AGES

0–5
Parent/Primary Caregiver Form

ABAS-3
TM

Adaptive Behavior Assessment System TM

Third Edition
Patti L. Harrison, PhD Thomas Oakland, PhD

Child Information

Name of child being evaluated (first, middle, last) Sex

Female Male

Today’s date Date of birth Age Grade

Years:   Months:

School City State

Race/Ethnicity

Does the child being evaluated have any disabilities or other limitations?

Yes No If yes, please describe:

Parent/Caregiver Information

Parent/Caregiver’s name (first, last) Occupation

Number of siblings the child has at home

None 1 2 3 or more

Your relationship to the child you are rating

Parent Guardian Grandparent

Other (describe):
 Directions

The Adaptive Behavior Assessment System, Third Edition, measures important behaviors a child displays at
home, school, and in other settings. The behaviors included on this questionnaire range from those suitable
for infants to those suitable for young children. Some items may seem too difficult for infants while others
may seem too easy for young children. Therefore, the individual you are rating is likely to perform some but not
all behaviors included on this questionnaire.

Please read and answer all items.

Please read each item carefully and rate the child’s performance of the behavior. Select only one response
(0, 1, 2, or 3) according to the guidelines below. Please provide a response to every item, even if some items do
not seem to apply to the child’s age group or are difficult to rate.

Record your answer by circling 0, 1, 2, or 3.

If you know that the child is unable to perform the behavior, circle 0 on the rating scale.
0 Is not able to do this behavior
If you know that the child is able to perform the behavior, rate how often he or she performs the behavior when
needed without reminders and without help.
1 Never (or almost never)
2 Sometimes
3 Always (or almost always)
Please circle only one rating of 0, 1, 2, or 3 for each item.

Indicate when your answer is a guess or estimate.

You may not have seen the child perform the specific behavior described in an item. If this is the case, you
may guess if you know how the child performs similar behaviors. If your rating is based on a guess, first circle
0, 1, 2, or 3, then check the box in the “Check only if you guessed” column.
Check the box in this column only if your rating is based on a guess or estimate.

Additional copies of this form (W-621A) may be purchased from WPS. Please contact us at 800.648.8857 or www.wpspublish.com.
Copyright © 2015 by Western Psychological Services. Not to be reproduced, adapted, and/or translated in whole or in part
without prior written permission of WPS (rights@wpspublish.com). All rights reserved. Printed in USA. 9 8 7 6 5 4 3 2 1
 The following examples show how to complete the questionnaire.
BEHAVIOR RATINGS

Ability Frequency
Never (or Sometimes Always (or Check
Is not almost never) when almost always) ONLY if you
able when needed needed when needed GUESSED

4. Raises and lowers voice to express different feelings or needs. 0 1 2 3

5. Says the names of other people (for example, “Mama,” “Daddy,” or names 0 1 2 3
of friends).

6. Follows simple commands (for example, “No” or “Come here”). 0 1 2 3

7. Uses one or more words to get something he or she wants, even if the word 0 1 2 3
is not said correctly or pronounced well.

··
Item 4 is rated 3 because this child always (or almost
always) raises and lowers his or her voice to express dif-
··Item 6 is rated 1 because, although this child is able
to follow simple commands, he or she never (or almost
ferent feelings or needs, when needed, without reminders never) does so when needed.
and without help.

··
Item 5 is rated 2 because this child sometimes says the
··Item 7 is rated 0 because this child is not able to use one
or more words to get something he or she wants, even if
names of other people. In this case, the rater also checked the word is not said correctly or pronounced well.
the box in the “Check only if you guessed” column because
their response was a guess or estimate.

The following table is provided to further assist you in filling out this questionnaire.
Rating The child:

0 ····cannot perform the behavior;

is too young to have tried the behavior;

····
Is not able
does not have the skill to perform the behavior;
has not been taught to perform the behavior; or

··has some limitation that prevents performing the behavior.

1 is able to perform the behavior, but

Never
(or almost never)
····
never or almost never does it when needed;
never or almost never does it without being reminded;
when needed
····
another person does it for the child instead of the child doing it; or
refuses to perform the behavior.

2 is able to perform the behavior, but

Sometimes
when needed
····
only does it sometimes when needed;
sometimes does it without help, but sometimes needs help; or

··
sometimes does it on his or her own, but sometimes needs to be reminded.

