CABS Data Sheet

Child’s Name or Number

Classroom or Teacher
Examiner’s Notes

Sex: Race: Date of Birth: Mo Day Year

Date of Test: Mo Day Year Grade

I.Q. Tests and Scores:

Achievements Test and Scores:

Other Tests and Scores:

Special Curriculum Needs:

Notes on Family Status:

Other Data:

CABS

SCORES AGE EQUIVALENT

(1) LD
(2) IF
(3) FRP
(4) EVA
(5) S

TOTAL SCORE

1980 by Humanics Limited ISBN 0.89334.055.3

Bert O. Richmond and Richard H. Kicklighter
 Language Development
Score

0 1 1. How old are you?

0 1 2. How many is that? (Hold up two fingers)

0 1 3. Say this, I am a big boy/girl and I like to play with my friends. (Must
repeat exactly.)

0 1 2 3 4 4. Name something that

(a) You can eat
(b) You can drink
(c) You can ride in or on
(d) Is round
0 1 2 3 4 5. (Ask the child to identify these colors)
(a)blue (b)green (c) red (d) yellow. (Present card A)

0 1 2 3 6. Name 3 kinds of animals that have four legs. (Do not prompt)

0 1 2 3 4 7. Tell me what this letter is. (Point to each letter one at a time. (Present
card B)
(a) A (b) C (c) E (d) D

0 1 2 3 4 8. (Show card B and ask child to write or print each letter)

_______________________________________________________

0 1 2 9. (Ask the child to write or print first and last name)

_______________________________________________________

0 1 2 3 4 10. Read these words out loud to me. (Present card C)

(a) Boy (b) Dog (c) Good (d) Girl
0 1 2 3 4 11. (Ask the child to write or print each word from card C)

________________________________________________________

0 1 12. (Present card D) Tell me what’s happening in this picture.

0 1 13. (Use two or more complex sentences in describing picture. Correct

grammar not necessary)
0 1 2 3 4 14. What do these words mean?
(a) Automobile
(b) Trouble
(c) Elevator
(d) Dangerous

HUMANICS LIMITED 1
 0 1 15. Tell me a short story and I’ll write it down. (Plot, character, ending
necessary.)
0 1 16. ( Present card E) Ask child to read those words:
(a) Huge, (b) future, (c) kind, (d) clean, (e) never

Total Score

HUMANICS LIMITED 2
 Independent Functioning
Score

0 1 2 3 4 5 1. Present card A of (a) knife (b) fork (c) spoon (d) plate (e) glass
Ask the child to name each
0 1 2 3 2. Pictures of knife, fork, spoon and plate.
a) Which one do you eat soup with?
b) Which one do you cut meat with?
c) Which one do you drink out of?
0 1 3. Give pair of paper and scissors. Ask the child to cut out a circle.
0 1 4. Ask to cut out a square
0 1 5. Ask the child to button the shirt, zip jacket, buckle belt, or ties
shoes. (Child’s own or you bring one along).
0 1 6. Show me your right foot.
0 1 7.
(a) Show me your left hand
0 1 8. What is your address?
0 1 9. What is your phone number? (Write it down and check it later; if
none, where calls are made.) ( Aunt’s house, neighbor’s store)
0 1 10. What you should do if you get lost in (name child’s home or
nearest town)?
0 1 11. Where could you find a doctor?
0 1 12. Where could you buy some meat for supper?
0 1 13. Where could you find the phone number of the police or sheriff?
0 1 2 3 14. Present Card B and ask for times indicated
a) 9:00
b) 10:30
c) 1:15
0 1 15. Why should you brush your teeth?
0 1 16. Why should you wash your face?
0 1 17. Where can you buy stamps to mail letter, envelopes and money
orders? (Name one place.)
0 1 18. Name all the days of the weak.
0 1 19. Where do you buy nails and a hammer?
0 1 20. Where do you buy bananas?
0 1 21. Where do you buy cough medicine or a prescription for medicine
from the doctor?
0 1 2 22. Name two ways Children can usually make money.

0 1 2 23. Name two ways a adults can usually make money.

0 1 24. ( Present card C) Ask child to find the phone number of fred Davis,
(Allow 90 seconds)
0 1 25. What number do you dial to call the operator?

HUMANICS LIMITED 3
 0 1 26. If the temperature were 90 degrees F, which would you be likely
to do?
(a) go swimming
(b) wear a coat?
(c) turn up the hear?
0 1 27. Name the town you live in.
0 1 28. Name the country you live in.
0 1 29. Name the current month.
0 1 30. Name the current year.

Total Score

HUMANICS LIMITED 4
 Family Role Performance
Score
0 1 1. (Present card A) Which one is a sister?
0 1 2. How many people are in your family?
0 1 3. (Give three directions to follow in order. Whatever is appropriate
in room, such as, “Take this pencil, touch door, then put pencil on
table.”)
0 1 4. (Present card B) What is this?
0 1 2 3 5. A father is a man.
A mother is a _________.
A brother is a _________.
A sister is a ___________.
0 1 6. Tell me a story about something that happened in your family last
week. (If no response – today, or sometime. Credit if mentions one
person other than self in family – story may have useful clinical
content.)
0 1 7. Do you have a dog (cat) at home? What is its name? (If “no,” what
is name of neighbor’s dog or cat?)
0 1 2 8. Do you have any jobs or chores that you usually do at home?
0 1 9. Which one do you use to make bread? (Name: carrot, jelly, flour,
cheese)
0 1 2 3 4 10. (Present card c) What do you use this for?
a) Broom
b) Towel
c) Clock
d) Telephone
0 1 2 11. Tell me two ways to cook an egg
0 1 2 12. What do you
a) Cook beans or peas in?
b) Do to learn about the news?
0 1 2 13. What would you do if your house caught on fire and nobody was
home but you? (If response is put it out – suppose you couldn’t
then what?)
0 1 2 3 4 5 14. (Present card D) In
a) Which room do you cook a hamburger?
b) Which room do you sleep?
c) Which room do you keep your toothbrush?
d) Which room do you sit, and watch T. V. or sit and talk to your
parents?
e) What do you do in this room? (Point to dining room.)
0 1 15. (Present card E) Ask which is the better house.
0 1 2 3 4 16. (If correct answer, ask for 4 things that you could do to make the
other one better.)
0 1 2 3 17. How old do you have to be to –

