Name------------------------------------------------------Sex----------Age--------Psy.Number-----------Date--------------
Gross
Motor
|
Score
|
Fine Motor
|
Score
|
1. ‡mvRv n‡q em‡Z cviv
|
1. nv‡Z
e¯‘ aiv
|
||
2. mvg‡b wcQ‡b †`vjv
|
2. `yÕnv‡Z
aiv
|
||
3. nvgv¸wo 8 wdU
|
3. Av½yj
w`‡q †Zvjv
|
||
4. emv †_‡K `uvov‡bv
|
4. †QvU
e¯‘ 2/3 Av½yj w`‡q aiv
|
||
5. GKv `uvov‡bv
|
5. GK
nvZ †_‡K Ab¨ nv‡Z †bIqv
|
||
6. dvwb©Pvi a‡i nuvUv
|
6. c¨uvPv‡bv
e¯‘ †Lvjv (PK‡jU)
|
||
7. 8-10 K`g nvuU‡Z cviv
|
7. e‡·i
XvKbv †Lvjv
|
||
8. †Pqvi, weQvbvq DV‡Z cviv
|
8. `iRvi
be/ cvwbi †Uc †Lvjv
|
||
9. ej †Qvov
|
9.
c¨uvPnxb XvKbv †Lvjv
|
||
10. mwVKfv‡e wmuwo w`‡q DVv bvgv
|
10.
KvMR/ Kvco fuvR Kiv
|
||
11. `ª“Z †`uŠov‡bv
|
11.
cyuwZ g‡a¨ m~Zv w`‡q Mvu_v
|
||
12. `yÕ cv‡q jvdv‡bv
|
12.
Nywoi m~Zv †cuPv‡bv
|
||
13. e‡j wVKfv‡e jvw_ cviv
|
13.
gvwU/ AvUv w`‡q wKQz ˆZwi Kiv
|
||
14. mi“ iv¯—vq nuvUv
|
14. ¯Œz
WªvBfvi w`‡q bvU †Nvov‡bv
|
||
15. `yÕ nv‡Z wKQz aiv
|
15. Pvwe
w`‡q Zvjv †Lvjv
|
||
16.
GK nv‡Z ai‡Z cviv (12) / 12 dzU `y‡i ej
†Qvov
|
16.
‡ebx/ †Luvcv Kiv/ Pzj AvuPov‡bv Pzj/
cvU/ Dj
|
||
17. `wo jvdvb
|
17. myB
myZv w`‡q UvK †`Iqv
|
||
18.
jvdv‡Z jvdv‡Z `ªyZ MwZ‡Z hvIqv/ †`uŠov‡bv
jvdv‡bv
|
18. myB
G myZv †XvKv‡bv
|
||
19.
10 / 12 wjUvi cvwb wb‡Z cviv / enb Kiv
|
19.
KvwP/ Qzwo w`‡q Qwe AvK…wZ Abymv‡i KvUv
|
||
20. MvQ, Qv` ev †`qv‡j DVv
|
20.
†mjvB Kiv, Nywo evbv‡bv †Ljbv ˆZwi
|
||
21. e¯—v Uvbv, av°v †`Iqv
|
21. Qwe
AvuKv, wcVv, iywU ˆZwi
|
||
22.
kn‡ii †Q‡j-¯‹zj/ dzUej kn‡ii †g‡q- ¯‹zj,
mvZuvi, bvP, MÖvgxY †Q‡j-dzUej / KvivwZ,
MÖvgxY †g‡q- mvZuvi/ gywo evbv‡bv
|
RS RS
Socialization
|
Score
|
Communication Comprehension
|
Score
|
1.cwiwPZ
†jvK †`‡L nvmv
|
1. cwiev‡ii †jv‡Ki KÚ †Pbv
|
||
2.Ab¨‡K
AbyKiY Kiv (ZvB-ZvB)
|
2. cvwievwiK cwiw¯’wZ‡Z cÖwZwµqv Kiv (KvIqv/
†Mvmj)
|
||
3. wKQz
PvB‡j †`q wKbv
|
3.
evwoi wRwbmc‡Îi bvg/ wPb‡Z
cviv
|
||
4.
mgeqmx/ eo‡`i mv‡_ Avb›` Kiv
|
4.
n¨uv/ bv †evSv
|
||
5.wb‡Ri
†Ljbv wb‡q A‡b¨i mv‡_ †Ljv
|
5.
mvaviY Av‡`k †evSv| nvZ
Zvwj/ Kv‡Q G‡mv
|
||
6.