3 is able to perform the behavior, and

Always
(or almost always)
····
does it most or all of the time without help and without being reminded; or
displayed the behavior at a younger age but has now outgrown it.
when needed

Check ONLY if
After you rate an item 0, 1, 2, or 3, fill in the square in this column if:
you GUESSED

····your rating was a guess or estimate;

you have not had the opportunity to see the child perform this behavior; or

·· you have seen the child perform similar behaviors, but not this one.

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 3

 BEHAVIOR RATINGS

Ability Frequency

Communication Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Looks at other people’s faces when they are talking to him or her. 0 1 2 3

2. Looks up or smiles when someone says his or her name. 0 1 2 3

3. Laughs when a parent or other person laughs. 0 1 2 3

4. Raises and lowers voice to express different feelings or needs. 0 1 2 3

5. Says the names of other people (for example, “Mama,” “Daddy,” or names 0 1 2 3
of friends).

6. Follows simple commands (for example, “No” or “Come here”). 0 1 2 3

7. Uses one or more words to get something he or she wants, even if the word 0 1 2 3
is not said correctly or pronounced well.

8. Shakes head or says “Yes” or “No” in response to a simple question (for 0 1 2 3

example, “Do you want something to drink?”).

9. Points to common items in a room when asked (for example, “Show me 0 1 2 3

the TV”).

10. Repeats words others say (for example, says “baby” when an adult says 0 1 2 3
“baby”).

11. Says phrases with at least two words (for example, “My book”). 0 1 2 3

12. Says the name of an object clearly enough that others recognize it (for 0 1 2 3
example, “ball,” “dog,” “cup”).

13. Listens closely for at least 1 minute when people talk. 0 1 2 3

14. Speaks clearly enough that others who do not know him or her can 0 1 2 3
understand most of what is said.

15. Follows simple, one-step directions that include “over” or “under” (for 0 1 2 3
example, “Put your hands over your head”).

16. Refrains from repeating what he or she says over and over again. 0 1 2 3

17. Names 20 or more familiar objects. 0 1 2 3

18. Sings all or part of the words to songs. 0 1 2 3

19. Makes plurals of words by adding an -s (for example, “shoes,” “socks,” 0 1 2 3

“dogs”).

20. Uses sentences with a noun and verb. 0 1 2 3

21. Tells parent, friends, or others about his or her favorite activities. 0 1 2 3

22. Asks questions such as “Will you play with me?” 0 1 2 3

23. Speaks in sentences of six or more words. 0 1 2 3

24. Uses past tense to talk about prior events (for example, “I stayed inside”). 0 1 2 3

25. Has a conversation with another person for at least 3 minutes. 0 1 2 3

26. Waits for others to finish what they are saying, without interrupting. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 78

Total guessed

4 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5

 BEHAVIOR RATINGS

Community Use Ability

Never (or
Frequency
Sometimes Always (or Check
Do not complete this skill area if the child being rated is younger than 1 year old. Is not almost never) when almost always) ONLY if you
able when needed needed when needed GUESSED

1. Stays with parents or other family members in a store and does not 0 1 2 3
wander off.

2. Recognizes own home in his or her immediate neighborhood. 0 1 2 3

3. Walks on sidewalk rather than street. 0 1 2 3

4. Informs parents when someone comes to the door. 0 1 2 3

5. Shows respect for public property (for example, throws trash in cans, does 0 1 2 3
not damage property).

6. Obeys an adult’s request to “don’t touch” items when shopping. 0 1 2 3

7. Asks to go to a park or other favorite community place. 0 1 2 3

8. Knocks on a door or rings the doorbell before entering another person’s 0 1 2 3

home.

9. Refrains from talking loudly in a public place (for example, in a theater, 0 1 2 3

movie, or church).

10. Remains seated during a religious service or a movie. 0 1 2 3

11. Asks to eat in a favorite restaurant. 0 1 2 3

12. Recognizes and names buildings (for example, hospital, gas station, fire 0 1 2 3
department).

13. Identifies neighborhood locations where his or her family obtains needed 0 1 2 3
items (for example, where to buy food).

14. Recognizes the need to pay for an item before leaving a store. 0 1 2 3

15. Describes the duties of workers (for example, says that firefighters put out 0 1 2 3
fires and doctors help the sick).

