Grades 7-12

R a t i n g System Social Skills Questionnaire

F r a n k M. G r e s h a m a n d S t e p h e n N. Elliott

Directions
First write t he information a b o ut yo urself in t he box b elo w. T h e n turn to p a g e 2.

Student Information

First Last .

DFemale Tod ay's date

Grade Birth date

School

Teacher 's na m e

AGS ®© 1 9 9 0 , American Gu i dance Service, Inc., Publishers' Building, Circle Pines, MN 55014- 1796

All rights reserved. N o part of this Questionnaire may b e photocopied or otherwise reproduced. Th i s Questionnaire w a s printed in two colors. Form: S S
8 0 9 8 7 6 5 4 3
This paper lists a lot of things that students your age may do. Pleas e read each sentence and think about
yourself. Decide how often you do the behavior described.

If you never do this behavior, circle the O.

If you sometimes do this behavior, circle the 1.
If you very often do this behavior, circle the 2.
Then, decide how important the behavior is to your relationships with others.

If it is not Important to your relationships, circle the O.

If it is important to your relationships, circle the 1.
If it is critical to your relationships, circle the 2.

Here are two examples:

How How
Often? Important?
Very Not

Never Sometimes Often Importent Importent Critical

I start conversations with classmates.
0 0 2
I keep my desk clean and neat.
0 2 ® 2

This student very often starts conversations with classmates, and starting conversations with classmates is
important to this student. This student sometimes keeps his or her desk clean and neat but a clean and
neat desk is not important to this student.

If you change an answer, be sure to erase completely. Please answer all questions. When you are finished,
wait for further directions from your teacher. B e sure to ask questions if you do not know what to do. There
are no right or wrong answers, just your feelings of how often you do these things and how important they
are to you.
Begin working when told to d o so.

How How
S o c i a l Skills Often? Important?
Very Not
Never Sometimes Often Importent Importent Critical

1. I make friends easily. 0 1 2 0 1 2

2. I say nice things to others wh en they have done
something well. 0 1 2 0 1 2

3. I as k adults for help w h e n other children try to hit m e or

0 1 2 0 1 2
push me around.
4. I am confident on dates. 0 1 2 0 1 2

5. I try to understand how my friends feel w hen they are

0 1 2 0 1 2
angry, upset, or sad.
6. I listen to adults w hen they are talking with me. 0 1 2 0 1 2

7. I ignore other children w hen they tease me or call

me names. 0 1 2 0 1 2

8. I ask friends for help with my problems. 0 1 2 0 1 2

9. I a s k before using other p e o p l e ' s things. 0 1 2 0 1 2

10. I disagree with adults without fighting or arguing. 0 1 2 0 1 2

11. I avoid doing things with others that may get me in

trouble with adults. 0 1 2 0 1 2

12. I feel sorry for others when bad things happen to them. 0 1 2 0 1 2

SUMS O F HOW OFTEN COLUMNS

C A E
S

2
 H ow H ow
Social Skills (cont.) Often? Important?
VMY Not
Never Someti Often Important Important Critical
13. I do my homework on time. 0 1
mes
2 0 1 2
14. I keep my desk clean and neat. 0 1 2 0 1 2
15. I do nice things for my parents like helping with
household chores without being asked. 0 1 2 0 1 2
16. I am active in school activities such a s sports or clubs. 0 1 2 0 1 2
17. I finish classroom work on time. 0 1 2 0 1 2
18. I compromise with parents or teachers when w e
0 1 2 0 1 2
disagreements.

19. I ignore classmates who are clowning around in class.

have
0 1 2 0 1 2
20. I ask s ome one I like for a date. 0 1 2 0 1 2
21 I listen to my friends when they talk about problems 0 1 2 0 1 2
they are having.
. I end fights with my parents calmly. 0 1 2 0 1 2
22 I give compliments to members of the opposite sex. 0 1 2 0 1 2
. I tell other people w hen they have done something well. 0 1 2 0 1 2
23 ,I smile, wave, or nod at others. 0 1 2 0 1 2
26.
. feeling
I start conversations with opposite-sex friends without
uneasy or nervous. 0 1 2 0 1 2
24
27. I accept punishment from adults without getting mad. 0 1 2 0 1 2
. I let friends know I like them by telling or showing them. 0
28. 1 2 0 1 2
29. I stand up for my friends w hen they have been
unfairly criticized. 0 1 2 0 1 2
30. I invite others to join in social activities. 0 1 2 0 1 2
31. I u s e my free time in a good way. 0 1 2 0 1 2
32. I control my temper w hen people are angry with me. 0 1 2 0 1 2
33. I get the attention of members of the opposite sex
without feeling embarrassed. 0 1 2 0 1 2
34. I take criticism from my parents without getting angry. 0 1 2 0 1 2
35. I follow the teacher's directions. 0 1 2 0 1 2
36. I u s e a nice tone of voice in classroom discussions. 0 1 2 0 1 2
37 I ask friends to do favors for me. 0 1 2 0 1 2
38.
. I start talks with classroom members. 0 1 2 0 1 2
39. I talk things over with classmates when there is
a
problem or an argument.
0 1 2 0 1
c A E S SUMS OF HOW OFTEN COLUMNS
2 to be sure all items have been marked.
Stop. Please check

3
FOR OFFICE USE ONLY

Total
+ A
+ E
+ S)

4
 Grades 7-12
Rating System S o c i a l S k i Is Q u e s t i o n n a i r e
Frank M. G r e s h a m and Ste ph e n N. Elliott

Directions
This questionnaire is designed to m eas u r e h o w o f t e n a student exhibits certain social skills and
h o w i m p o r t a n t those skills are for s u cc es s in y o u r classroom. Ratings of problem behaviors an d academic
com peten ce are also requested. First, complete the information about the student and yourself.

