Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Listed below are a series of requests you may present to your child in a given day. What is the likelihood that your child will comply to this request if the request is slated only once? Please check (√) the appropriate box beside each command.
Almost Usually Occasionally Rarely Skill not This request is alwavs (51-75%) (26-50%,) (0-25%) learned important to (76-100%) me (√) o r ( X )
I. HOUSEHOLD REQUESTS DRESSING
1. Get your shirt from the drawer/closet.
2. Get your sweater from the drawer.
3. Gel your pants from the drawer/closet.
4. Get your underpants from the drawer.
5. Gel your socks from the drawer.
6. Gel your coal from the closet.
7. Gel your shoes from the closet.
8. Put on your shirt.
9. Put on your sweater.
10. Put on your pants.
11. Put on your underpants.
12. Put on your socks.
13. Put on your coat.
14. Put on your shoes.
15. Fasten your buttons.
16. Fasten your buckle.
17. Fasten your shoes.
Page 1 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE Almost Usually Occasionally Rarely Skill not This request is alwavs (51-75%) (26-50%,) (0-25%) learned important to (76-100%) me (√) o r ( X )
II. DRESSING (cont’d)
18. Do up your zipper.
19. Hang up your coat.
20. Hang up your shirt.
21. Hang up your sweater.
22. Hang up your pants.
23. Take off your shirt
24. Take off your sweater.
25. Take off your pants.
26. Take off your underpants.
27. Take off your coat.
28. Take off your socks
29. Take off your shoes
30. Undo your buttons.
31. Undo your snap(s).
32. Undo your buckle.
33. Undo your zipper.
34. Undo your shoes.
35. Fold your sweater.
36. Fold your shirt
37. Fold your pants,
Page 2 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
III. HYGIENE (cont'd)
38. Wash your hands.
39. Brush your hair.
40. Wash your face.
41. Turn on the tap.
42. Turn off the tap.
43. Flush the toilet.
44. Pick up the soap.
45. Dry your hands.
46. Dry your face.
47. Co to the bathroom. -
48. Close the door.
49. Pull your pants down.
50. Rub your hands together.
51. Take the cap off the toothpaste.
52. Wet your toothbrush.
53. Put toothpaste on your toothbrush.
54. Brush your teeth.
55. Spit the toothpaste into the sink.
Page 3 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
HYGIENE (cont'd)
56. Rinse your mouth
57. Put the cap on the toothpaste.
58. Put the toothbrush away.
59. Put the toothpaste away.
IV. PLAY
60. Go get your (play item).
61. Do the puzzle.
62. Put this piece in the puzzle.
63. Throw me the ball.
64. Catch the ball.
65. Play some music for me.
66. Sing to the music
67. Dance to the music.
68. Jump up and down.
_____ 69. Do a somersault.
70. Ride your (individual item).
71. Draw me a picture.
Page 4 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to (76-100%) me (√) o r ( X )
P L A Y (cont'd)
72 Colour the picture.
73. Turn on the music.
74. Turn on the T.V.
75. Turn up/down the volume.
76. Stand on one foot.
77. Hop.
78. Spin around.
79. Put your hands up in the air.
80. Stamp your feet.
81. Play patty cakes with me.
82. Stack the blocks.
83. Push the toy car.
84. Hug the doll/stuffed animal.
■ ,
V. ACADEMIC |
85. Trace the (particular object).
86. Draw a (particular object).
87. Draw a line.
Page 5 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to (76-100%) me (√) o r ( X )
88. Cut out the picture. 89. Point to the ______
90. Find me a picture of a ______
91. Print your name.
92. Tell me your name.
93. Show me the ______.
94 Give me the ______.
95. Tell me were your ______is.
96. Count to ten.
97. Count the items.
98. Tell me what time it is.
99. Open the book.
100. Read this to me.
101. Turn the page.
102. Show me your right/left hand.
103. Bring me the ______.
104. Touch your ______.
105. Touch my ______.
Page 6 of 13
Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to (76-100%) me (√) o r ( X )
Social
106. Give me a Hug
107. Give me five
108. Shake my hand.
109. Give me a kiss.
110. Clap your hands.
1011 Hold my hand.
112. Come sit beside me.
113. Smile
114 Wink
115 Talk on the phone
Meal Time
116. Set the Table
117. Put the ______on the table.
118. Open the fridge.
119. Get the ______from the fridge.
120 Come to the table.
121. Eat your (particular food item)
Page 7 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
MEALTIME (cont'd)
122. Use your spoon.
123. Use your fork.
124. Use your knife.
125. Pass the (particular item).
126. Use your (particular utensil).
127. Sit in your chair.
128. Drink your (particular drink).
129 Pour yourself a drink of
130. Take your medication.
131. Wipe your mouth.
132. Go get a (particular treat).
-..
CLEAN-UP
133. Make your bed.
134 Put away your coat.
135. Put away your shoes.
136 Put away your toys.
137. Put away your book.
Page 8 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
CLEAN – UP (cont’d)
138. Pick up your (particular object).
139. Put your dish in the sink.
140. Wash the dish/cup.
141. Rinse the dish/cup.
142. Dry the dish/cup.
143. Clear the table.
144. Clear the plate(s) off the table.
145. Clear the utensil(s) off the table.
146. Clear the cup/glasses off the table.
147. Sweep the floor.
148. Fold the blanket/towel.
BEDTIME
149. Go to your bedroom.
150. Go to bed.
151. Get your pyjamas out.
152. Get your pyjamas on.
Page 9 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
BEDTIME( cont'd)
154. Turn out the light.
155. Get under the covers.
156. Pull up the covers.
157. Put your dirty clothes away.
158. Say goodnight.
COMMUNITY REQUESTS
159. Look both ways before crossing the street.
160. Walk on the sidewalk.
161. Don't cross when the light is red.
162. Cross when the light is green.
163. Push the button to cross.
164. Hold my hand while crossing. .
165. Cross the street.
166. Don't run across the street.
167. Don't play in the street.
Page 10 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
TRANSPORTATION
168. Get into the car/bus.
169. Put on your seatbelt.
170. Stay in your seat.
171. Get out of the car/bus.
OUTSIDE
172. Sit on the teeter-totter.
173. Sit on the swing.
174. Ride your bike/tricycle.
175. Climb on the monkey bars.
176. Blow bubbles.
177. Go down the slide.
178. Jump rope.
179. Skip.
180. Water the flowers/grass.
181. Run.
Page 11 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
SHOPPING
182. Put the (grocery item) into the buggy.
183. Get a buggy from the front of the store.
184. Push the buggy.
185. Stay with me.
186. Wait in line.
187. Put the groceries into bags.
188. Pay the cashier.
189. Put the groceries into the car.
RESTAURANT
190. Pick out what you would like to eat.
191. Give the waitress your order.
192. Finish your meal.
193. Stay in your seal.
194. Keep your voice down.
Page 12 of 13 Name: ______Date. ______COMPLIANCE PROBABILITY QUESTIONNAIRE
Almost Usually Occasionally Rarely Skill not This request is always (51-75%) (26-50%,) (0-25%) learned important to me (76-100%) (√) o r ( X )
GENERAL
195. Follow
196. Look at me.
197. Come here
198. Hold this.
199. Stand up.
200. Sit down.
201. Go to the (particular place), music. 202. Turn off the music.
203. Turn off the T.V.
204. Push your chair in.
205. Bring me (non-play item).
206. Tell me your telephone number.
207. Tell me your name.
208. Tell me your address.
209. Bring in the newspaper.
210. Bring me the mail.
Page 13 of 13