Behavioural Assessment Scales for Indian Children

with Mental Retardation, (BASIC-Mit) Part B

r AuitIors:
UeetaFesMwarja, £ Venkatesanj

RECORD BOOKLET

Name of the student Age

Level/Class Sex

Dates:
Baseline Assessment Evaluated by
First Quarter Assessment Evaluated by
Second Quarter Assessment Evaluated by
Third Quarter Assement Evaluated by

Instructions
1. Eact item should be scored based on three levels of severity/frequencey of problem behaviours, i.e., Never (N),
Occasionally (0) and Frequently (F). Score 0 for "Never", I for "Occasionally" and 2 for "Frequently".

2. Enter the appropriate numerical score against each item for the child, depending on the severity/frequency of the
problem behaviourin question, and inthe appropriate box, i.e., baseline, first quarter assessment, second quarter
assessment and/or third quarter assessment

3. Add the total problem behaviour raw score and enter it in the profile sheet of BASIC-MB, Part-B.

Item No. DOMAINS/ITEMS Assessments

BgseIb,. 1*Qr 2tdQr idQr

Violent and Destructive Behaviour

1. Kicks others

2. Pushes others

3. Pinches others fl [11 fl

4. Pulls hair, ear, body parts of others

5. Slaps others fl [II] fl

6. Hits others [III fl [11 [1
7. Spits on others LII] fl LI LI
8. Bangsobjects LI LI LI [III]
9. Slamsdoors fl [II]
10. Bites others

Ii. Attacks or pokes others with weapon

(blade, stick, pencil)

12. Throws objects at others

• NIMLI. Secunderabad 1922
51
13. Tears/pulls threads from own or others
clothing LILII[I]LJ
14. Tears up own or others books, papers,
magazines
15. Breaks objects/glass/toys fl LII] LII E
16. Damages furniture

Temper Tantrums
[I] fl
17. Cries excessively E [III
1& Screams
19. Stamps feet fl [j fl
20. Rolls on floor

Misbehaves with others

fl [J fl [III]
21. Pulls objects from others E LI] fl
22.

23.
Interrupts in between when others are
tsThing
Makes loud noise when others are
[IEEE
working or reading
24. Makes face to tease others [I [I [I [III
25. Uses abusive/vulgar language [I [I [I] [I
26. Takes others possession without their
permission openly
27. Tells others what to do and wants
his/herway (bossy) [I [I LII [I
Self Injurious behaviours
28. Bangs head [I [I LI] [I
29. Bites self [I [I [I [I
30. Cuts or mutilates self
31. Pullsownhair [III] [I [III [I
32. Scratches self [III] [I LI] [I
33. Eteseff [IEEE
34. Puts objects into eyes/nose/ear [I [I [I LI]
35. Eats inedible things [I [I [I [I
32
L Saudis. 1MQr 2ndRr SrdQk
36.

37.
Peels skin/wounds
Bites nail
[1 fl
Repetitive behaviours
3t Rocisbody DEED
39. Nods head E LII] [II] E
40. Sucks thumb E [III E E
41. Makes peculiar sounds LII E LI LI
42. Bites ends of pen/pencil LII LI LII LII
43. Shakes parts of the body repeatedly fl LIII LII LI
44. Grinds teeth [II] LII LI LI
45. Swings round and round LII LI LIII LI
Odd behaviours

46. Laughs to self [II LI LI LI

47. Laughs inappropriately LI LI] LI [III]
48. Talks to self [J fl LII]
49. Hoards unwanted objects (sticks, thread,
pieces of old clothes) LI LII [III] LI
50. Picks nose LI [II] LI LI
51. Plays with unwanted objects like chappal,
strings, faeces and dirt excessively

52. Kisses, hugs, and licks people

unnecessarily
53. Smells objects LII [III LII [1111]
Hyperactivity
54. Does not sit at one place for required time
fl LII LI
55. Does not pay attention to what is told
fl LII LI
56. Does not continue with the task at hand
for required time

Rebellious behaviours
[ LI
57. Refuses to obey commands [II LII LI LII
58. Does opposite of what is requested
[J
33
item No. DOl%fAfNs/rm Assessments
HM.**1*QI pidQr. SMQn
59. Takes very long time intentionally to
complete a task
60. Wanders outside school
61. Runs away from school
62. Argues without purpose
Antisocial behaviours
63.
advantage or blames otters
64. Cheats in games or no sense of ir play
65. Steals
DEED
66.

67.
Makes obscene gestures

Exposes body parts inappropriately

fl LI]
68. Makes sexual advances towards
members of opposite sex
69. Touches own private parts in public
70.

71.
Touches others private parts in public
Gambles
fl [I]
Fears
72.

73.
Fear of objects

Fear of animals
fl fl
74. Fear of places
fl J] fl
75. Fear of persons
fl [I] fl
Any others:
LII] E E [III]

Tota!Rczw Score Baseline Ist Quarter find Quarter Ifird Quarter

[Cumulative
Score
Domains)

34
 Appendir
BEHAVIOURAL PROFILE ON BASIC-MR. PART - A
Name of the student V.5. F?AV/ Level/Class Date/s Evaluated by Date/s Evaluated by
Ja E ARS Baseline Assessment Second Quarter Assessment
Age :
t.33.

i
Sex rstQuarterAssessmeni ThirdQuarterAssessment MrSARQtJ

ItemNo. 12 4 5 6 7 8 91011121314151617181920 ItemNo. 2l2z23iiz62728293O313233343536338394O

Motor scS5cscsssS333aSi
5 3 (S 5 5 5 S 5 ' 3 5 S S S
1 I Motor
S 52 S5 S rs S S 4ç / .3 2.
I
/o
I

! i I PI ! ! £ I I I E .. 2 1I £L LL LL
AD!. C 3 ADL 5'
.