S t u d e n t Information

S t u d e n t ' s name,

Grade Birth Sex: 0 Fem ale 0

Male

Ethnic group (optional)

D Asian D Indian (Native American)

D Black D White

D Hispanic D Other

Is this student handicapped? D Y e s D No

If handicapped, this student is classified as:

D Learning-disabled D Mentally handicapped

D Behavior-disordered
D Other handicap (specify),

Te a c h e r Information

Teacher's Sex: o F em ale 0 Male

W h a t is your assignment?

D Regular D D Self-contained D Other (specify)

Resource

AGS ®© 1990, American Guidance Service, Inc., Publishers' Building, Circle Pines, MN 55014-1796

All rights reserved, N o part of this Questionnaire may b e photocopied or otherwise reproduced, T h i s Questionnaire w a s printed in two colors. Form: T S
8 0 9 8 7 6 5 4 3 2 1
Next, r e a d e a c h item o n p a g e s 2 a n d 3 (items 1 - 42) a n d think about this student's beha vior during the past
month or two. D e c i de how often the student d o e s the behavior described.

If the student never d o e s this behavior, circle the O.

If the student sometimes d o e s this behavior, circle the 1.
If the student very often d o e s this behavior, circle the' 2.

F or items 1 - 30, yo u s h o u ld a ls o rate how important e a c h of the s e be hav ior s is for s u c c e s s in your
classroom.

If the behavior is not important for s u c c e s s in your classroom, circle the O.

If the be havior is important for s u c c e s s in your classroom, circle the 1.
If the beha vior is critical for s u c c e s s in your classroom, circle the 2.

H e re are two examples:

How How
Often? Important?
Very Not
Never Sometimes Often Important Important Critical

S how s empathy for peers. 0 0 2

A s ks questions of you when unsure of what to

do in schoolwork. 0 2
0
This student very often s h o w s e m pa th y for c la s sm at es . A lso, this student sometimes a s k s questions
w h e n un su r e o f sch oolw ork. Th is t e a c h e r thinks that s h ow ing e m p a t h y is important for s u c c e s s in his or
her c l a s s r o o m a n d that a s kin g ques tion s is critical for succes s.

Please do not skip any items. In s o m e c a s e s y ou m a y not h a v e ob s e r v e d the student perform a particular
behavior. M a k e a n estimate of the de gr e e to w hic h y ou think the student w ou ld probably perform that behavior.

How How
FOR OFFICE S o c i a l S k i ll s Often? Important?
USE ONLY
How Often? Very Not
Never Sometimes Often Important Important Critical

1. Produces correct schoolwork. 0 1 2 0 2

2. Keeps his or her work area clean without

being reminded. 0 1 0 2

3. Respo nds appropriately to physical aggreSSion

from peers. 0 1 2 0 2

4. Initiates conversations with peers. 0 1 2 0 2

5. Volunteers to help peers on classroom tasks. 0 1 2 0 2

6. Politely refuses u n r e as o n a b l e requests from others. 0 1 2 0 2

7. Appropriately questions rules that may be unfair. 0 1 2 0 2

8. R e s p o n d s appropriately to teasing by peers. 0 1 2 0 2

9. A ccepts peers' ideas for group activities. 0 1 2 0 2

10. Appropriately expresses feelings w hen wronged. 0 1 2 0 2

11. Re ceives criticism well. 0 2 0 2

12. Attends to your instructions. 0 1 2 0 2

1 3. U s e s time appropriately while waiting for your help. 0 1 2 0 2

14. Introduces himself or herself to n e w p e o p l e without being

0 1 2 0 2
told to.
15. Co mpr omis es in conflict situations by changing
own ideas to reach agreement. 0 1 2 0 2

c
A S SUMS OF HOW OFTEN COLUMNS

2
 HOW H ow
ONLY Social S k i l s (cont.)· Often? I m po rt an t ?
How Often? Yery Not
Never Someti mes Often Important Important C.ritical

.. , 16. Acknowledgescomplirnents or praise from peers. 1 2 o 2

.
17. Easily makes transition from on e classroom
activity to another. 0 1 2 o 2
. .
18. Controls temper in conflict situations with peers. 0 1 2 o 2
19. Finishes class aSSignments within time limits. 0 1 2 o 2
20. Listens to classmates w hen they present their
work or ideas. 0 1 2 o 2
21. Appears confident ih social interactions with
opposite-sex peers. 1 2 2
22. Invites others to join in activities. 0 1 2 o 2
23. Controls temper in conflict situations with adults. 0 1 1 2
24. Ignores peer distractions wh en doing class work. 0 1 2 o 2
25. Stands up for peers w he n they have been
unfairly criticized. 0 1 2 o 2
26. Puts work materials or school property away. 0 1 2 o 2
27. Appropriately tells you w hen h e or s he thinks you
have treated him ()r her unfairly. 0 1 2 o 2
28. G ives compliments to members of the opposite s e x . . 1 2 o 2

29. Complies with your directions. 0 1 2 o 2

30. Re s pon ds appropriately to peer pressure. 0 1 2 o 2

C A S SUMS OF HOW OFTEN COLUMNS

H ow
FOR
OFFICE
Problem Often?
.. Yery
Never Someti mes Often
Do. not make
31. Like s to b e alone. 0 1 2
importance ratings
32. Fights with others. 0 1 2
for items 31 - 42
33. Is e asily embarrass'ed. 0 1 2

34. A r g u e s with others. 0 1 2

35. T h r e a t e n s or bullies others. 0 1 2

36. T a l ks b a c k to adults w h e n corrected. 0 1 2

37. H a s temper tantrums. 0 1 2

38. A p p e a r s lonely. 0 1 2

39. G e t s an gr y easily. 0 1 2

40. S h o w s an xi e ty ab out b e i n g with a g r o u p of children. 0 1 2

41. A c t s s a d or depressed. 0 1 2

42. H a s low self-esteem. 0 1 2

E I SUMS OF HOW OFTEN Go on to

COLUMNS Page 4. �

3
 Academic Competence
T h e n e x t n i n e i t e m s r e q u i r e y o u r j u d g m e n t s o f this s t u d e n t ' s a c a d e m i c o r l e a r n i n g b e h a v i o r s a s o b se r v e d in your class­

room. C o m p a r e t h e s t u d e n t w i t h o t h e r c h i l d r e n w h o a r e in the s a m e classroom.

