Aberrant Behavior Checklist Please rate the childs behavior for the last 4 weeks according to the scale

below. 0 !ot at all a "roble# 1 $he behavior is a "roble#% b&t slight in degree 2 $he "roble# is #oderatel' serio&s 3 $he "roble# is severe in degree Please keep the following points in mind: a. $ake relative fre(&enc' into acco&nt for each behavior s"ecified. )or e*a#"le% if the child averages #ore te#"er o&tb&rsts than #ost other children% its "robabl' #oderatel' serio&s or severe% even if it occ&rs onl' once or twice a week. +ther behaviors% s&ch as nonco#"liance% wo&ld "robabl' have to occ&r #ore often to #erit an e*tre#e rating. b. ,onsider how the child behaves with others% not -&st with 'o&. $r' to take the whole "ict&re into acco&nt. c. $r' to consider whether a given behavior interferes with the childs development, functioning or relationships. )or e*a#"le bod' rocking or social withdrawal #ight not disr&"t other "eo"le% b&t it "robabl' hinders individ&al develo"#ent or f&nctioning. Do not spend too much time on each item your first reaction is usually the correct one.

1. .*cessivel' active at ho#e% school% work% or elsewhere 2. /n-&res self on "&r"ose 3. 0istless% sl&ggish% inactive 4. 1ggressive to other children or ad&lts 2verball' or "h'sicall'3 5. 4eeks isolation fro# others 5. 6eaningless% rec&rring bod' #ove#ents 7. 8oistero&s 2ina""ro"riatel' nois' and ro&gh3 9. 4crea#s ina""ro"riatel' :. $alks e*cessivel' 10. $e#"er tantr&#s/o&tb&rsts

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11. 4tereot'"ed behavior; abnor#al% re"etitive 0 1 #ove#ents 12. Preocc&"ied% states into s"ace 0 1 13. /#"&lsive 2acts witho&t thinking3 0 1 14. /rritable and whin' 0 1 15. <estless% &nable to sit still 0 1 15. =ithdrawn; "refers solitar' activities 0 1 17. +dd% bi>arre in behavior 0 1 19. ?isobedient% diffic&lt to control 0 1 1:. @ells at ina""ro"riate ti#es 0 1 20. )i*ed facial e*"ression; lacks e#otional 0 1 res"onsiveness Anless otherwise indicated% all #aterials on these "ages are co"'righted. 1ll Version 1 03/15/2012

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reserved. !o "art of these "ages% either te*t or i#age #a' be &sed for an' "&r"ose other than "ersonal &se.

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21. ?ist&rbs others 22. <e"etitive s"eech 23. ?oes nothing b&t sit and watch others 24. Ancoo"erative 25. ?e"ressed #ood 25. <esists an' for# of "h'sical contact 27. 6oves or rolls head back and forth re"etitivel' 29. ?oes not "a' attention to instr&ctions 2:. ?e#ands #&st be #et i##ediatel' 30. /solates hi#self/herself fro# other children or ad&lts 31. ?isr&"ts gro&" activities 32. 4its or stands in one "osition for a long ti#e 33. $alk to self lo&dl' 34. ,ries over #inor anno'ances and h&rts 35. <e"etitive hand% bod'% or head #ove#ents 35. 6ood changes (&ickl' 37. Anres"onsive to str&ct&red activities 2does not react3 ?oes not sta' in seat 2d&ring lesson% training 39. session% #eals% etc.3 3:. =ill not sit still for an' length of ti#e 40. /s diffic&lt to reach% contact% or get thro&gh to 41. ,ries and screa#s ina""ro"riatel' 42. Prefers to be alone 43. ?oes not tr' to co##&nicate b' words or gest&res 44. .asil' distractible 45. =aves or shakes the e*tre#ities re"eatedl' 45. <e"eats a word or "hrase over and over 47. 4ta#"s feet or bangs ob-ects or sla#s doors 49. ,onstantl' r&ns or -&#"s aro&nd the roo# 4:. <ocks bod' back and forth re"eatedl' 50. ?eliberatel' h&rts hi#self/herself 51. 52. 53. 54. 55. 55. Pa's no attention when s"oken to ?oes "h'sical violence to self /nactive% never #oves s"ontaneo&sl' $ends to be e*cessivel' active <es"onds negativel' to affection ?eliberatel' ignores directions

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Bas te#"er o&tb&rsts or tantr&#s when does 57. not get own wa' 59. 4hows few social reactions to others