†eov‡Z wM‡q Avb›` cvIqv
|
6.
kix‡ii A½ cÖZ½ mbv³/ wPb‡Z
cviv
|
||
7.
†eov‡Z wM‡q mwVK e¨envi Kiv
|
7.
bvg ï‡b Qwe wPb‡Z cviv
|
||
8.
mgeqmx‡`i mv‡_ MVbg~jK †Ljv
|
8.
wb‡`©kbv AbymiY Ki‡Z cviv
(Avcy‡K WvKv)
|
||
9. eo‡`i
Aby‡iva †g‡b Pjv
|
9.
Mí, bvUK, Qwe, weÁvcb †evSv
|
||
10. mgeqmx/ eo‡`i mv‡_ mn‡hvMxZvg~jK
†Ljv Kiv
|
10.
iO I AvK…wZ Avjv`v Ki‡Z/
wPb‡Z cviv
|
||
11.
evwo‡Z †gngvb Avm‡j Lywk nIqv
|
1. cÖv_wgK
i‡Oi bvg/ mbv³ Ki‡Z cviv
|
||
12.
mvgvwRK (mvjvg) Awfev`b †`Iqv
|
2.
mwVK w`K wb‡`©kbv ‡evSv
(Wvb/evg/Dt/`t)
|
||
13. wkï/
cÖvYx/ Ab¨‡`i cÖwZ mnvb~f~wZkxj
|
3.
wecixZ aviYv ‡evSv
(Dci-bxP, †Lvjv-eÜ)
|
||
14.Ab¨‡`i
Amy¯’Zv/ mgm¨v m¤ú‡K© m‡PZb
|
4.
`y‡Uv cwiwPZ e¯‘I g‡a¨
cv_©K¨ Ki‡Z cviv (wUwf, †iwWI)/ Rvgv kvU©
|
||
15.
Avc¨vqb Kiv
|
5.
mg‡qi mv‡_ mvgÁm¨ Kiv(mKv‡j
bv¯—v Kiv)
|
||
16.
ab¨ev`/ AbyMÖn/ `ytwLZ m~PK Awfe¨w³ cÖKvk
|
6.
mßvn/ gvm/ eQ‡ii evsjv
Bs‡iRx bvg/ RvZxq Drm‡ei w`b
|
||
17.†¯^”Qvq
Ab¨‡K mvnvh¨ Kiv
|
7.
1,2,5,10,20,50 I 100 UvKv
†evSv/ mbv³ Ki‡Z cviv
|
||
18.
eo‡`i m¤§vb †`Lvb (D‡V `vovb/ †Pqvi †`Iqv)
|
8.
wjwLZ I †gŠwLK wb‡`©kbv
†evSv
|
||
19. fyj
n‡j ¶gv PvIqv
|
|||
20.
A‡b¨i wRwbm e¨envi Ki‡Z AbygwZ †bIqv
|
|||
21.
RbMY/ A‡b¨i/ m¤úwËi cÖwZ m¤§vb Rvbvb
|
|||
22.
mvgvwRK Kg©Kv‡Ê †¯^”Qvq AskMÖnY Kiv
|
 |
9. cwiev‡ii †jv‡Ki KÚ †Pbv
|
Independent Behaviour Assessment Scale (IBAS)
Communication
Comprehension
|
Score
|
Language Expression
|
Score
|
Eating and Meal Preparation
|
Score
|
11.
cwiev‡ii
†jv‡Ki KÚ †Pbv
|
1.
w¶‡`/ Amw¯ZKi Ae¯’vq Kvu`v
|
1. webv
AvcwˇZ big Lvevi LvIqv
|
|||
12.
cvwievwiK cwiw¯’wZ‡Z cÖwZwµqv Kiv (LvIqv/
†Mvmj)
|
2.