R a t e a l l i t e m s u s i n g a s c a l e o f 1 to 5. C i r c l e t h e n u m b e r that b e s t r e p r e s e n t s y o u r j u d g m e n t . T h e n umb e r 1 indicates the

l o w e s t o r l e a s t f a v o r a b l e p e r f o r m a n c e , p l a c i n g t h e s t u d e n t in t h e l o w e s t 1 0 % Qf t h e c l a s s . N u m b e r 5 indicate s the highest o r

O
m o s t f a v o r a b l e p e r f o r m a n c e , p l a c i n g t h e s t u d e n t i n t h e h i g h e s t 1 0 % c o m p a r e d with other stude nt s in the classroom.
Lowest Next Lowest Middle Next Highest Highest
10% 20% 40% 20% 10%

43. Compare d with other children in my classroom, the

O 44.
ov e r a ll a c a d e m i c p e r f o r m a n c e of this child is:
In rea ding, how do e s this child compare with
1 2 3 4 5

F 45.
other students?
In ma th em at ic s, how does this child compare
1 2 3 4 5

with other students? 1 2 3 4 5

46. In terms of grade-level expectations, this child's
U skills in r e a d in g are: 1 2 3 4 5
47. In terms of grade-level expectations, this child's
skills in m a t h e m a t ic s are: 1 2 4 5
48. This child's o v e r a ll m ot iv ation to succeed
N academically is: 1 2 3 4 5
This
49. child's pa re n ta l e n c o u r a g e m e n t to succeed
F 50.
academically is:
Compare d with other children in my
1 2 3 4 5

classroom this child's Intellectual f u n c ti on i n g 1 2 3 4 5

is:
SL 51. C ompared with other children in my classroom 1 2 3 4 5
this child's o v e r a ll c l a s s r o o m be h a v io r is:

IA
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MO F Stop. P l e a s e c h e c k to b e s u r e all Items h a v e be e n marked.

C
OL
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MN
C SUMMARY
FOR OFFICE USE ONLY PROBLEM BEHAVIORS
S OCIAL S KILLS ACADEM IC COMPETENCE

OFTEN? BEHAVIOR HOW OFTEN? BEHAVIOR RATING COMPETENCE

Y TOTAL" LEVEL
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D
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D
D
Rank . Score Rank Score Rank
standard Percentile

Sat)l D
(s e
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Confidence Level aID (se Apndix
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Apndix
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SEM 95% SEM 95%
68%0 0 0 SEM 68% 0 95%
Confidence Confidence Confidence
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4
 .Grades 7-12
Rating System Social Skills Quest ion nair e
Frank M. Gresham and Stephen N."Eliiott

Directions
This questionnaire is designed to measure h o w o ften your child exhibits certain social skills and

h o w imp ortant .those skills are to your child's development. Ratings of problem behaviors are a l s o requested. First,
complete the information about your child and yourself.

Student Information

Date
Month Day Year
State

Birth date Sex: DFemale D Male

Month Day Year
Teacher's name.

Ethnic group (optional)

D Asian 0 Indian (Native American)

D Black 0 White

D Hispanic D Other

How many brothers and sisters does this child have at home?

D None D 1 D 2 O· 3·or

more

Parent Information
First Middle

Sex: 0 Female D Male

How are you related to this child?

D Mother o Guardian

D Father D Other

AGS ®© 1990, American Guidance Service, Inc., Publishers' Building, Circle Pines, MN 55014-1796
All rights reserved. No part of this Questionnaire may be photocopied or otherwisa reproduced.This Questionnaire was printed in two Form: PS
colors.
80 9 8 7 6 5 4 3 2 1
Next,read each item on p ages 2-4 (items 1-52) and think about your child's present behavior. Decide h o w often
your child do es the behavior described.
If your child never does this behavior,circle the O.
If your child s o m e t im e s does this behavior,circle the 1.
If your child very often d oes this behavior,circle the 2.

For items 1-40,you should also rate h o w Important each of these behaviors is for your child's development.

If it is no t Important for your child's development,circle the O.

If it is Important for your child's development,circle the 1.
If it is critical for your child's development,circle the 2.

Here are two examples:

How How
Often? Important?
Not
Never Someti mes Criti cal

S how s a se ns e of humor. o
Answ ers the phone appropriately.

This parent thought that the child very often showed a sense o f humor and that showing a sense o f humor
was Important to the child's development. This parent also thought that the child never answered the
phone appropriately and that answering the phone appropriately was crltlcsl to the child's development.

There are no right or wrong answers. Y o u may take as much time as you like.
P l e a s e d o n o t s k i p any Items.

How How
S o c i a l S k ill s Often? Important?
Very Not
Never Someti mes Often Important Important Criti cal

1. Starts conversations rather than waiting for others to

talk first. 0 2 0 2
2. Helps you with household tasks without being told. 0 2 0 2
3. Attempts household tasks before asking for your help. 0 2 0 2
4. Participates in organized activities such as sports
or clubs. 0 2 0 2
5. Politely refuses unreasonable requests from others. 0 2 0 2
6. Introduces himself or herself to new people without
being told. 0 2 0 2
7. U s e s free time at home in an acceptable way. 0 2 0 2
8. S a ys nice things about himself or herself when
appropriate. 0 2 0 2

9. R e s po n ds appropriately to teasing from friends or

relatives of his or her own age. 0 2 0 2
10. Re spon ds appropriately w he n hit or pushed by other
children. 0 2 0 2
11. Volunteers to help family members with tasks. 0 2 0 2
12. Invites others to your home. 0 2 0 2
13. Avoids situations that are likely to result in trouble. 0 2 0 2

