FACS Completed Sample
Family Assessment of Child Skills (FACS)
Child Information
- Child's Name: Marcus Greene
- Date of Birth: May 24, 2017
- Family's Name and Address: Veronica Greene, 3873 Red Run Road, Baltimore, MD 21211
- Person Completing Form: Veronica Greene
- Relationship to Child: Mother
- Email Address: greene.veronica@gmail.com
- Preferred Method(s) of Contact: Email
- Language(s) Spoken at Home: English
Overview
The Family Assessment of Child Skills allows parents and other caregivers to share details about a child’s developmental skills. This information is needed to select appropriate learning goals for an IFSP or IEP. Easy-to-answer questions are listed in eight areas: Fine Motor, Gross Motor, Adaptive, Social-Emotional, Social-Communication, Cognitive, Literacy, and Math.
Fine Motor Skills
Fine motor skills involve the movement and use of the hands. These skills include grasping, using scissors, writing, and drawing.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child move or wave their hands toward objects on people? (FM.A1) | M: Y/S/N |
| 2 | Can your child pick up small objects using the thumb and index finger? (FM.A2) | M: Y/S/N |
| 3 | Does your child stack three or more objects? (FM.A3) | M: Y/S/N |
| 4 | Does your child use one finger to turn toys or objects on or off? (FM.B1) | M: Y/S/N |
| 5 | Can your child turn objects by turning their wrist? (FM.B2) | M: Y/S/N |
| 6 | Does your child use two hands to move or manipulate objects? (FM.B3) | M: Y/S/N |
| 7 | Does your child use three fingers to hold objects? (FM.C1) | M: Y/S/N |
| 8 | Does your child activate an electronic device with a finger? (FM.D1) | M: Y/S/N |
Gross Motor Skills
Gross motor skills involve moving and getting around. These skills include rolling, walking, running, and jumping.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child move independently while lying on their back? (GM.A1) | M: Y/S/N |
| 2 | Does your child put weight on one hand while reaching? (GM.A2) | M: Y/S/N |
| 3 | Can your child roll over from back to stomach? (GM.A3) | M: Y/S/N |
| 4 | Can your child move to a sitting position without help? (GM.A4) | M: Y/S/N |
| 5 | Does your child get out of a child-size chair without help? (GM.A5) | M: Y/S/N |
| 6 | Can your child crawl or creep forward at least 6 feet? (GM.B1) | M: Y/S/N |
| 7 | Does your child bend to reach objects and stand up? (GM.B2) | M: Y/S/N |
| 8 | Does your child walk without bumping into things? (GM.B3) | M: Y/S/N |
| 9 | Can your child walk up and down stairs alternating feet? (GM.B4) | M: Y/S/N |
| 10 | Does your child run without bumping into objects? (GM.B5) | M: Y/S/N |
| 11 | Can your child jump forward with feet together? (GM.B6) | M: Y/S/N |
| 12 | Can your child skip using an alternating step-hop pattern? (GM.B7) | M: Y/S/N |
| 13 | Does your child swing a bat to hit an object? (GM.C1) | M: Y/S/N |
| 14 | Can your child hang from play equipment? (GM.C2) | M: Y/S/N |
| 15 | Can your child ride a two-wheel bike without assistance? (GM.C3) | M: Y/S/N |
Adaptive Skills
Adaptive skills involve being able to care for oneself. These include eating, drinking, and dressing.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child take food off a spoon without choking? (AD.A1) | M: Y/S/N |
| 2 | Does your child eat a variety of foods? (AD.A2) | M: Y/S/N |
| 3 | Can your child eat using utensils with little spilling? (AD.A3) | M: Y/S/N |
| 4 | Can your child drink from a cup without spilling? (AD.A4) | M: Y/S/N |
| 5 | Does your child eat in socially appropriate ways? (AD.A5) | M: Y/S/N |
| 6 | Can your child prepare food by removing inedible parts? (AD.A6) | M: Y/S/N |
| 7 | Does your child use the toilet independently? (AD.B1) | M: Y/S/N |
| 8 | Can your child bathe with minimal assistance? (AD.B2) | M: Y/S/N |
| 9 | Can your child brush their teeth and comb their hair? (AD.B3) | M: Y/S/N |
| 10 | Can your child undress without help? (AD.C1) | M: Y/S/N |
| 11 | Does your child choose clothing appropriate for the weather? (AD.C2) | M: Y/S/N |
| 12 | Does your child act to relieve distress or pain? (AD.D1) | M: Y/S/N |
| 13 | Does your child follow safety rules? (AD.D2) | M: Y/S/N |
| 14 | Does your child avoid dangerous conditions? (AD.D3) | M: Y/S/N |
| 15 | Can your child report danger to a caregiver? (AD.D4) | M: Y/S/N |
Social-Emotional Skills
Social skills involve interacting and participating with others. These include showing affection, managing conflict, and identifying emotions.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child initiate positive social behavior with familiar adults? (SE.A1) | M: Y/S/N |
| 2 | Does your child continue interaction with familiar adults? (SE.A2) | M: Y/S/N |
| 3 | Does your child prepare for routines independently? (SE.A3) | M: Y/S/N |
| 4 | Does your child respond to others' emotions? (SE.B1) | M: Y/S/N |
| 5 | Does your child recover from distress? (SE.B2) | M: Y/S/N |