16. Looks both ways before crossing a street or parking lot. 0 1 2 3

17. Asks to go to the library. 0 1 2 3

18. Finds the restroom in public places. 0 1 2 3

19. Orders own meals when eating out. 0 1 2 3

20. Makes a small purchase at a food store. 0 1 2 3

21. Carries enough money to make small purchases (for example, a soft drink). 0 1 2 3

22. Walks alone to friends’ houses or apartments in the neighborhood. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 66

Total guessed

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 5

 BEHAVIOR RATINGS

Functional Pre-Academics Ability

Never (or
Frequency
Sometimes Always (or Check
Do not complete this skill area if the child being rated is younger than 1 year old. Is not almost never) when almost always) ONLY if you
able when needed needed when needed GUESSED

1. Points to at least one body part when asked (for example, “head” or “leg”). 0 1 2 3

2. Turns book pages one by one. 0 1 2 3

3. Points to pictures in books when asked (for example, points to a horse 0 1 2 3

or cow).

4. Counts three or more objects. 0 1 2 3

5. States his or her age in years when asked. 0 1 2 3

6. Sings the alphabet song. 0 1 2 3

7. Names six or more colors, including red, blue, and yellow. 0 1 2 3

8. Names four or more shapes (for example, circle, square, rectangle, 0 1 2 3

triangle).

9. Recites nursery rhymes from memory. 0 1 2 3

10. Reads his or her name when printed. 0 1 2 3

11. Names at least two letters when shown his or her name. 0 1 2 3

12. Identifies at least one coin by name (for example, penny or dime). 0 1 2 3

13. Answers simple questions about a story read to him or her. 0 1 2 3

14. Counts 10 or more objects without using fingers. 0 1 2 3

15. Draws a recognizable face that includes two eyes, a nose, a mouth, and hair. 0 1 2 3

16. Names most letters when shown the alphabet. 0 1 2 3

17. Counts from 1 to 20. 0 1 2 3

18. Prints at least two letters in his or her name. 0 1 2 3

19. Reads and obeys common signs (for example, Do Not Enter, Exit, Stop). 0 1 2 3

20. States the days of the week in order. 0 1 2 3

21. Writes or prints his or her first and last name. 0 1 2 3

22. Writes numbers 1 through 10 correctly. 0 1 2 3

23. Tells which day comes before another (for example, “Wednesday comes 0 1 2 3
before Thursday”).

24. States days and times of favorite after-school activities, such as sports 0 1 2 3
practice, music lessons, or television shows.

FOR EXAMINER USE ONLY Raw total 72

Total guessed

6 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5

 BEHAVIOR RATINGS

Home Living Ability

Never (or
Frequency
Sometimes Always (or Check
Do not complete this skill area if the child being rated is younger than 1 year old. Is not almost never) when almost always) ONLY if you
able when needed needed when needed GUESSED

1. Removes cookies, chips, or other food from a box or bag. 0 1 2 3

2. Shows concern when he or she spills something (for example, says “Oh no” 0 1 2 3
or tells an adult).

3. Points to where commonly used foods are kept in his or her home (for 0 1 2 3
example, the refrigerator).

4. Points to the place where his or her clothes are stored. 0 1 2 3

5. Takes a shirt or other piece of clothing out of a drawer when asked. 0 1 2 3

6. Assists other people with putting away toys, games, and other items. 0 1 2 3

7. Picks up and throws away trash or paper at home. 0 1 2 3

8. Does a simple errand when asked (for example, runs to get a towel for a 0 1 2 3
spill).

9. Refrains from kicking or hitting furniture. 0 1 2 3

10. Turns television on and off. 0 1 2 3

11. Refrains from throwing food or paper on the floor. 0 1 2 3

12. Washes hands without splashing water on the floor. 0 1 2 3

13. Gets own snacks from cabinet or pantry. 0 1 2 3

14. Assists adults with preparing simple snacks or meals (for example, hands 0 1 2 3
slices of bread to adult for making sandwiches).