C A R S SUMS OF HOW OFTEN COLUMNS

2
 How How
Social Skills (cont.) Often? Important?
No
Never Sometime tImportant Important
s CrItical
14. M a k e s friends easily. 0 2
0 2
15. K eeps room clean and neat without being reminded. 0 2 0 1 2

16. Completes household tasks within a reasonable time. 0 2 0 1 2

17. S h o w s concern for friends and relatives of his or her

own age. 0 2 0 2

18. Controls temper in conflict situations with you. 0 2 0 2

19. E n ds disagreements with you calmly. 0 1 2 0 2

20. Speaks in an appropriate tone of voice at home. 0 1 2 0 2

21. Acknowledges compliments or praise from friends. 0 2 0 2

22. Controls temper when arguing with other children. 0 2 0 2

23. Appropriately expresses feelings when wronged. 0 2 0 2

24. Follows rules w hen playing game s with others. 0 2 0 2

25. Attends to your instructions. 0 2 0 2

26. J oins group activities without being told to. 0 2 0 2

27. Compromises in conflict situations by changing own

ideas to reach agreement. 0 2 0 2

28. Puts away belongings or other household property. 0 2 0 2

29. Waits turn in gam es or other activities. 0 2 0 2

30. U s e s time appropriately while waiting for your help with

0 2 0 2
homework or s o m e other task.
31. Re ceives criticism well. 0 2 0 2

32. Informs you before going out with friends. 0 2 0 2

33. Follows household rules. 0 2 0 2

34. Is self-confident in social situations s uch a s parties or

. group outings. 0 2 0 2

35. S h o w s interest in a variety of things. 0 2 0 2

36. Reports accidents to appropriate persons. 0 2 0 2

37. Is liked by others. 0 2 0 2

38. An sw ers the phone appropriately. 0 2 0 1 2

39. A s k s sales clerks for information or assistance. 0 2 0 2

40. A p p e a r s self-confident in s o c i a l interactions with

0 2 0 2
opposite-sex friends.

c A R SUMS OF HOW OFTEN COLUMNS

G o o n to
Page4. . .

3
 How
Problem Behaviors Often?
Very
Never Sometimes Often
Do not make
41 . Likes to be alone. 1 2
importance ratings
42. Fights with others. 0 1 2
for items 41 - 52
43. Is easily embarrassed. 0 1 2

44. Argues with others. 0 1 2

45. Threatens or bullies others. 0 1 2

46. Talks back to adults when corrected. 0 1 2

47. H as temper tantrums. 0 1 2

48. A ppears lonely. 0 1 2

49. Gets angry easily. 0 1 ,2

50. Sho�s anxiety about being with a group of children. 0 1 2
51 . Acts s a d or depressed. 0 1 2
52. H as low self-esteem. 1 2

E I S U M S O F H O W O F T E N C OL U MN S Stop. Please check to be sure all items have been marked.

FOR OFFICE USE ONLY

A +
-
.

+
s

4
 Record
Frank M. Gresham and Stephen N. Elliott

Studen.t .. nformation

Date of Birth

Sex: D Female D Male Ethnic Group (optional) Age

Years Months

Grade and School

Parents' or guardians' names

1.

2.

Teacher's name

Reason for referral

Social Skills A s s es s m en t

Record the S S R S forms that have been completed and by whom. Also list any other methods of assessing the
student's behavior that have been completed and will be summarized on page 6 of this report.

SSRS Date Completed Rater

Teacher Form

Parent Form

Student Form

Other assessment methods

AOS" © 1990, Ame ri can G u i da n ce Service, Inc., Publishers' Building, Circle Pines, M N 55014-1796 F O R M : AIR
All rights reserved. No part of this form may be photocopied or otherwise reproduced. This form was printed in two colors.
8 0 9 8 7 6 5 4 3 2
 Standard Score Summary

Instructions
Copy the standard score, the percentile rank, the standard error of measurement, the confidence level and the
standard score confidence band from the individual Teacher, Parent, and Student questionnaires in the appropriate
space s below.

If you wish to s ee a graphic summary of these results, complete the Graphic Profile Summary on page 3.

Pa rent Student
T e a c he r
S OC IA L SKILLS
S O CI A L SKILLS SOCIAL SKILLS
Percentile
D D D D D
Standard Percentile

D
Standard Percentile Standard
Score Rank Score Rank Score Rank

SEM D 68%
Confidence Level

0 95%
SEM D Confidence

68% 0
Level

95%
SEM D C o n f i d e n Level

68%0 95% 0
Confidence
Band
0 Confidence
Band
0 Confidence
(standard to
to to
��
(standard scores) (standard scores)
s co e

P R O B L E M BEHAVIORS PR O B L E M BEHAVIORS

Standard Percentile Standard Percentile

Score Rank Score Rank

D D D D
SEM U Confidence Level

68% 0 95%
SEM D Confidence

68% 0
Level

95%

Confidence
Band
0 Confidence
Band
0
to to
(standard scores) (standard scores)

ACADEMIC COMPETENCE

Standard Percentile
Score Rank

D D
U
Confidence Level
SEM
68% 0 95%

Confidence
Band
0
to
(standard scores)

D e s c r i p t i o n o f Subscales
SOCIAL SKILLS

T he S S R S is designed to evaluate the frequency a n d the importance of S o c i a l S k ills in five areas.

The s e areas are:
Cooperation: behaviors such as helping others, sharing materials, and complying with rules and directions

Assertion: initiating behaviors, such as asking others for information, introducing oneself, and respond­
ing to the actions of others, such as peer pressure or insults

<Responsibility:
behaviors that demonstrate ability to communicate with adults a n d regard for property or work

Empathy: behaviors that show concern a n d respect for others' feelings a n d viewpoints

Self-Control: behaviors that e me r g e in conflict situations, s u c h a s responding appropriately to teasing, and in

nonconflict situations that r e q u i r e t ak i n g turn� a n d c o m p r o m i s i n g

2
 G r a p h i c P r o fi l e S u m m a r y
Instructions
The relationships among teacher, parent, and student ratings for the scales and subscales can be made readily
apparent. Transfer the results from each questionnaire to the profile below. Simply make X's in each box for each
form. (See sample below.) Y o u may wish to use different colors for Teacher, Parent, and Student Forms. A n ex­
ample of a completed profile is shown in Chapter 3 of the S S R S Manual. If you need more specific statistical infor­
mation for the scales, refer to page 2 of this Record.