`yB kã ejv (eyey/ gvgv/
`v`v)
|
2. Av½yj
w`‡q Lvevi gy‡L †bIqv
|
|||
13.
evwoi wRwbmc‡Îi bvg/ wPb‡Z
cviv
|
3.
Pvi kã ejv (gv gv gv gv/
`v`v `v`v)
|
3. Kvc/
Mvm I cvwb LvIqv
|
|||
14.
n¨uv/ bv †evSv
|
4.
cvwicvwk¦©K e¯‘‡K GK k‡ã
ejv (gvg-cvwb)
|
4. Lvevi
Gi cÖwZ wb‡`©kbv Kiv
|
|||
15.
mvaviY Av‡`k †evSv| nvZ
Zvwj/ Kv‡Q G‡mv
|
5.
mvg‡b _vKv e¯‘i bvg ej‡Z
cviv (cyZzj/ `v`v)
|
5. k³
Lvevi wPwe‡q LvIq
|
|||
16.
kix‡ii A½ cÖZ½ mbv³/ wPb‡Z
cviv
|
6.
20wU kã ej‡Z cviv
|
6. Av½yj
w`‡q Lvevi gy‡L wb‡q LvIqv
|
|||
17.
bvg ï‡b Qwe wPb‡Z cviv
|
7.
kix‡ii mKj A½ cÖZ‡½i bvg
ejv
|
7. nvZ/
PvgP w`‡qfvZ/ ZiKvix wgwk‡q LvIqv
|
|||
18.
wb‡`©kbv AbymiY Ki‡Z cviv
(Avcy‡K WvKv)
|
8.
mvaviY ev‡K¨ wb‡Ri Pvwn`v/
Av‡eM/ mgm¨v cÖKvk Kiv
|
8. cÖwZw`‡bi
Lvevi m¤ú~Y© Kiv
|
|||
19.
Mí, bvUK, Qwe, weÁvcb †evSv
|
9.
‡Kv_vq/ †K/ wK/ wKfv‡e/ †Kb
cÖkœ Kiv
|
9. RM/
†evZj ‡_‡K cvwb Xvj‡Z cviv
|
|||
20.
iO I AvK…wZ Avjv`v Ki‡Z/
wPb‡Z cviv
|
10. 4-7
k‡ãi m¤ú~Y© evK¨ ejv
|
10.
mvg‡b †_‡K cÖ‡qvRb gZ Lvevi
Zz‡j †bqv
|
|||
21.
cÖv_wgK i‡Oi bvg/ mbv³ Ki‡Z
cviv
|
11. evev-gvi
bvg/ cwiev‡ii m`m¨ Ges wRÁvmv Ki‡j wVKvbv ej‡Z cviv
|
11.
wb‡Ri cQ›` gZ Lvevi Zz‡j
†bqv| jeY, wPwb
|
|||
22.
mwVK w`K wb‡`©kbv ‡evSv
(Wvb/evg/Dt/`t)
|
12. wcZvgvZvi
†ckv m¤ú‡K© ej‡Z cviv
|
12.
‡h‡Kvb kieZ ˆZwi Kiv
|
|||
23.
wecixZ aviYv ‡evSv
(Dci-bxP, †Lvjv-eÜ)
|
13. †QvU KweZv gyL¯’/ Ave„wË Kiv
|
13.
cvwb, `ya, ZiKvix, wWg,
Avjy†dvUv‡bv/ wm×
|
|||
24.
`y‡Uv cwiwPZ e¯‘I g‡a¨
cv_©K¨ Ki‡Z cviv (wUwf, †iwWI)/ Rvgv kvU©
|
14. RwUj
ev‡K¨i e¨envi
|
14.