| 6 | Does your child express positive statements about themselves? (SE.B3) | M: Y/S/N |
| 7 | Does your child play with other children? (SE.C1) | M: Y/S/N |
| 8 | Can your child engage in imaginary play? (SE.C2) | M: Y/S/N |
| 9 | Does your child collaborate with peers? (SE.C3) | M: Y/S/N |
| 10 | Does your child follow game rules? (SE.C4) | M: Y/S/N |
| 11 | Does your child initiate and complete independent activities? (SE.D3) | M: Y/S/N |
| 12 | Can your child resolve disagreements? (SE.D4) | M: Y/S/N |
| 13 | Does your child seek solutions to meet physical needs? (SE.E1) | M: Y/S/N |
| 14 | Does your child use social rules outside of home? (SE.E2) | M: Y/S/N |
| 15 | Does your child follow community setting rules? (SE.E3) | M: Y/S/N |
| 16 | Does your child know personal information? (SE.E4) | M: Y/S/N |
Social-Communication Skills
Social-communication skills involve listening and speaking.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child look at someone talking nearby? (SC.A1) | M: Y/S/N |
| 2 | Does your child babble the same sounds? (SC.A2) | M: Y/S/N |
| 3 | Does your child respond to caregiver's words? (SC.A3) | M: Y/S/N |
| 4 | Does your child point to objects after getting attention? (SC.A4) | M: Y/S/N |
| 5 | Does your child look where others are looking? (SC.B1) | M: Y/S/N |
| 6 | Can your child identify 10 familiar objects? (SC.B2) | M: Y/S/N |
| 7 | Can your child follow two linked directions? (SC.B3) | M: Y/S/N |
| 8 | Does your child answer questions about why, how, and when? (SC.B4) | M: Y/S/N |
| 9 | Does your child use sentences of three words or more? (SC.C1) | M: Y/S/N |
| 10 | Does your child maintain social exchanges? (SC.D1) | M: Y/S/N |
| 11 | Can your child share or gather information? (SC.D2) | M: Y/S/N |
Cognitive Skills
Cognitive skills involve mental processes and reasoning.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child respond to noises and objects? (CO.A1) | M: Y/S/N |
| 2 | Can your child use two actions together? (CO.A2) | M: Y/S/N |
| 3 | Does your child copy unfamiliar gestures? (CO.B1) | M: Y/S/N |
| 4 | Does your child imitate unfamiliar words? (CO.B2) | M: Y/S/N |
| 5 | Can your child describe a past event? (CO.B3) | M: Y/S/N |
| 6 | Does your child search for misplaced items? (CO.C1) | M: Y/S/N |
| 7 | Can your child recognize symbols for objects? (CO.C2) | M: Y/S/N |
| 8 | Can your child sort objects by features? (CO.C3) | M: Y/S/N |
| 9 | Does your child compare concepts? (CO.C4) | M: Y/S/N |
| 10 | Can your child use one object to get another? (CO.D1) | M: Y/S/N |
| 11 | Does your child use different actions for new outcomes? (CO.D2) | M: Y/S/N |
| 12 | Can your child try different problem-solving methods? (CO.D3) | M: Y/S/N |
| 13 | Does your child make reasonable predictions? (CO.D4) | M: Y/S/N |
| 14 | Does your child ask observational questions? (CO.E1) | M: Y/S/N |
| 15 | Can your child share information about discoveries? (CO.E2) | M: Y/S/N |
Literacy Skills
Literacy skills involve pre-reading and reading processes.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Does your child enjoy reading time? (LI.A1) | M: Y/S/N |
| 2 | Does your child understand directionality in writing? (LI.A2) | M: Y/S/N |
| 3 | Can your child recognize printed words? (LI.A3) | M: Y/S/N |
| 4 | Does your child say rhyming words? (LI.B1) | M: Y/S/N |
| 5 | Can your child separate compound words? (LI.B2) | M: Y/S/N |
| 6 | Can your child identify syllables in a word? (LI.B3) | M: Y/S/N |
| 7 | Can your child break a word into sounds? (LI.B4) | M: Y/S/N |
| 8 | Can your child name several letters? (LI.C1) | M: Y/S/N |
| 9 | Can your child describe pictures in a book? (LI.D1) | M: Y/S/N |
| 10 | Can your child retell a story accurately? (LI.D2) | M: Y/S/N |
| 11 | Can your child write and draw? (LI.E2) | M: Y/S/N |
Math Skills
Math skills involve counting and number manipulation.
Assessment Questions
| No. | Question | Rating |
|---|---|---|
| 1 | Can your child count 3 items out loud? (MA.A1) | M: Y/S/N |
| 2 | Can your child count 10 items out loud? (MA.A2) | M: Y/S/N |
| 3 | Can your child count 20 items out loud? (MA.A3) | M: Y/S/N |
| 4 | Can your child count by tens up to 100? (MA.A4) | M: Y/S/N |
| 5 | Can your child compare small sets? (MA.B1) | M: Y/S/N |
| 6 | Can your child compare medium sets? (MA.B2) | M: Y/S/N |
| 7 | Can your child compare large sets? (MA.B3) | M: Y/S/N |
| 8 | Can your child write numerals for up to 5 items? (MA.C1) | M: Y/S/N |
| 9 | Can your child write numerals for 6 to 10 items? (MA.C2) | M: Y/S/N |
| 10 | Can your child write numerals for 11 to 20 items? (MA.C3) | M: Y/S/N |
Intervention Priorities
- Getting dressed and undressed by himself
- Holding a pencil correctly
Assessment, Evaluation, and Programming System for Infants and Children, Third Edition (AEPS®-3), by Bricker, Dionne, Grisham, Johnson, Macy, Slentz, & Waddell. © 2022 Brookes Publishing Co. All rights reserved.