Scales Subscales

SOCIAL SKILLS Cooperation Assertion Self-Control Empathy

Responsibility

Mo r e
0 0 0 o
OOO 0 0 0 0 0 0 0
More

Mo re Average
0 0 0 A v e r ag e
M or e

o Average

Fewer
Average
0 0 0 0 0 0 0 0 0 0 o Fewer

0 0 0 Fewer Fewer
0 0 0 0 0 0 0 0 0 0 Student

Teacher Parent Student Teacher Parent Student Teacher Parent Student Teacher Parent Student
P R O B L E M BEHAVIORS Externalizing Internalizing Hyperactivity
Parent

M or e
0 0 0 0
0 0 00 0
More More
Average
0 0 0 0 More
Average

Average
0 0
Fewer
0 0 0 0 0 0
Teacher Parent Teacher Parent

Fewer

Average Fewer
A C A D E M I Fewer
C COMPETENCE
0 0 S A M PL E : Teacher Parent

Example of Fewer, Average, and More ratings

0 Ab o ve Average

�
Teacher Parent

0 0 MORE

0
AVERAGE
Average

0 � 0
0
FEWER
Below Average

Te a c he r
� 0 0

P R O B L E M BEHAVIORS
T he S S R S Teacher and Parent Forms provide frequency ratings of potential P r o b l e m B e h a v io r s in three areas at
the elementary level and two areas at the preschool and secondary levels. Th e s e areas are:

Externalizing: behaviors involving verbal or physical aggression toward others, poor control of temper, and
arguing

Internalizing: behaviors indicating anxiety, sadness, loneliness, and poor self-esteem

Hyperactivity: behaviors involving excessive movement, fidgeting, and impulsive reactions (elementary level
only)

ACADEMIC COMPETE NC E
Th e S S R S Teacher Forms also include a nine-item scale of A c a d e m i c C o m p e te n ce . Ratings of reading, mathe­
matics, motivation, and parental support are included in this scale.

3
 · 8ehaviors c

Identifying Social Sldlls Strengths and Weaknesses

and Interfering
Problem Behaviors
T h e S t a n d a r d S c o r e S u m m a r y a n d t h e G r a p h i c P r o f i l e S u m m a r y ha v e e n a bl e d y ou to identify a student's

o v e r a l l s tr e n g t h s a n d w e a k n e s s e s . B e f o r e p l a n n i n g interventions for the s e ge ne ra l w e a k n e ss e s , a n analy­sis

of the behaviors represented by the items in the subscales is needed. This analysis should focus on
those social skills that have been identified as general strengths ("more than") or general weaknesses
("fewer than"). Imp ortance ratings, as well as F r e q u e n c y ratings must be use for this analysis. Y o u will p
need to examine the questionnaires to complete this analysis. A sample case identifying a student's
strengths and weaknesses is given in Chapter 4 of the S S R S Manual.

S o c i a l S k i l l s S treng ths are defined by Frequency ratings of 2 and Importance ratings of 1 or 2.

S o c i a l S k il ls Pe r f o r m a n c e D eficits are mild deficits and are defined by Frequency ratings of 1 and
Importance ratings of 2.

S o c i a l S k i l l s A c q u i s i t i o n Deficits are moderate to severe deficits and are defined by Frequency ratings
of 0 and Importance ratings of 1 or 2.

P r o b l e m B e h av io r s are those behaviors of an externalizing, internalizing, or hyperactive nature that can

interfere with the acquisition or performance of social skills. Any item on the Problem Behaviors subscales
that receives a Frequency rating of 2 may suggest an interfering problem behavior.

Social Sldlls Strengths (Frequency = 2, Importance = 1 o r 2) Review the S S R S questionnaires to

identify items that characterize social skills strengths. Enter a brief description of the items in the appropriate
section below. List one or two behaviors rated as strengths from each subscale if that subscale is rated "More."
Remember, the subscales are designated: C Cooperation, A Assertion, R
= Responsibility, E
= Empathy, = =

S =Self-Control.

Teacher Form Parent Form

Student Form

Comments on social skills strengths

4
S o c i a l S k i l l s P e r f o r m a n c e D e fi c i t s (Frequency = 1, Importance = 2) R e v i e w the S S R S question­
naire s to identify items that ch aracterize social skills pe rf orm anc e deficits. Enter a brief description of the items in
the appropriate s e c t io n be lo w . If p o s sible , list o n e or two behaviors rated a s p e r f or m a n c e deficits from e a c h
s u b s c a l e that h a s a B e h a v io r Le ve l of "Fewer."

T e a c h e r Fo rm Parent Form Studen t

Form

C o m m e n t s o n s ocia l skills per fo r ma n ce deficits

S o c i a l S k i l l s A c q u i s i t i o n D e fi c i t s (Frequency = 0, Importance = 1 or 2) R e v i e w the S S R S

ques tionnaire s to identify items that c haracterize s oc ia l skills acquisition deficits. Enter a brief description of the
items in the appropriate s e ctio n be lo w . If po ssible, list o n e or two behaviors rated a s acquisition deficits from e a ch
s ub s c a le that h a s a Beh avior Le ve l of "Fewer."