15. Places dirty clothes in the proper place (for example, a hamper or clothes 0 1 2 3
basket).

16. Wipes up spills at home. 0 1 2 3

17. Takes own clothes from drawers or closet when getting dressed. 0 1 2 3

18. Keeps dirty shoes and feet off furniture. 0 1 2 3

19. Puts his or her own dirty glass or plate in the sink or dishwasher. 0 1 2 3

20. Puts things in their proper places when finished using them. 0 1 2 3

21. Keeps toys, games, and other belongings neat and clean. 0 1 2 3

22. Disposes of his or her leftover food. 0 1 2 3

23. Pours liquid from a larger container into own cup or glass without spilling. 0 1 2 3

24. Makes his or her bed. 0 1 2 3

25. Folds clean clothes. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 75

Total guessed

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 7

 BEHAVIOR RATINGS

Ability Frequency

Health and Safety Is not

able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Swallows liquid medicines as needed, without fussing. 0 1 2 3

2. Sits still in high chair, booster seat, or chair, without climbing or sliding off. 0 1 2 3

3. Avoids bumping into walls or objects when crawling or walking. 0 1 2 3

4. Allows temperature to be taken without fussing. 0 1 2 3

5. Shows, points to, or tells another person about a cut, bruise, or other minor 0 1 2 3
injury.

6. Follows another person’s direction to “stop” when near danger, such as fire 0 1 2 3
or broken glass.

7. Points to the body part that hurts when he or she is sick or injured. 0 1 2 3

8. Remains fairly still when an adult treats a cut or scrape. 0 1 2 3

9. Refrains from putting non-edible objects in mouth (for example, crayons, 0 1 2 3

blocks, sand).

10. Avoids getting too near a fire, broken glass, or other potential danger. 0 1 2 3

11. Avoids touching or playing with dangerous items (for example, insect spray 0 1 2 3
or sharp knives).

12. Avoids crawling or climbing on high or dangerous places. 0 1 2 3

13. Tells an adult if he or she has a stomachache or other illness. 0 1 2 3

14. Tests hot foods before eating them. 0 1 2 3

15. Puts on a coat or sweater when cold. 0 1 2 3

16. Carries breakable objects safely and carefully. 0 1 2 3

17. Asks an adult before going near something that might be dangerous (for 0 1 2 3
example, animals, busy streets, or high playground equipment).

18. Buckles own car seat or seat belt. 0 1 2 3

19. Carries scissors safely. 0 1 2 3

20. Carries hot containers safely and carefully. 0 1 2 3

21. Uses electrical outlets or sockets safely. 0 1 2 3

22. Cares for own minor injuries (for example, paper cuts, knee scrapes, 0 1 2 3
nosebleeds).

FOR EXAMINER USE ONLY Raw total 66

Total guessed

8 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5

 BEHAVIOR RATINGS

Ability Frequency

Leisure Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Smiles or shows interest when he or she sees a favorite toy. 0 1 2 3

2. Plays with a variety of toys instead of only one or two. 0 1 2 3

3. Plays with a single toy or game for at least 1 minute. 0 1 2 3

4. Plays alone with toys and games, or does other fun activities. 0 1 2 3

5. Plays simple games like “peek-a-boo” or rolls a ball to others. 0 1 2 3

6. Looks with an adult at pictures in books or magazines. 0 1 2 3

7. Watches for a few minutes as people play with toys or games. 0 1 2 3

8. Shows interest in a toy or other object by pointing to it. 0 1 2 3

9. Chooses a game or toy during playtime. 0 1 2 3

10. Plays with toys, games, or other fun items with others. 0 1 2 3

11. Plays with a single toy or game for more than 5 minutes. 0 1 2 3

12. Plays on playground equipment. 0 1 2 3

13. Asks to be read to from a favorite book. 0 1 2 3

14. Attends fun activities at another’s home. 0 1 2 3

15. Engages in imaginary or make-believe play with others. 0 1 2 3

16. Participates regularly in a specific fun activity (for example, listening to a 0 1 2 3

certain type of music or playing a favorite computer game).

17. Plays simple games with playmates without adult supervision. 0 1 2 3

18. Invites others to join him or her in playing games and other fun activities. 0 1 2 3

19. Saves things of interest (for example, rocks, feathers, pictures). 0 1 2 3

20. Waits for his or her turn in games and other fun activities. 0 1 2 3

21. Follows the rules in games and other fun activities. 0 1 2 3

22. Invites others home for a fun activity. 0 1 2 3

23. Plays simple board games. 0 1 2 3

24. Participates in an organized program for a sport or hobby (for example, 0 1 2 3

practices basketball or takes a music class).

