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Self-Care Assessment

For each of the skills in this assessment you will be asked to evaluate your child’s mastery and his or her motivation as described below:

Basic Steps Not Mastered. These are skills for which your child cannot do all of the basic steps; he or she needs to learn some (or all) of the actions involved.
Needs Assistance with Decisions. These are skills for which your child can do the basic steps but needs help in making decisions about skill performance—he or she needs to be told when to do the skill, or what materials are needed, or how to begin, or whether the skill has been done well.
Can Do Well and Independently. These are skills for which your child can do the basic actions and make necessary decisions—so that you do not need to be there at all.

A Problem. These are skills that your child does not perform without urging; he or she needs to be motivated.
Not a Problem. These are skills that your child performs regularly without special encouragement.

	MASTERY			MOTIVATION
1	2	3		1	2
SKILLS	Basic Steps Not Mastered	Needs Assistance with Decisions	Can Do Well and Independently	A Problem	Not a Problem
Basic Dressing
Puts on underpants
Puts on undershirt
Puts on socks*
Puts on pants*
Puts on pullover shirt, sweater*
Puts on front-button shirt, blouse*
Takes off pullover shirt, sweater
Pulls zipper up/down (if started)*
Threads a belt*
Starts a zipper*
Buttons*
Fastens snaps, hooks
Ties shoes*
Puts on a slip
Puts on a bra (if appropriate)
Puts on nylons/pantyhose (if appropriate)
Ties a necktie (if appropriate)

	MASTERY			MOTIVATION
	1	2	3	1	2
SKILLS	Basic Steps Not Mastered	Needs Assistance with Decisions	Can Do Well and Independently	A Problem	Not a Problem
Clothes Selection and Care
Puts dirty clothes in hamper
Puts clean clothes away
Folds and hangs clothes*
Wears clothes that are clean and pressed
Selects clothes that fit
Selects clothes that match
Selects age-appropriate clothes
Selects clothes appropriate to weather
Selects clothes appropriate to social occasion

	MASTERY			MOTIVATION
	1	2	3	1	2
SKILLS	Basic Steps Not Mastered	Needs Assistance with Decisions	Can Do Well and Independently	A Problem	Not a Problem
Grooming and Personal Hygiene
Uses toilet and toilet paper
Washes and dries hands
Washes and dries face*
Takes bath or shower, with soap and washcloth*
Uses deodorant
Washes and rinses hair*
Brushes teeth* and uses mouthwash
Cleans ears
Shaves (if appropriate)
Applies makeup (if appropriate)
Combs and brushes hair*
Uses a mirror to spot-check appearance
Trims fingernails/toenails
Uses aftershave/perfume
Uses a handkerchief/tissue
Takes care of eyeglasses or contact lenses (if appropriate)
Gets a haircut
Wipes food/dirt off clothes
Uses tampons or sanitary napkins (if appropriate) and disposes of them properly