T e a c h e r Form Parent Form Studen t

Form

C o m m e n t s o n s oc ia l skills acquisition deficits

P r o b l e m B e h a v i o r s (Frequency = 2) R e v i e w the S S R S qu es tionna ir e s to identify items that characterize

problem behaviors. F r o m t h os e Beh avior Le v e ls rated "More," list in the appropriate s e ction be low all behaviors
from e a c h s u b s c a le that h a v e a F r e q u e n c y r a t in g of 2. R e m e m b e r , the s u b s c a l e s are de s igna ted as:
E = Ext er naliz ing, I = Internalizing, H = Hyperactivity.

T e a c h e r Fo r m P arent Form

C o m m e n t s o n problem behaviors

5
 S u m m a r y of Additional Asse ssment Information
U s e this p a g e to s u m m a r i z e other a s s e s s m e n t s of this student.

Direct o b s e r v a t i o n s - s c h o o l

Direct observations-h o m e

S o c i o m e t r i c me a s u re s

T e a c h e r interview

P a re nt interview

R ol e pl ay s

O t h e r beha vior ratings

A c hie v em e nt or cognitive m e a s u r e s

Self-c once pt or se l f-efficac y measures,

P re v ious intervention o u t c o m e data

6
 Linking A s s e s s m e n t to Intervention
O n c e the a na ly sis of the S S R S ratings h a s b e e n completed, it is pos s ible to d e ve lop ge ner a l intervention strategies.
T e a c h i n g s tudents social skills involves m a n y of the s a m e me t hods a s tea ching a c a d e m i c conc epts . T hus, effective
interventions for both a c a d e m i c difficulties a n d so c ia l skills deficits often involve mode ling correct behaviors, eliciting
imitative re s pons e s, providing corrective feedback, a n d arranging opportunities for practice. W h i le s o m e social skills
interventions require s pe c ia liz e d training, mo st m a y b e implem en ted in regular c la s s r o o m s by t ea c her s or at h ome
by parents.

T h r e e ba s ic intervention a p p r o a c h e s - o p e r a n t , soc ia l learning, c o g ni t iv e - b e h a v i o r a l - a r e c om mon ly u s e d to im­

prove soc ia l behavior. T h e s e pr o c e du r e s a re r e view e d in detail in C ha pte r 4 of the Manual.

T h e u s e of the s pecific pr o c e du r e s d e p e n d s o n the severity of the soc ia l skills deficits a n d the e xis te nc e of possible
interfering pr oble m behaviors. T h e mo r e s e rio u s the s oc ia l behavior deficit, the m ore involved a n d direct the
intervention. T h e S S R S A n a l y s i s of S o c ia l B e h a vior s giv en o n p a g e s 4 a nd 5 of this A I R form c a tegor iz es the type
of social skills problem. T h e following table s u g g e s t s different kinds of interventions for various categories.

N o Interfering Interferi ng
Pro blem Behaviors Problem Behaviors

So ci al Skills Direct instruction Modeling

A c q ui s i t i o n Deficits Modeling Coaching

Behavioral Rehearsal Differential Reinforcement of a

L o w R a te of R e s po n s e (DRL)
Coaching
Differential Reinforcement of Other
Behavior (ORO)

Reductive procedures to decrease

interfering problem behaviors

S o c i a l Skills Operant methods to manipulate Operant methods to manipulate

antecedent or consequent antecedent or consequent
P e r f o r m a n c e Deficits
conditions to increase the rate conditions to increase the rate
of existing behaviors of existing prosocial behaviors

Differential Reinforcement of a
L o w Ra te of R es ponse (DRL)

Differential Reinforcement of Other

Behavior (ORO)

Reductive procedures to decrease

interfering problem behaviors

S o c i a l Skills Reinforcement procedures to Reinforcement procedures to

maintain desired social behavior maintain desired social behavior
Strengths
U s e student a s a model for other Reductive procedures to decrease
students interfering problem behaviors

7
 Intervention Plan S u m m a r y
In this section, summarize your intervention plans. Describe the desired outcome behaviors, the procedures for
obtaining these behaviors, the materials and personnel involved, and the method of evaluating results. Each of
these components of an Intervention Plan is discussed in Chapter 4 of the S S R S Manual.

Short-Te r m Objecti ves

T a r g e t behav ior( s)

Critical setting or situations for change

Interventi on Procedures
Procedure for maintaining strengths

Procedure for promoting skill acquisition

Procedure for increasing skill performance

Procedure for reducing problem behaviors

Procedure for facilitating generalization,

Intervention Resources

Instructional or intervention materials

Intervention personnel

Intervention Evaluati on

C h a n g e in S S R S ratings

Mainstreamed-peer comparisons

Outcome interviews with significant adults

Intervention and Follow-u p Evaluation Dates

Intervention begins Intervention projected to end Actual ending

Intervention evaluation completed Re-evaluation of target behavior(s)

8
A.S & A .6 B E H A V I O R L E V E L S , S E C O N D A R Y

B e h a v i o r L e v e l s C o r r e s p o n d i n g to S u b s c a l e a n d T otal S c a l e R a w S c o r e s

A.S
Girls (grades 7 through 12)

Behavior Le vels (Teacher) Behavior Leve ls (Parent) Behavior Levels (Student)

Su b scale and Scale Fewer Average More Fewer Average More Fewer Average More

Social Skills

Cooperation 0- 13 1 4 - 19 20 0-9 1 0 - 16 1 7 - 20 0-11 12-1 7 1 8 - 20

Assertion 0-7 8-1 7 1 8 - 20 0- 10 1 1 - 18 1 9 - 20 0-8 9-1 5 1 6 - 20

Responsibility - - -
0- 14 15-1 9 20 - - -

Empathy - - - - - -
0- 13 14-1 9 20

Self-Control 0- 10 1 1 - 18 1 9 - 20 0-9 10-1 7 1 8 - 20 0-7 8-1 3 1 4 - 20

Total So ci al Skills Scale 0- 34 3 5 - 55 5 6 - 60 0-47 48- 66 67-8 0 0 - 45 4 6 - 61 62-80