Pyjv R¡vjv‡Z cviv
|
|||
25.
mg‡qi mv‡_ mvgÁm¨ Kiv(mKv‡j
bv¯—v Kiv)
|
15. AZxZ
AwfÁZv eY©bv Ki‡Z cviv
|
15.
dj/ ZiKvix, Qzwi/ evwU w`‡q
KvUv
|
|||
26.
mßvn/ gvm/ eQ‡ii evsjv
Bs‡iRx bvg/ RvZxq Drm‡ei w`b
|
16. ‡`vKv‡b
wM‡q wRwb‡mi Aby‡iva Kiv/ PK‡jU
|
16.
mvavib Lvevi ˆZwi Kiv fvZ/
Avjy fZ©v/ Wvj
|
|||
27.
1,2,5,10,20,50 I 100 UvKv
†evSv/ mbv³ Ki‡Z cviv
|
17. ‡Uwj‡dv‡b
DËi †`qv/ msev` †`qv (kn‡ii †Q‡j/ †g‡q)cÖwZ‡ekx‡K Lei †cuŠ‡Q †`qv (MÖvg †Q‡j/
†g‡q)
|
||||
28.
wjwLZ I †gŠwLK wb‡`©kbv
†evSv
|
18. e¨w³/
wRwbm m¤ú‡K© cÖkœ Kiv| ¸i“Z¡c~Y© e¨w³‡`i bvg ej‡Z cviv
|
||||
19. Mí/ †RuvK/ bvUK ej‡Z cviv
|
|||||
20. K‡_vcK_‡b
AskMÖnY
|
Independent
Behaviour Assessment Scale (IBAS)
Toileting
|
Score
|
Dressing
|
Score
|
1.
c¨v›U wf‡R †M‡j A¯^w¯’‡eva
Kiv
|
1. Kvco cov‡Z Ges Lyj‡Z mn‡hvwMZv Kiv
|
||
2.
gjgyÎ Z¨v‡Mi K_v ej‡Z cviv
|
2. wb‡Ri
Kvco evQvB Kiv
|
||
3. wbw`©ó
RvqMvq ev_i“g Kiv
|
3.
mvaviY Kvco Lyj‡Z
cviv|(c¨v›U/Rvgv)
|
||
4.
ev_i“g †k‡l DV‡Z cviv
|
4. m¤ú~Y© w`M¤^i n‡q hvIqv
|
||
5. w`‡b
gj wbqš¿Y Ki‡Z cviv
|
5.
†Pb, †evZvg Lyj‡Z cviv
|
||
6. GKv
ev_i“‡g †h‡Z cviv
|
6.
mvaviY Kvco co‡Z cviv|(c¨v›U/ wXjvRvgv)
|
||
7.
Ny‡gi g‡a¨ gj Z¨vM bv Kiv
|
7. wVKfv‡e RyZv, †m‡Ûj cv‡q †`qv
|
||
8. wb‡Ri
c¨v›U Ly‡j ev_i“‡g hvIqv
|
8.
Kvc‡oi †Pb, †evZvg jvMv‡Z
cviv
|
||
9. ev_i“‡g
wb‡R cwi¯‹vi nIqv| nvZ †avqv
|
9.
Kvco c‡o mwVKfv‡e †evZvg Ni jvMv‡bv
|
||
10.
gj Z¨vM †k‡l ¯’vbwU cwi¯‹vi
Kiv
|
10.
RyZvi eK‡jm wdZv jvMv‡Z
cviv
|
||
11.
ev_i“‡g e‡m `iRv eÜ Kiv
|
11.
Rvgvi †cQ‡bi †evZvg/ †Pb
†Lvjv
|
||
12.
wcKwbK ev evRvi hvÎvKv‡j
gjgyÎ wbqš¿Y Kiv
|
12.
Rvgvi †cQ‡bi †evZvg/ †Pb eÜ
Kiv
|
||
13.
bZzb RvqMvq ev_i“g Av‡Q wK
bv ej‡Z cviv
|
13.
kxZ Mi‡gi Kvco wbev©Pb Kiv
|
||
14.
`y‡ii hvÎvq ev_i“g wbqš¿Y
Kiv|(evm)
|
14.
is wWRvBb Kvco wg‡j‡q cov
|
||
15.
|
15.
