Student Behaviour Profile

Student name:
Completed by:
Date:

The purpose of the interview is to get more information about the child’s reinforcers
(likes/dislikes), his/her social behaviour, communication problems, self-help skills, task
persistence and additional information. The information gathered will be useful in planning
the individual educational plan and in helping both parents and teachers to work together as
a team in implementing the child’s program successfully.

Section A: Social Behaviour

1. What is her/his most challenging/difficult behaviour?

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2. How do you handle/respond to the challenging/difficult behaviour?

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3. Does s/he identify/recognize individuals who are familiar to her/him?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

4. How does s/he react/do to show that s/he identify/recognize individuals?

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5. Does s/he identify/recognize things/objects that are familiar to her/him?

All the time Very often Sometimes Rarely Never

1 2 3 4 5
6. How does s/he recognize things/objects?
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7. Does your child express/shows emotion towards others?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

8. How does your child express/shows happy emotion towards others?

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9. Does your child express/shows sad emotion towards others?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

10. How does your child express/shows sad emotion towards others?
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11. Does your child express/shows anger emotion towards others?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

12. How does your child express/shows anger emotion towards others?
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13. Does your child express/shows fear emotion towards others?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

14. How does your child express/shows fear emotion towards others?
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15. Does s/he comply/follow with any rules or instructions?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

16. Do you let your child have freedom to behave /do activity anyway they choose at
home?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

17. Did you bring your child with you to any events?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

18. When attending the events, how does s/he act or behave?
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19. Does s/he participate in cooperative play with other kids, siblings, or adults?

All the time Very often Sometimes Rarely Never

1 2 3 4 5
20. Specified.
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21. Does s/he annoy/disturb/bother other kids/siblings?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

22. Does s/he like being touched?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

23. Does s/he like being tickled?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

24. What usually works best to calm her/him down when she/he is upset or crying?
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25. Does s/he react to sound that are within the range of typical speaking volume?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

26. Described the sounds, and how s/he makes them.

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27. How does s/he react/respond when hear loud noises?
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28. When playing, does s/he act appropriately?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

29. Does s/he recognise the danger/threat?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

30. Does s/he have effort to kept her/himself safe?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

31. Does s/he take very good care of her/his toys? (clean up after playing, keep them
properly)

All the time Very often Sometimes Rarely Never

1 2 3 4 5

32. Does s/he break toys when s/he play?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

33. If yes, when does this usually happen?

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Section B: Communication

1. How does your child make requests when s/he need something?
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2. How does your child communicate at home?

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3. What language are the parents using at home to speak/communicate with the child?
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Section C: Self help skills

1. What kind of food would s/he be able to eat? (Can s/he chew, consume solid food, or
only soft food?
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2. Can s/he feed himself using hands?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

3. Can s/he feed himself using forks?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

4. Can s/he feed himself using spoons?

All the time Very often Sometimes Rarely Never

1 2 3 4 5
5. Does s/he wash her/his hands and faces by her/himself?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

6. Has s/he been toilet/potty trained?

Yes No

7. How will your child let you know if s/he has to use the restroom/toilet?
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8. Can s/he finds her/his way to restroom/toilet subsequently?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

9. Can s/he leave the bathroom/washroom clean and tidy?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

10. Does s/he use bathroom/washroom appropriately?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

11. Does s/he UNDRESS her/himself or do you have to assist/help her/him?

All the time Very often Sometimes Rarely Never

1 2 3 4 5
12. Does s/he DRESS her/himself or do you have to assist/help her/him?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

13. Does s/he make her/his own dress choices?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

14. Will s/he perform basic housework tasks like sweeping the floor, setting things in
their proper places, washing the dishes?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

15. What homework task that she like to perform?

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Section D: Task persistance

1. Is s/he capable to complete a given task on their own?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

2. Specified the task.

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3. How long does s/he need to complete/finish the task?

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4. Does s/he seek for assistance in completing/finishing the task?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

5. Does s/he require consistent guidance to complete the task?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

Section E: Additional information

1. Does s/he have any allergies or health issues/allergies?

Yes No

2. Please specify the allergies or health issues/allergies.

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3. Does your child receive any treatment?

Yes No

4. If yes, please specify. (Speech, oral, tactile, etc.).

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5. How does your child act when meeting someone unfamiliar to them? Such as a
barber, a dentist, a physiotherapist, etc.
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6. Does s/he have a sleeping problem?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

7. Please describe the sleeping habits of your child.

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8. Do you provide her or him with anything to aid in falling asleep?

All the time Very often Sometimes Rarely Never

1 2 3 4 5

9. What is the biggest accomplishment you hope for your child following the NASOM
intervention programme?
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10. Will you cooperate with NASOM to make your child's accomplishment a reality?
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