Problem Behaviors

Externalizing -
0-4 5 - 12 0 1-6 7-1 2 - -
-

Internalizing -
0-6 7-1 2 0-2 3-7 8-1 2
- - -
Total Problem
Behaviors Scale 0-1 2-9 1 0 - 24 0-3 4 - 11 1 2 - 24 - - -

A cadem i c Competence Below Average Abov e Below Average Above Below Average Abov e
(No subscales)
9 - 27 28-4 3 44 - 45 - - - - - -

A.6
Boys (grades 7 through
12)
Behavior Levels (Teacher) Behavior Levels (Parent) Behavior Levels (Student)

Su bsc ale and Scale Fewer Average More Fewer Average More Fewer Average More

Social Skills

Cooperation 0 - 10 11- 19 20 0- 8 9-1 5 16- 20 0 - 10 11- 16 17-2 0

Assertion 0-7 8-1 6 17- 0 - 10 11- 18 19- 20 0-8 9-1 5 16- 20

20
Responsibility - - -
14-1 8 19- 20 - - -

0 -1 3
Empathy - - - - - -
0 - 10 1 1 - 17 1 8 - 20

Self-Control 0-9 1 0 - 18 1 9 - 20 0-9 1 0 - 16 17-2 0 0-7 8-1 3 1 4 - 20

Total Social Skills Scale 0 - 29 3 0 - 50 5 1 - 60 0 - 42 4 3 - 65 6 6 - 80 0 - 40 4 1 - 58 59- 80

Problem Behaviors
-

Externalizing -
0-6 7-1 2 0-1 2-7 -

8-1 2
-

Internalizing -
0-6 7-1 2 0-1 2-7 -

8-1 2
Behaviors
Total ProblemScale 0-1 2- 11 12 - 0-3 4-1 2 13- 24 - - -

24
A cadem i c Competence Below Average Ab ove Below Average Abov e Below Average Above
(No subscales)
9-2 3 24- 41 42- 45 - ..! - - - -

154
 8.5 S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S
( T E A C H E R F O R M , S E C O N D A R Y GIRLS)

Standard S c o r e s and Percentile R a n k s C o r r e s p o nd i ng to Total S c ale R a w S c o re s

Grades 7 12

Social Skills Problem Behaviors Academic Competence

Total Scale Total Scale Total Scale
Standard Percentile Standard Percentile Standard Percentile Standard Pe rc e ntil
Score Rank Score Rank Score Rank Score Rank
>130 >98 79 8 145 >98 >115 >84
125 95 77 6 143 >98 >115 >84
122 93 76 5 142 >98 113 81
119 90 74 4 140 >98 111 77
117 87 72 3 108 70
138 >98
115 84 71 3 137 >98 106 66
113 81 24 70 2 135 >98 105 63
112 79 69 2 133 >98 103 58
110 75 22 67 <2 132 98 101 53
108 70 21 66 <2 100 50
15 130 98
106 66 65 <2 128 97 98 45
105 63 64 <2 125 95 97 42
104 61 18 62 <2 122 93 95 37
102 55 61 <2 119 90 94 34
101 53 60 <2 92 3)
10 117 87
99 47 59 <2 114 82 90 25
98 45 58 <2 111 77 89 23
96 39 13 56 <2 109 73 87 19
95 37 12 55 <2 106 66 85 16
41 94 34 11 54 <2 83 13
103 58
93 32 52 <2 99 47 82 12
91 27 51 <2 96 39 80 9
90 25 50 <2 91 27 78 7
37 89 23 49 <2 <85 <16 76 5
87 19 48 <2 <85 <16 74 4

86 18 5 46 <2 72 3
84 14 4 45 <2 70 2
83 13 3 44 <2 68 2
82 12 43 <2 67 <2

31 80 9 41 <2 66 <2
0 40 <2
64 <2
62 <2
61 <2
60 <2
58 <2

56
55 <2
<2

162
 B.6 S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S
( T E A C H E R F O R M , S E C O N D A R Y B OYS )

Standard S c o r e s and Percentile R a n k s C o r r es p o nd in g to Total S cale R a w Sc ore s

Grades 7 through 12

Social Skills Problem Behaviors A c a de m ic Competence

Total Scale Total Scale Total Scale

Standard Percentile Standard Percentile Standard Percentile Standard Percentile

Score Rank Score Rank Score Rank Score Rank
>130 >98 86 18 145 >98 >115 >84
>130 >98 84 14 143 >98 >115 >84
130 98 83 13 140 >98 >115 >84
128 97 81 10 21 137 >98 >115 >84
125 95 80 9 113 81
135 >98
123 94 79 8 19 133 >98 111 77
121 92 77 6 18 130 98 109 73
119 90 76 5 17 128 97 108 70
117 87 75 5 16 125 95 106 66
116 86 74 4 105 63
123 94
114 82 73 4 14 121 92 104 61
113 81 19 72 3 13 119 90 102 55
111 77 18 71 3 12 117 87 101 53
110 75 70 2 11 115 84 99 47
108 70 16 68 2 98 45
10 113 81
107 68 15 66 <2 111 77 96 39
106 66 65 <2 108 70 94 34
105 63 13 63 <2 106 66 93 32
103 58 61 <2 103 58 91 27

41 102 55 11 59 <2 89 23
53 100
97 50
101 10 58 <2 42 87 19
99 47 9 56 <2 3 93 32 86 18
98 45
39 8 52
54 <2 87 19 23 84 14
96 <2 1 <85 <16 83 13
95 37 50 <2 <85 <16 21 81 10

93 32 47
49 <2 79
80 9
91 27 <2 19 8
90 25 3 45 <2 18 76
77 6
89 23 43 <2 17 75 5
87 19 1 42 <2 16 5
40 <2
15 73 4
14 70
72 3
2
12 68 2
11 66 <2

10 63 <2
9 61 <2

163
C.S S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S
( P A R E N T F O R M , S E C O N D A R Y GIRLS)

Standard S c o r e s a nd Percentile R a n k s C o r r e s p o n d in g to Total S cale R a w S c o r e s