¯‹zj/ evwo/ evB‡i hvevi
Kvco wbe©vPb Kiv
|
RS
RS
Independent Behaviour
Assessment Scale (IBAS)
Self-care
|
Score
|
Domestic
skill
|
score
|
1. `uvZ
gvR‡Z mn‡hvwMZv Kiv
|
1. wKQz PvB‡j †`qv| (†ccvi)
|
||
2. Pzj
AvPov‡bv, bL KvUvq mn‡hvwMZv
|
2. wbw`©ó
¯’v‡b gqjv †djv
|
||
3. cvwbi Kj
†Q‡o bx‡P nvZ †`qv
|
3.
eB/Rvgv/ ¯‹zj e¨vM/
†Ljbv e¨env‡ii ci ¸wQ‡q
ivLv
|
||
4. ‡fRv gyL
UvIqvj wUm¨y w`‡q †gvQv
|
4. †Ljbv/ evwo AvmevecÎ gqjv n‡j cwi¯‹vi Kiv
|
||
5. Av½yj/
eªvk/gvRb w`‡q `uvZ gvRv
|
5.
gqjv/cwi¯‹vi Kvco Avjv`v ¯’v‡b ivLv
|
||
6. ‡Mvmj
K‡i kixi †gvQv
|
6.
Lvevi Gi mgq
Lvev‡ii cvÎ GwM‡q wb‡h hvIqv
|
||
7. mvevb
w`‡q nvZ gyL †avqv
|
7. Lvevi
†k‡l †cU miv‡bv
|
||
8. wb‡R wVKgZ
`vuZ gvRv
|
8.
mvaviY wRwbm cwi¯‹vi Kiv
|
||
9. wb‡R
wb‡R †Mvmj K‡i Rvgv civ
|
9.Ab¨‡K
Avc¨vqb Kiv
|
||
10.
LvIqvi Av‡M c‡o nvZ †avqv
|
10.
N‡ii Kv‡R evev, gv‡K mvnvh¨ Kiv
|
||
11. Av¸b/cï/†cvKvgvKo
†_‡K wbivc` _vKv
|
11.
Kvco ay‡Z cviv
|
||
12.
aviv‡jv e¯‘ mveav‡b e¨envi Kiv
|
12.
¯‹zj/evB‡i hvIqvi cÖ‡qvRbxq KvR Ki‡Z cviv|
(wUwdb/cvwb
|
||
13.
cÖwZw`b cÖ‡qvRb Abyhvqx Pz‡ji
|
13. ¯‹zj/evB‡i
†_‡K AvmevecÎ, wb‡Ri wRwbm, e¨vM, Rvgv, ¸Qv‡bv
|
||
14.mvevb/k¨v¤úy
w`‡q Pzj cwi¯‹vi Kiv
|
14.
DVvb/Ni/i“g cwi¯‹vi Ki‡Z cviv
|
||
15.
Av½y‡ji bL KvU‡Z cviv
|
15. fvix
Kvco wbOwi‡q †g‡j †`Iqv, ïwK‡q †M‡j wb‡q Avmv
|
||
16.
mvgvb¨ †K‡U/cy‡o †M‡j hZœ †bIqv
|
16.
Nygv‡bvi Av‡M wb‡Ri weQvbv Ki‡Z cviv
|
||
17.‡n‡U
iv¯—v/cyj cvi nIqv
|
17.
mvaviY Kvco B¯¿x Kiv
|
||
18.
wb‡Ri Kvco/eB/†Ljbv ¸wQ‡q ivLv
|
18. Lvevi
Mig Kiv, iv¯—vcvi n‡q †`vKv‡b mwVK wRwbm †Kbv
|
||
19.
Lvevi †X‡K ivL‡Z cviv
|
19.
N‡ii UzwKUvwK wRwbm †givgZ Kiv
|
||
20.
mvgvb¨ Amy¯’ n‡j hZœ †bIqv
|
RS
RS
Motor
SK
|
RS
|
|
Socialization
SK
|
RS
|
|
Communicative
SK
|
RS
|
|
Daily
SK
|
RS
|
Total Score
|
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