Social Communication Worksheet (Primary-Teacher)
Dietrich Browne MA, CCC-SLP May, 2014
Student: ________________________________ Age:_______
Completed by:___________________________Date:____________________
Strengths/Interests:___________________________________________________________________
Please provide feedback regarding the following compared to peers.
Circle or highlight significant descriptors and expand comment sections as needed.
Communication
Circle one of the following: Like Peers
Concern
Problem
Difficulties with conversational turn-taking, staying on topic, asking or answering questions? Sticking to
preferred topics only? Problems with small talk? Solving problems using communication? Lacks initiating
shared enjoyment? Overusing sound bites or routine scripts? Repetitive questioning? Problems meeting
listener’s needs? Lecturing? Too literal? Frequent misunderstandings? Inability to make repairs? Frustration?
Comments:_______________________________________________________________________________
Social Awareness
Like Peers Concern
Problem
Difficulties with conforming to the social expectations the situation? Problems following directions or
predicting what to do? Missing non-verbal cues like gestures or facial expressions to adjust their behavior?
Failure to see how their actions impact others? Lack tact or fails to see others’ feelings? Disengaging?
Comments:_______________________________________________________________________________
Interactions
Like Peers Concern
Problem
Difficulty interacting with peers? Limited schemes for interacting? Difficulty with agreed upon rules of playsuch as cooperation or fantasy play? Rigidly enforcing rules? Insisting on their own way? Tattling? Problems
sharing, turn-taking, negotiating or problem solving? Adult needed to avert difficulty? Little flexibility?
Stuck on one interest? Preoccupied by things peers show little interest in? Avoiding interacting?
Comments:_______________________________________________________________________________
Transitions/Schedules
Like Peers Concern
Problem
Rigidly follows/enforces routines? Difficulty with breaks of or unexpected changes in schedule or personnel?
Problems adjusting to new or different situations? Problems transitioning from one activity to the next?
Comments:______________________________________________________________________________
Emotions
Like Peers Concern
Problem
Feels anger or anxiety more intensely/longer duration than peers? Upsets easily or for unexpected reasons?
Anxious regarding social events? Problems with perfectionism or dealing with disappointment? Difficulty
calming self? Acting out verbally/physically or shutting down? Elopement/running away?
Comments:_______________________________________________________________________________
Functioning
Like Peers Concern
Problem
Difficulty changing tasks, getting started, or maintaining focus? Failure to complete or turn work in?
Organization difficulties? Monopolizing discussions or not participating? Problems with group work? Refusal
of assignments seen as “stupid”? Rigid/literal thinking? Own agenda?
Comments:_______________________________________________________________________________
What is the first thing that should be addressed?
____________________________________________________________________________