Grades 7 through 12

Social Skills Problem Behaviors

Total Scale Total Scale
St Percentile Standard Percentile Standard Percentile
anScore Rank Score Rank Score Rank
dar
d >130 >98 76 5 145 >98
>130 >98 75 5 143 >98
>130 >98 74 4 142 >98
>130 >98 72 3 140 >98
>130 >98 71 3
139 >98
>130 >98 70 2 137 >98
>130 >98 69 2 135 >98
>130 >98 68 2 134 >98
127 96 67 <2 16 132 98
124 95 67 <2
15 128 97
122 93 66 <2 124 95
120 91 65 <2 120 91
118 88 64 <2 116 86
116 86 63 <2 11 113 81
114 82 62 <2
109 73
112 79 61 <2 105 63
110 75 60 <2 101 53
109 73 60 <2 98
107 68 59 <2 93 32
105 63 58 <2
90 25
104 61 57 <2 86 18
102 55 56 <2 <85 <16
100 50 55 <2 <85 <16
99 47 17 54 <2 <85 <16
97 42 54 <2 <85 <16

96 39 53 <2
95 37 14 52 <2
93 32 51 <2
92 30 50 <2
90 25 49 <2

89 23 49 <2
88 21 48 <2
86 18 47 <2
85 16 46 <2
84 14 45 <2

82 12 44 <2
81 10 43 <2
79 8 43 <2
78 7 42 <2
77 6 1 41 <2
40 <2

172
 C.S S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S
(P A R E N T F O R M , S E C O N D A R Y B OYS)

Standard S c o r e s and Percentile R a n k s C o rr e s p o n d ing to Total Scale R a w S cor es

Grades 7 through 12

Social Skills Problem Behaviors

Total Scale Total Scale
Standard Percentile Standard Percentile Standard Percentile
Score Rank Score Rank Score Rank

>130 >98 82 12 145 >98

>130 >98 81 10 143 >98
>130 >98 80 9 141 >98
>130 >98 79 8 140 >98
>130 >98 78 7
138 >98
>130 >98 76 5 136 >98
>130 >98 75 5 135 >98
>130 >98 73 4 133 >98
130 98 72 3 131 98
127 96 71 3
125 95
125 95 70 2 120 91
122 93 69 2 116 86
120 91 68 2 112 79
119 90 67 <2 109 73
117 87 66 <2
106 66
115 84 65 <2 102 55
114 82 64 <2 98 45
112 79 63 <2 95 37
110 75 62 <2 92 30
109 73 61 <2
89 23
107 68 60 <2 86 18
105 63 59 <2 <85 <16
104 61 58 <2 <85 <16
102 55 57 <2 <85 <16
10 1 53 56 <2 <85 <16

99 47 55 <2
98 45 54 <2
96 39 53 <2
95 37 52 <2
94 34 51 <2

93 32 50 <2
92 30 49 <2
91 27 48 <2
90 25 47 <2
89 23 46 <2

88 21 45 <2
87 19 44 <2
86 18 43 <2
85 16 42 <2
84 14 41 <2
40 <2

173
0.3 .S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S

( S T U D E N T F O R M , S E C O N D A R Y GIRLS)

Standard S c o r e s and Percentile R a n k s C o rr e s p o nd ing to Total S cale R a w S c o r e s

Grades 7 through 12

Social Skills
Total Scale
Standard Percentile Standard Percentile
Score Rank Score Rank

>130 >98 77 6
>130 >98 75 5
>130 >98 74 4
>130 >98 72 3
>130 >98 71 3

>130 >98 70 2
>130 >98 69 2
>130 >98 68 2
>130 >98 67 <2

71 >130 >98 66 <2

>130 >98 65 <2

>130 >98 64 <2
130 98 64 <2
128 97 63 <2
126 96 62 <2
95
124 61 <2
122 93 60 <2
119 90 59
59 <2
117 87 <2
115 84 58 <2
57
113 81 <2
111 77 55
56 <2
108 70 <2
106 66 54 <2
104 61 54 <2
53
102 55 <2
101 53 52 <2
99 47 51 <2
97 37
42 50
49 <2
95 <2
94
34 48 <2
92 30 47
48 <2
90 25 <2
88 21 46 <2
87 19 45 <2

85 16 44 <2
83 13 43 <2
81 10 43 <2
80 9 42 <2
78 7 41 <2
4() <2

178
 D.4 S T A N D A R D S C O R E S & P E R C E N T I L E R A N K S
(S TUDENT F O R M , S E C O N D A R Y BOYS)

Standard S c o r e s and Percentile R a n k s C o rr e s p o nd ing to Total Scale R a w Scores

Grades 7 through 12

Social Skills
Total Scale

Raw Standard Percentile Standard Percentile

Score Rank Score Rank

>130 >98 85 16
>130 >98 39 84 14
>130 >98 82 12
>130 >98 37 80 9
>130 >98 79 8

75 >130 >98 78 7
>130 >98 76 5
>130 >98 75 5
>130 >98 73 4
71 >130 >98 31 72 3

>130 >98 71 3
>130 >98 69 2
>130 >98 68 2
67 >130 >98 27 67 <2
129 97 66 <2

128 97 65 <2
126 96 64 <2
124 95 63 <2
122 93 62 <2
61 121 92 21 61 <2

119 90 60 <2
117 87 19 59 <2
115 84 18 58 <2
57 114 82 17 57 <2
112 79 16 56 <2

110 75 15 55 <2
108 70 14 54 <2
107 68 13 53 <2
105 63 12 52 <2
51 104 61 11 51 <2

102 55 50 <2
49 100 50 9 49 <2
98 45 8 48 <2
47 97 42 47 <2
95 37 46 <2

93 32 5 45 <2
92 30 4 44 <2
90 25 3 43 <2
88 21 2 42 <2
41 87 19 1 41 <2
40 <2

179