HUMANICS LIMITED 5
 a) Vote?
b) Get a full-time job?
c) Drive a car?
0 1 18. Tell me how to fix any food for yourself (except a sandwich).
0 1 2 19. If you came home from school, found no one else at home, a
window was broken out and you noticed that your T. V. was gone,
what would you do?
0 1 2 20. What do you do if you see a car wreck in front of your house?

Total Score

HUMANICS LIMITED 6
 Socialization
Score

0 1 2 3 4 1. What is your first and last name? your mother’s first name? your
father’s first name?
0 1 2. If you have two dolls (balls) and your best friend had none, what
would you do?
0 1 3. What would you say if you bump into someone without meaning
to?
0 1 4. What should you say if someone gives you a piece of candy?
0 1 2 5. What should you do if your little brother or sister cuts their finger at
home and your parents are not there? ( independent answer – 2,
dependent – 1)
0 1 2 3 6. (Present Card A)
(a) Identify emotions of each face
(b) Which face do you use when you fall down and hurt your knee?
(c) Which face do you use when you play a game with your parents?
0 1 2 3 7. Show me how you look when your mother (present card A)
(b) Gives you a candy
(c) Is angry with you
(d) Has a surprise for you
0 1 8. (Present card B) say let’s pretend you are in the picture. Put your
finger on the one that would be you.

0 1 9. (Present card B & A) say pretend this is you at new school for the
first time. Which of these three faces show how you would feel
about joining the other children?
0 1 10. (Present cards C & A) say: pretend this is your family together.
Which of these faces show how you feel when you are with your
family?
0 1 11. What should you do if a little kid called you a bad name?
0 1 12. What should you do if you found a billfold ( purse) on the ground
with two dollars in it ?
0 1 13. When you go home from school do you prefer to play by yourself or
with others?
0 1 14. At recess would you rather play with just one friend or with several
friends?
0 1 15. What should you do if your best friend asked you for an answer
during a test?
0 1 16. Tell me a joke or something that is funny (Ask what’s funny if not
clear.)
0 1 2 3 17. Name three games you can play with other children on the
playground.

HUMANICS LIMITED 7
 0 1 18. Which game can you play by yourself?
a) Jumping rope
b) Baseball
c) Red Rover

0 1 19. What could you do to make your father (mother) happy?

0 1 20. A boy who lost his basketball would feel ___________________.
0 1 21. A girl who found a quarter would feel ___________________.
0 1 22. A boy who got a bad grade on his report card would feel
____________.
0 1 23. What should you do if you lose your reading book?
0 1 24. If your class put on a play, would you like a part in it?
0 1 2 3 25. If you move into a new neighbourhood (or school), name three
things you could do to make new friends.
0 1 26. Why should we take turns?
0 1 27. Why do grownups have to work?
0 1 28. Why do we need to have laws?

Total Score

HUMANICS LIMITED 8
 Economic - Vocational Activity
Score

0 1 2 1. Which is more?(Show blocks or any similar object)

(a) Show 4 blocks and 2 blocks
(b) Show 8 blocks and 6 blocks
0 1 2. (Present card A ) Which costs more?
0 1 2 3 3. (Present card B ) Which one is a dentist?
Which one is a farmer
Which one is a cook?
0 1 4. Which one do you use to fix a car? (Present card C; if hammer is chosen,
ask to explain)
0 1 2 3 4 5. Which costs more?
(a) car- bicycle
(b) candy-watch
(c) coat-shirt
(d) baseball-radio
0 1 6. Where do you get your car worked on? (If answer is “at home “ask: if a
stranger is in town has trouble with his car, where would he get it
fixed?)
0 1 7. Where does a nurse usually work?
0 1 8. What does a plumber do?
0 1 2 3 4 9. (Present card D)
(a) Which one would you usually use to fix your bicycle?
(b) Which one would you usually use to make a dress?
(c) Which one would you usually use to make a breakfast?
(d) Which one would you usually use if you were a carpenter?
0 1 2 3 4 10. (Show penny, nickel, dime, quarter) Ask child to name each.)
0 1 11. (Show penny, nickel, dime, quarter.) Which is worth more or will buy
the most?
2 3 4 12. Show me the one that is worth the smallest amount. (then the next,
the next, then the most)
0 1 13. Choose the coins that add up to a dollar. ( Display 3 quarters, 3
times, 3 nickels, 3 pennies)
0 1 2 14. Ask child to give you the following amount of money.
(a)75 cents
(b)98 cents
0 1 2 15. Give the correct change from $1.00 for a purchase of 27d: 35d.
0 1 16. About how much does a can of a soft drink (pop, soda, etc.) cost?
0 1 17. About how much does a small candy bar cost?
0 1 18. How much does a stamp cost to mail a letter?
1 2 3 19. Who make more money?
(a)teacher- principal
(b)engineer- janitor

HUMANICS LIMITED 9
 (c)gas station attendant- doctor

Total Score

HUMANICS LIMITED 10