Teacher Report Part II - Student Asessment

Teacher Report Part II – Student Assessment

Social Skills Questionnaire - TEACHER FORM

Grades 1-6

Thank you, in advance, for responding to the following questions. This survey is designed for you to rate the social skills and academic competence of specific children in your classroom. It should take approximately 10-15 minutes per student to complete.

Please contact Dr. Barbara Dietsch with any questions at 562.799.5126 or by email at bdietsc@wested.org

Read each item (items 1-48) and think about this student’s behavior during the past month or two. Decide how often the student does the behavior described.

If the student never does this behavior, mark the

If the student sometimes does this behavior, circle the 1

If the student very often does this behavior, circle the 2

Here are two examples:

	How Often?
	Never	Sometimes	Very Often
Shows empathy for peers.	1	2	3 
Asks questions of you when unsure of what to do in schoolwork.	1	2 	3
This student very often shows empathy for classmates. Also, this student sometimes asks questions when unsure of schoolwork.

Please do not skip any items. In some cases you may not have observed the student perform a particular behavior. Make an estimate of the degree to which you think the student would probably perform that behavior.

Social Skills	How Often?
	Never	Sometimes	Very Often
1. Controls temper in conflict situations with peers.	1	2	3
2. Introduces herself or himself to new people without being told.	1	2	3
3. Appropriately questions rules that may be unfair.	1	2	3
4. Compromises in conflict situations by changing own ideas to reach agreement.	1	2	3
5. Responds appropriately to peer pressure.	1	2	3
6. Says nice things about himself or herself when appropriate.	1	2	3
7. Invites others to join in activities.	1	2	3
8. Uses free time in an acceptable way.	1	2	3
9. Finishes class assignments within time limits.	1	2	3
10. Makes friends easily.	1	2	3
11. Responds appropriately to teasing by peers.	1	2	3
12. Controls temper in conflict situations with adults.	1	2	3
13. Receives criticism well.	1	2	3
14. Initiates conversations with peers.	1	2	3
15. Uses time appropriately while waiting for help.	1	2	3
16. Produces correct schoolwork.	1	2	3
17. Appropriately tells you when he or she thinks you have treated him or her unfairly.	1	2	3
18. Accepts peers’ ideas for group activities.	1	2	3
19. Gives compliments to peers.	1	2	3
20. Follows your directions.	1	2	3
21. Puts work materials or school property away.	1	2	3
22. Cooperates with peers without prompting.	1	2	3
23. Volunteers to help peers with classroom tasks.	1	2	3
24. Joins ongoing activity or group without being told.	1	2	3
25. Responds appropriately when pushed or hit by other children.	1	2	3
26. Ignores peer distractions when doing class work.	1	2	3
27. Keeps desk clean and neat without being reminded.	1	2	3
28. Attends to your instructions.	1	2	3
29. Easily makes transition from one classroom activity to another.	1	2	3
30. Gets along with people who are different.	1	2	3

Problem Behaviors	How Often?
	Never	Sometimes	Very Often
31. Fights with others.	1	2	3
32. Has low self-esteem.	1	2	3
33. Threatens or bullies others.	1	2	3
34. Appears lonely.	1	2	3
35. Is easily distracted.	1	2	3
36. Interrupts conversations of others.	1	2	3
37. Disturbs ongoing activities.	1	2	3
38. Shows anxiety about being with a group of children.	1	2	3
39. Is easily embarrassed.	1	2	3
40. Doesn’t listen to what others say.	1	2	3
41. Argues with others.	1	2	3
42. Talks back to adults when corrected.	1	2	3
43. Gets angry easily.	1	2	3
44. Has temper tantrums.	1	2	3
45. Likes to be alone.	1	2	3
46. Acts sad or depressed.	1	2	3
47. Acts impulsively.	1	2	3
48. Fidgets or moves excessively.	1	2	3

The next nine items require your judgments of this student’s academic or learning behaviors as observed in your classroom. Compare the student with other children who are in the same classroom.

Rate all items using a scale of 1 to 5. Circle the number that best represents your judgment. The number 1 indicates the lowest or least favorable performance, placing the student in the lowest 10% of the class. Number 5 indicates the highest or most favorable performance, placing the student in the highest 10% compared with other students in the classroom.

	Lowest 10%	Next Lowest 20%	Middle 40%	Next Highest 20%	Highest 10%
49. Compared with other children in my classroom, the overall academic performance of this child is:	1	2	3	4	5
50. In reading, how does this child compare with other students?	1	2	3	4	5
51. In mathematics, how does this child compare with other students?	1	2	3	4	5
52. In terms of grade-level expectations, this child’s skills in reading are:	1	2	3	4	5
53. In terms of grade-level expectations, this child’s skills in mathematics are:	1	2	3	4	5
54. This child’s overall motivation to succeed academically is?	1	2	3	4	5
55. This child’s parental encouragement to succeed academically is?	1	2	3	4	5
56. Compared with other children in my classroom this child’s intellectual functioning is:	1	2	3	4	5
57. Compared with other children in my classroom this child’s overall classroom behavior is:	1	2	3	4	5

Repeated for each child in the SSRS sample.

28

Permission to use specific items may be required