ASK SOCIAL SKILLS CLUB

PRE-ASSESSMENT QUESTIONNAIRE

Based on the parent and therapist’s assessments, each group is tailored to meet the specific needs
of the children within that particular group. The information requested in this questionnaire will be
used to help with the programme facilitator with their initial assessment.

Student’s Name
(Last name, First name)
Parent or Guardian
(Last name, First name.):
Date: 26 May 2019

Please rate your child’s skills in the following areas:

Conversational Skills Good Average Below Average

Maintaining appropriate physical distance
from others
The questionnaire should be completed by the child’s parent / guardian, with every field filled in
Listening skills quoting N/A when Not Applicable.
Using tone of voice
Using appropriate greetings
Introducing yourself
Starting a conversation
Taking turns speaking
Knowing how and when to interrupt
Staying on topic
Maintaining a conversation
Joining a conversation
Ending a conversation
Asking questions when you don’t
understand
Saying “I don’t know”
Introducing topics of interest to others
Shifting topics
Not talking too long
Dealing with sensitive topics
Complimenting others

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Cooperative Play Good Average Below Average

Asking someone to play
Joining others in play
Compromising
Sharing
Taking turns
Playing a game
Dealing with loosing
Dealing with winning
Ending a play activity
Accepts when other children ask to play

Friendship Management Good Average Below Average

Informal versus formal behaviour
Respecting personal boundaries
Facts versus opinions (respecting other’s
opinions)
Sharing a friend
Getting attention in positive ways
Offering help
When to tell on someone
Modesty
Appropriate touch
Dealing with peer pressure
Dealing with rumors
Calling a friend on the phone
Answering the phone
Getting to know someone new
Apologizes when appropriate

Empathy Good Average Below Average

Showing understanding for other’s feelings
Cheering up a friend

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Self-Regulation Good Average Below Average

Recognizes feelings
Feeling thermometer (placing feelings in
perspective)
Keeping calm
Understanding anger
Talking to others when upset
Dealing with family problems
Problem solving
Dealing with a mistake
Trying when something is difficult
Tries again when frustrated
Trying something new

Conflict Management Good Average Below Average

Asserting yourself
Accepting “No” for an answer
Dealing with teasing
Has different words to deal with teasing
Dealing with being left out
Avoiding being “set-up”
Giving criticism in a positive way
Accepting criticism
Having respectful attitude

Please return the completed form to the programme facilitator at socialskills@allspecialkids.org prior to
arranging a mandatory social skills assessment.

Assessment fees of CHF70 for ASK member or CHF100 for non-ASK members should be paid directly to the
programme facilitator at the end of the assessment.

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