Social Development

1. Does the child engage in (select all that apply):

Parallel play (plays near other children but does not interact) Interactive play (engages with others but without structured cooperation) Cooperative play (plays with others) Pretend play (creates or acts out imaginative scenarios) Other:

2. Does the child follow the rules of a game?

Yes No

3. Does the child share materials/toys?

Yes No

4. Does the child patiently wait for his/her turn?

Yes No

5. Does the child take turns?

Yes No

6. Does the child initiate peer interactions?

Yes No

7. Does the child interact with familiar peers only?

Yes No

8. How often does the child engage in conflict?

Frequently Sometimes Rarely Never Other:

9. Does the child seek out adult interaction?

Yes No

10. Does the child respond well to adult guidance?

Yes No

11. Does the child hesitate to engage with unfamiliar adults?

Yes No Other:

12. Does the child avoid interactions with adults?

Yes No

13. Does the child establish and maintain eye contact when interacting with others?

Yes No

14. Does the child remain seated and/or remain with the group during an activity?

Yes No

15. What tends to upset the child?

16. How does the child react when upset?

17. How does the child typically react when a change or disappointment occurs?

Child adjusts easily Child cries Child verbally expresses frustration Child withdraws from the activity Child requires adult support to transition Other:

18. Does the child self-regulate?

Yes No

19. Does the child demonstrate difficulty self-regulating?

Yes No

20. What strategies does the child use to self-regulate?

Engages in deep breathing Uses sensory tools (fidgets, weighted blankets, sensory cushion, brushing, etc.) Seeks adult support Withdraws from the situation Other:

21. Does the child demonstrate safety awareness (avoiding dangerous situations, following safety rules)?

Yes No

22. Does the child identify and express their own feelings?

Yes No Other:

23. Does the child recognize and identify with the emotions of others?

Yes No

24. Does the child demonstrate empathy for others?

Yes No

25. Does the child respect the personal space of others?

Yes No

26. Is the child receiving counseling services?

Yes No

27. If yes, have you conferred with the therapist provider regarding the child's progress?

Yes No

28. What are the child's social strengths?

Engages well with peers Demonstrates strong communication skills Shows empathy and concern for others Follows social rules (e.g., waiting their turn, raising their hand) Demonstrates leadership qualities Other:

29. What activities or social settings does the child prefer?

Playing alone Small group activities Large group activities Structured games Unstructured/free play Other:

30. What are the child's social interests?

31. What are the social development needs of the child?

32. Have parents expressed concerns about their child's social development?

Yes No

33. Have parents expressed concerns regarding their child's emotional regulation?

Yes No

34. If yes, what concerns have the parents shared?

A. Behavior and Interaction with Peers and Adults

Eye Contact & Group Participation

Response to Change and Disappointment

Self-Regulation and Coping Strategies

Safety Awareness & Emotional Understanding

B. Student Strengths, Preferences, and Interests

C. Social Development Needs and Parent Concerns