Communication Form and Function
Name:
Date:
Examiner:
Requests
adult to act.
Requests out
of activity/task.
Requests help.
Requests to leave.
Chooses person/
activity/object.
Protests change in
routine.
Protests adult
action.
Protests loss of
something.
Indicates pain.
Indicates affection.
Shares information.
Initiates
interaction.
Other.
Sample informal language and communication checklist.
Adapted from Scheuerman & Weber (2001). Autism: Teaching Does Make a Difference Belmont, CA: Wadsworth Publishing.
Other
Aggression
Tantrums/SIB
Crying or whining
Moves another
Nods yes or no
Gestures/pointing
Echolalia
Signs
Single words
Phrases
Communicative
FUNCTION
Requests objects/
food/event.
Complex speech
Communicative Forms