Directions: Review the descriptions of aspects and skills on pages 14–21, then provide a 1–7 score for each of
the 11 skills. When selecting a skill for intervention, you may choose to use the section of the Skill
Component Analysis that provides details for that skill and report the average score here.
Interact
______ Participation ____ ____ ____ ____ ____ ____ ____
______ Indication ____ ____ ____ ____ ____ ____ ____
______ Social Acceptability ____ ____ ____ ____ ____ ____ ____
______ Emotional Balance ____ ____ ____ ____ ____ ____ ____
Communicate
______ Nonsymbolic ____ ____ ____ ____ ____ ____ ____
______ Symbolic ____ ____ ____ ____ ____ ____ ____
Receive
______ Attention Skills ____ ____ ____ ____ ____ ____ ____
______ Behavioral Response Skills ____ ____ ____ ____ ____ ____ ____
______ Contextual Response Skills ____ ____ ____ ____ ____ ____ ____
Express
______ Vary Message Functions ____ ____ ____ ____ ____ ____ ____
______ Intelligibility ____ ____ ____ ____ ____ ____ ____
Comments: ___________________________________________________________________________________________
______________________________________________________________________________________________________
7 = (Established) independent
6 = (Established) independent with certain partners or in certain opportunities
5 = (Emerging) prompts or interpretations, 2/10 attempts (low assistance)
4 = (Emerging) prompts or interpretations, 4/10 attempts (moderate assistance)
3 = (Emerging) prompts or interpretations, 6/10 attempts (moderate/high assistance)
2 = (Potential) prompts or interpretations, 8/10 attempts (high assistance)
1 = (Potential) total prompting and interpreting required
N/O= No Opportunity
Communication
Independence
Rating Scale:
Dates of Administration
X = ________________
●●
●● = ________________ ✔ = ________________ ❒ = ________________
64
Achieving Communication Independence
© 2003 Thinking Publications
Duplication permitted for educational use only.
N/O
1234567
Potential Emerging Established
From Achieving Communication Independence: A comprehensive Guide to Assessment and Intervention, by Y. Gillette, 2003, Eau Claire, WI: Thinking Publications.
