me. discipline including severely disruptive. Child suspensions. is in danger of expulsion. If the needs / functioning fall within a shaded box, explain why: child’s II-14. School Achievement (PAST 30 DAYS) – Child is doing well in school, Child is doing well in school Child is having moderate Child is having severe any concerns are age achievement, although some problems with school achievement problems and appropriate or this problems exist, such as achievement. He / she may may be failing most subjects or has failed information is unknown to failing to turn in work, be failing some subjects. me. disorganization or refusal to more than 1 year within do some assignments. the past two years. If the needs / functioning fall within a shaded box, explain why: child’s B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-15. School Relationship with Teachers – Child has good relations with Child has occasional Child has difficult relations Child has very difficult teachers. Any concerns are difficulties relating with at with teachers that notably relations with all teachers age appropriate or this least 1 teacher or during at interferes with his / her or with their only teacher information is unknown to least one subject period. education. which prevents the child me. from learning. If the needs / functioning fall within a shaded box, explain why: child’s II-16. Impulsivity / Hyperactivity (PAST 30 DAYS) No evidence of impulsivity / Some problems with Clear evidence of problems Clear evidence of a hyperactivity, any concerns impulsive, distractible or with impulsive, distractible or dangerous level of are age appropriate or this hyperactive behavior. hyperactive behavior that is impulsive behavior that can information is unknown to interfering with the place the child at risk of child’s me. ability to function. physical harm. If the needs / functioning fall within a shaded box, explain why: child’s II-17. Oppositional Behaviors (PAST 30 DAYS) No evidence of oppositional History or recent onset of Clear evidence of Clear evidence of a behaviors. Child displays defiance towards authority oppositional and / or defiant dangerous level of age appropriate resistance figures. behaviors which are oppositional behavior
me. discipline including suspensions. severely disruptive. Child is in danger of expulsion. If the child’s needs / functioning fall within a shaded box, explain why: II-14. School – Achievement (PAST 30 DAYS) Child is doing well in school, any concerns are age appropriate or this information is unknown to me. Child is doing well in school achievement, although some problems exist, such as failing to turn in work, disorganization or refusal to do some assignments. Child is having moderate problems with school achievement. He / she may be failing some subjects. Child is having severe achievement problems and may be failing most subjects or has failed more than 1 year within the past two years. If the child’s needs / functioning fall within a shaded box, explain why: B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-15. School – Relationship with Teachers Child has good relations with teachers. Any concerns are age appropriate or this information is unknown to me. Child has occasional difficulties relating with at least 1 teacher or during at least one subject period. Child has difficult relations with teachers that notably interferes with his / her education. Child has very difficult relations with all teachers or with their only teacher which prevents the child from learning. If the child’s needs / functioning fall within a shaded box, explain why: II-16. Impulsivity / Hyperactivity (PAST 30 DAYS) No evidence of impulsivity / hyperactivity, any concerns are age appropriate or this information is unknown to me. Some problems with impulsive, distractible or hyperactive behavior. Clear evidence of problems with impulsive, distractible or hyperactive behavior that is interfering with the child’s ability to function. Clear evidence of a dangerous level of impulsive behavior that can place the child at risk of physical harm. If the child’s needs / functioning fall within a shaded box, explain why: II-17. Oppositional Behaviors (PAST 30 DAYS) No evidence of oppositional behaviors. Child displays age appropriate resistance History or recent onset of defiance towards authority figures. Clear evidence of oppositional and / or defiant behaviors which are Clear evidence of a dangerous level of oppositional behavior
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