I!
I I511 II
.
.

cc 1 15' IS L A 1± - - I
Language:
Language:
.f 11
Receptive
Reading I ! II 1 5 1 5 1 ! L
s c .c cs s s r
.1
5 5 '1 S I I I I I - -
Expressive
Wrifing
Time
S
.E
5 if
.r 5' 5_S 5' 3. 3•5'! / 33 "
5'
' ' i
1

S c gs g .c s .'s' .c 5' c' c

—
Numbcr
Domestic 3 3 3 S'I I I I F Social ci f / I s'

Pre-VocationalS 5' 32 / .. / , - Money 55' g5ç 3. 31 1 / / / -

-
Scoring Key: lndependent:5 - Clueing:4 - Verbal prompting:3 Phyuical pronting:2 - Totally dependent:I - Not applic.ble:0

GRAPHIC- PROFILE
Second Qr. rdQ
DOMIAN KS % KS % KS % KS %

:—=°
C
BASELINE TRAINING
Motor 37j.( /907o 14O 70 '47Z.
100
ADL —
IS'17?.g /O ab Ut 8, /63 RIS
iJoS
;;fH
m e 80

- —
ifing
Number-Time — '8 L17 loS 52S 107 11± a..
I
v
20
Domestic-Social 7 3.5' Ia i1S 3. 9 iS"
S Pre vocational-Money 5q. 2.7 £L 31 S 32.g 77 385
IQr. jlQr. lIlQr. TOTAL 82 S%Z/ Qj .f flo 2$ V& \
(Key:RS-Riw Score:Qr.-Quarter)

35
 Appendix i
BEHAVIOURAL PROFILE ON BASIC-MR. PART - A
Date/s Evaluated by Date/s Evaluated by
Name of the student Level/Class
Baseline Assessment Second Quarter Assessment ________
Age
First Quarter Assessment Third Quarter Assessment ______
Sex
ken No. 27
56
Motor
ADL
Language:

Writini
Time
Social

Scoring Key : Independent:5 - Ctueing:4 - Verbal prompting:3 - Physical prompting:2 - Totsity dependent:1 - Not .pplicable:0

GRAPHIC PROFILE
— —
Baseline First Qr.
RS %
RS %
BASELINE TRAINING
C 100
uP
m a 80
7oo
• ° 40
t ri
VIt
I 20
0
a
S
I Qr. llQr. IIIQr.
ItS - Raw Score : Qr.

36
 Appendix ii
BEHAVIOURAL PROFILE ON BASIC-MR. FART - B
Name of the student V £'- K M/) Level/Class CEeZJ%JtØ (SI Date/s Evaluated by Date/s Evaluated by
Age
Sex
ii. ?t..v
MALE
Baseline Assessment
FirstQuarterAssessment
Second Quarter Assessment
Third QuarterAssessment 2.3. ¶). ir .-Qv"a
blent and Destructive Behaviours Temper Tantrums Misbehaves with others Self injurious Behaviours Repetitive Behaviours
123456789 10 11 12 13 14 15 16 17 18 24 25 26 27 282930 31 3233 343 3839404142434445
19 2O21 22f23
Oovooo 00 oa Oc 0 0 00 00 b
coijJoo oool cO
ô 0 0 0 0 0 0
O C'
cIa oiv
J Odd Behaviours
5152
Hyperactive
II! 4748 49 50 53 54 55 56

00 C' ty 0 0 0
H
Scring K : Never (N) :0; Occasionally (0): 1; Frequen4ly (F) : 2

GRAPHIC PROFILE
CUMULATIVE SCORES
BASELINE TRAINING
C
p ioo ASSESSMENT RAW SCORES CUMULATIV1
: so PERCENTAGES

•t IC
60 — — BASELINE lb !t-67
ri 40
20
FIASTQUARTER H-f 9-3
•9 0_ . . SECOND QUARTER 00

: BASELINE IQr. Ilir. IIlQr. THIRD OUARTER 3-30

37
 Appegdfr II
JAVIOURAL PROFILE ON BASIC-MR. PART - B
Name of the student Level/Class Date/s Evaluated by Date/s Evaluated by
Age Baseline Assessmern cond Quartet Assessment
Sex First Quarter Assessment Third Quarter Assessment

iolent and Destructive Behaviour Temper Tantrums Misbehaves with others Self injurious Behaviours Repetitive Behaviours
I 45 67 8 9lOl1 1213 141516 17 18 19 20 21 22 23 24 25 26 313233 34 35 36
27 28293O
23 373839h0'4142434445
I — — — ——— I —

GRAPHIC PROFILE
CUMULATIVE SCORES
BASELINE TRAININD
C
p too I ASSESSMENT RAW SCORES CUMULATIVE

:: PERCENTAGES

• .n 60 BASELINE

FIRST QUARTER
20
•OS o
SECOND QUARTER

, BASEUNC I Qr. 11 Qr. Ill Qr. THIRD QUARTER

38