementary) – 2 –

EMOTIONAL REGULATION Almost Always Often Sometimes Almost

Never 2.1 Understanding Emotions

1. Identifies likes and dislikes 2. Identifies emotions in self 3. Identifies emotions on others 4. Justifies emotions once identified (eating because I’m


5. Demonstrates affection and empathy toward peers 6. Refrains from aggressive behaviors toward peers 7. Refrains from aggressive behaviors toward self 8. Does not exhibit intense fears or phobias 9. Interprets body language 10. Uses different tones of voice to convey messages

2.2 Self Regulation 1. Allows others to comfort him/her if upset or agitated 2. Self regulates when tense or upset 3. Self regulates when energy level is high 4. Deals with being teased in acceptable ways 5. Deals with being left out of a group 6. Accepts not being first at a game or activity 7. Accepts losing at a game without becoming upset/angry 8. Says “no” in acceptable way to things he/she does not want

to do

9. Accepts being told “no” without becoming upset/angry 10. Able to say “I don’t know” 11. Able to end conversations appropriately

2.3 Flexibility 1. Accepts making mistakes without becoming upset/angry 2. Accepts consequences of his/her behavior 3. Accepts unexpected changes 4. Continues to try when something is difficult 5. Ignores others or situations when it is desirable to do so

2.4 Problem Solving 1. Identifies/defines problems 2. Generates solutions to problems 3. Carries out solutions by negotiating or compromising 4. Understands impact his/her behavior has on peers

Social Skills Checklist (Elementary) – 3 –

COMMUNICATION SKILLS Almost Always Often Sometimes Almost

Never 3.1 Conversational Skills

1. Initiate conversation when it is appropriate to do so 2. Initiates conversation around specific topic 3. Asks “Wh” questions 4. Responds to “Wh” questions 5. Makes a variety of comments, related to the topic during


6. Introduces him/herself to someone new 7. Introduces people to each other 8. Ends conversations appropriately

3.2 Nonverbal Conversational Skills 1. Maintains appropriate proximity to conversation partner 2. Orients body toward speaker 3. Pays attention to a person’s nonverbal language and

understands what is being communicated

4. Waits to interject 3.3 Compliments

1. Gives appropriate compliments to peers

2. Appropriately receives compliments

3. Asks for a favor appropriately

4. Apologizes independently

Social Skills Checklist (Elementary) – 4 –


Total % Marked

as Almost Always

Total % Marked as


Total % Marked as Sometimes

Total % Marked as

Almost Never 1.1 Beginning Play Behaviors

1.2 Intermediate Play Behaviors

1.2 Advanced Play Behaviors

2.1 Understanding Emotions

2.2 Self Regulation

2.3 Flexibility

2.4 Problem Solving

3.1 Conversational Skills

3.2 Nonverbal Conversational Skills

3.3 Compliments

Calculation: For each section, calculate the percentage of questions marked as Almost Always, Often, Sometimes, and Almost Never. To calculate, total the number of questions checked under the category in that specific section and divide by the total number of questions in the section, then multiply by 100.

Example: To calculate the total % of components marked “Almost Always” under the Beginning Play Behaviors section, first total the # of questions checked “Almost Always” in that section. Then, determine the # of total questions under Beginning Play Behaviors. Divide the # of questions checked by the total # of questions and then multiply by 100.

________ questions marked “Almost Always” ÷ 6 total questions, x 100 = _______ %