FOR EXAMINER USE ONLY Raw total 72

Total guessed

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 9

 BEHAVIOR RATINGS

Ability Frequency

Self-Care Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Swallows liquids without difficulty. 0 1 2 3

2. Sleeps through most of the night, waking no more than one or two times. 0 1 2 3

3. Swallows soft, strained, or mashed food such as baby food or applesauce. 0 1 2 3

4. Opens mouth when offered food on a spoon. 0 1 2 3

5. Feeds himself or herself crackers, cookies, dry cereal, or other finger foods. 0 1 2 3

6. Eats firm foods that require biting and chewing (for example, steamed 0 1 2 3
vegetables).

7. Drinks from a cup or glass, even if another person must hold it. 0 1 2 3

8. Lifts arms as needed when another person is dressing or undressing him 0 1 2 3

or her.

9. Points to or asks for food when hungry. 0 1 2 3

10. Takes shoes off. 0 1 2 3

11. Feeds himself or herself with a spoon or fork, not hands. 0 1 2 3

12. Washes hands with both soap and water. 0 1 2 3

13. Wipes his or her own face when given a washcloth by an adult. 0 1 2 3

14. Remains dry without wetting throughout the day. 0 1 2 3

15. Sits on the toilet or potty seat without being held. 0 1 2 3

16. Tells parent or other adult when he or she needs to use the bathroom. 0 1 2 3

17. Remains dry without wetting throughout the night. 0 1 2 3

18. Brushes teeth with little fussing when told to do so by an adult. 0 1 2 3

19. Uses bathroom without help. 0 1 2 3

20. Dresses himself or herself. 0 1 2 3

21. Buttons own clothing. 0 1 2 3

22. Takes a bath or shower without help. 0 1 2 3

23. Washes his or her own hair. 0 1 2 3

24. Cuts meats or other foods into bite-size pieces with a knife. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 72

Total guessed

10 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5

 BEHAVIOR RATINGS

Ability Frequency

Self-Direction Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Shows interest in a toy or other object by looking at it for a few seconds. 0 1 2 3

2. Sits quietly for at least 1 minute without demanding attention. 0 1 2 3

3. Finds something to do for at least 5 minutes without demanding attention. 0 1 2 3

4. Plays with a toy without putting it into his or her mouth. 0 1 2 3

5. Explores an unfamiliar room or other new situation, even if a parent must 0 1 2 3

encourage it (for example, a doctor’s waiting room).

6. Chooses the food or snack he or she wishes to eat when given a choice. 0 1 2 3

7. Moves a few feet away from a parent in a new situation as long as the 0 1 2 3
parent is in sight (for example, when visiting an unfamiliar residence).

8. Tries to do most things alone without an adult’s help (for example, dressing 0 1 2 3
or feeding self).

9. Follows an adult’s request to “quiet down” or “behave.” 0 1 2 3

10. Resists pushing or hitting another child when angry or upset. 0 1 2 3

11. Follows simple household rules (for example, “No running in the house”). 0 1 2 3

12. Stands still when needed, without fidgeting or moving around. 0 1 2 3

13. Starts an activity at once when told to do so (for example, “Go take a 0 1 2 3
bath”).

14. Controls temper when a parent or other adult takes a toy or object away. 0 1 2 3

15. Asks permission from an adult when needed (for example, “May I go 0 1 2 3
outside to play?”).

16. Keeps working on hard tasks without becoming discouraged, quitting, or 0 1 2 3

needing reminders.

17. Works independently and asks for help only when necessary. 0 1 2 3

18. Stops a fun activity, without complaining, when told that time is up. 0 1 2 3

19. Controls temper when disagreeing with friends. 0 1 2 3

20. Follows a routine without being reminded (for example, brushing teeth 0 1 2 3
before bedtime or feeding a pet).

21. Asks permission before playing with another child’s toy or game. 0 1 2 3

22. Chooses own clothes almost every day. 0 1 2 3

23. Works on one home or school activity for at least 15 minutes without 0 1 2 3
reminders.

24. Discusses ways to solve conflicts with others (for example, “You can have 0 1 2 3
this now if I can have it later”).

FOR EXAMINER USE ONLY Raw total 72

Total guessed

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 11

 BEHAVIOR RATINGS

Ability Frequency

Social Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Smiles when he or she sees a parent. 0 1 2 3

