|
I.
|
Expressive Communication Forms
|
Yes
|
Yes, with these supports
|
No
|
|
1.
|
Uses vocalizations and sounds
|
□
|
|
□
|
|
2.
|
Says real words or phrases
|
□
|
|
□
|
|
3.
|
Uses sign language or modified signs
|
□
|
|
□
|
|
4.
|
Uses leading gestures (pulling staff)
|
□
|
|
□
|
|
5.
|
Uses pushing toward or pushing away gestures
|
□
|
|
□
|
|
6.
|
Uses pointing gestures
|
□
|
|
□
|
|
7.
|
Uses reaching gestures
|
□
|
|
□
|
|
8.
|
Uses facial expressions
|
□
|
|
□
|
|
9.
|
Uses eye gaze
|
□
|
|
□
|
|
10.
|
Uses head nods and head shakes
|
□
|
|
□
|
|
11.
|
Uses body orientation by standing near someone or something
|
□
|
|
□
|
|
12.
|
Uses pictures (photos or line drawings)
|
□
|
|
□
|
|
13.
|
Uses actual objects to convey messages
|
□
|
|
□
|
|
14.
|
Uses a simple voice output device (low tech)
|
□
|
|
□
|
|
15.
|
Uses a complex voice output device (high tech)
|
□
|
|
□
|
|
16.
|
Uses challenging behavior to convey messages
|
□
|
|
□
|
|
II.
|
Expressive Functions
|
Yes
|
Yes, with these supports
|
No
|
|
17.
|
Communicates the names of people, objects, and activities
|
□
|
|
□
|
|
18.
|
Communicates social pleasantries (“hi” and “bye”)
|
□
|
|
□
|
|
19.
|
Communicates interest in activities
|
□
|
|
□
|
|
20.
|
Communicates protest
|
□
|
|
□
|
|
21.
|
Communicates emotional state (happy, sad, angry, enthusiastic)
|
□
|
|
□
|
|
22.
|
Communicates physical state (sick, well, tired, hurt)
|
□
|
|
□
|
|
23.
|
Requests desired items (objects, routines)
|
□
|
|
□
|
|
24.
|
Requests desired people
|
□
|
|
□
|
|
25.
|
Requests an event or activity continue
|
□
|
|
□
|
|
26.
|
Requests help
|
□
|
|
□
|
|
27.
|
Secures a listener’s attention before communicating
|
□
|
|
□
|
|
28.
|
When given a choice, deliberately chooses one choice over another
|
□
|
|
□
|
|
29.
|
Uses communication to direct other people’s actions
|
□
|
|
□
|
|
30.
|
Initiates communication
|
□
|
|
□
|
|
31.
|
Knows how to terminate communication
|
□
|
|
□
|
|
32.
|
Uses a “my turn/your turn” style
|
□
|
|
□
|
|
33.
|
Repairs communication if own message is not understood
|
□
|
|
□
|
|