2. Relaxes body when held (for example, snuggles). 0 1 2 3

3. Squeals or laughs when happy or delighted. 0 1 2 3

4. Displays closeness to a parent (for example, is happy when parent returns). 0 1 2 3

5. Shows a sense of humor (for example, laughs when someone acts silly). 0 1 2 3

6. Lifts arms to express a desire to be picked up. 0 1 2 3

7. Responds differently to familiar and unfamiliar persons (for example, is less 0 1 2 3

warm to an unfamiliar person).

8. Hugs and kisses parents or others. 0 1 2 3

9. Imitates actions of adults (for example, pretends to clean house or drive 0 1 2 3

a car).

10. Shows respect for persons in authority by following their rules and 0 1 2 3
directions (for example, parents, teachers, police officers).

11. Shares toys willingly with others. 0 1 2 3

12. Greets other children (for example, says “Hi”). 0 1 2 3

13. Says “Thank you” when given a gift. 0 1 2 3

14. Shows sympathy for others when they are sad or upset. 0 1 2 3

15. Seeks friendship with others in his or her age group. 0 1 2 3

16. Responds appropriately when introduced to others (for example, says 0 1 2 3

“Hello”).

17. Says “Please” when asking for something. 0 1 2 3

18. Says when he or she feels happy, sad, scared, or angry. 0 1 2 3

19. Displays good table manners (for example, by using a napkin and 0 1 2 3
remaining at the table until excused).

20. Offers assistance to others (for example, to carry packages or put away 0 1 2 3
food).

21. Apologizes if he or she hurts the feelings of others. 0 1 2 3

22. Places reasonable demands on friends (for example, does not become 0 1 2 3
upset when a friend plays with another friend).

23. Refrains from saying or doing things that might embarrass or hurt others. 0 1 2 3

24. Personally makes or buys gifts for family members on birthdays or major 0 1 2 3
holidays.

FOR EXAMINER USE ONLY Raw total 72

Total guessed

12 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5

 BEHAVIOR RATINGS

Ability Frequency

Motor Is not
able
Never (or
almost never)
when needed
Sometimes
when
needed
Always (or

when needed
Check
almost always) ONLY if you
GUESSED

1. Lifts head to look around. 0 1 2 3

2. Follows a moving object by turning head. 0 1 2 3

3. Rolls from stomach to side. 0 1 2 3

4. Shakes rattle or other toys. 0 1 2 3

5. Reaches for objects such as a bottle or toy. 0 1 2 3

6. Transfers objects from one hand to the other. 0 1 2 3

7. Sits upright on the floor without support. 0 1 2 3

8. Moves to a sitting position, even if balance is unsteady. 0 1 2 3

9. Pulls himself or herself to a standing position (for example, in a crib). 0 1 2 3

10. Picks up small flat objects from a table (for example, coins or buttons). 0 1 2 3

11. Crawls for about 10 feet without falling over. 0 1 2 3

12. When standing, bends over to pick up items from the floor. 0 1 2 3

13. Stands up from a sitting position. 0 1 2 3

14. Rolls ball to others. 0 1 2 3

15. Walks without help. 0 1 2 3

16. Throws a small ball overhand. 0 1 2 3

17. Walks up at least five to six steps without falling (may use handrail). 0 1 2 3

18. Kicks a ball without falling. 0 1 2 3

19. Runs without falling. 0 1 2 3

20. Bounces a ball for several seconds. 0 1 2 3

21. Catches a ball tossed from 5 to 10 feet away. 0 1 2 3

22. Draws straight lines across a piece of paper. 0 1 2 3

23. Colors within the lines of a drawing or in a coloring book. 0 1 2 3

24. Puts twist-off tops back on jars and closes them tightly. 0 1 2 3

25. Uses scissors to cut along a straight line. 0 1 2 3

26. Uses scissors to cut shapes with curved lines. 0 1 2 3

FOR EXAMINER USE ONLY Raw total 78

Total guessed

ABAS-3 Parent/Primary Caregiver Form Ages 0 –5 13

 Comments

14 ABAS-3 Parent/Primary Caregiver Form Ages 0 –5