Anless otherwise indicated% all #aterials on these "ages are co"'righted. 1ll rights reserved. !o "art of these "ages% either te*t or i#age #a' be &sed for an' "&r"ose other than "ersonal &se. Version 1 Page 3 03/15/2012 of 2

Perilaku menyimpang Checklist 4ilakan #enilai "erilak& anak sela#a 4 #ingg& terakhir #en&r&t skala di bawah ini. 0 1 2 3 $idak sa#a sekali #asalah Perilak& adalah #asalah% ta"i sedikit dala# dera-at 6asalahn'a adalah c&k&" seri&s 6asalahn'a adalah "arah dala# dera-at

Silakan menjaga hal berikut dalam pikiran : a. 1#bil frek&ensi relatif ke acco&nt &nt&k setia" "erilak& 'ang ditent&kan. 4ebagai contoh% -ika rataCrata anak 'ang lebih ledakan #arah dari"ada keban'akan anakCanak lain% it& #&ngkin c&k&" seri&s ata& berat% bahkan -ika it& han'a ter-adi sekali ata& d&a kali se#ingg&. Perilak& lain% se"erti ketidak"at&han% #&ngkin akan ter-adi lebih sering "antas rating ekstri#. b. Perti#bangkan bagai#ana anak ber"erilak& dengan orang lain% b&kan han'a dengan 1nda. ,obalah &nt&k #enga#bil sel&r&h ga#bar ke rekening. c. ,obalah &nt&k #e#"erti#bangkan a"akah s&at& "erilak& tertent& #enggangg& perkembangan anak, fungsi atau hubungan. 6isaln'a go'ang badan ata& "enarikan sosial #&ngkin tidak #enggangg& orang lain% ta"i #&ngkin #enghalangi "enge#bangan individ& ata& berf&ngsi. Jangan terlalu banyak menghabiskan waktu pada setiap item - reaksi pertama Anda biasanya adalah yang benar. 1. $erlal& aktif di r&#ah% sekolah% beker-a% ata& di 2. 6el&kai diri "ada t&-&an te#"at lain 3. 0es&% lo'o% tidak aktif 4. 1gresif &nt&k anakCanak lain ata& orang dewasa 5. 6encari isolasi dari orang lain 2secara verbal ata& fisik3 5. 8erarti% gerakan t&b&h ber&lang 7. <i&h 2tidak te"at berisik dan kasar3 9. Deritan tidak te"at :. Pe#bicaraan berlebihan 10. $e#"er tantr&# / ledakan 11. Perilak& stereoti"% abnor#al% gerakan ber&lang 12. 4ib&k% #en'atakan ke l&ar angkasa 13. /#"&lsif 2bertindak tan"a ber"ikir3 14. /rritable dan cengeng 15. Eelisah% tidak bisa d&d&k dia# 15. ?itarik; lebih s&ka kegiatan soliter 17. 1neh% aneh dala# "erilak& 19. $aat% s&lit &nt&k #engontrol 1:. 8erteriak "ada wakt& 'ang tidak 20. .ks"resi wa-ah teta"% tidak #e#iliki res"on e#osional Version 1 03/15/2012 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Page 4 of 2

21. 6enggangg& orang lain 22. Pidato 8er&lang 23. 1"akah a"aCa"a selain d&d&k dan #enonton 24. .nggan orang lain #e#bant& 25. Perasaan de"resi 25. 6enolak segala bent&k kontak fisik 27. 8ergerak ata& g&l&ngan ke"ala bolakCbalik 29. $idak #e#"erhatikan instr&ksi ber&langC&lang 2:. $&nt&tan har&s segera di"en&hi 30. 6engisolasi dirin'a / dirin'a dari anakCanak lain ata& orang dewasa 31. 6enggangg& kegiatan kelo#"ok 32. ?&d&k ata& berdiri dala# sat& "osisi &nt&k wakt& 33. 8erbicara dengan diri keras 'ang la#a 34. $eriakan atas gangg&an kecil dan #en'akitkan 35. $angan 'ang ber&lang% t&b&h% ata& ke"ala gerakan 35. Per&bahan #ood ce"at 37. <es"onsif terhada" kegiatan terstr&kt&r 2tidak 39. $idak tinggal di k&rsi 2sela#a "ela-aran% sesi bereaksi3 "elatihan% #akanan% dll3 3:. $idak akan d&d&k dia# &nt&k wakt& 'ang la#a 40. 1"akah s&lit di-angka&% h&b&ngi% ata& sa#"ai ke"ada 41. $eriakan dan -eritan tidak te"at 42. 0ebih s&ka #en'endiri 43. $idak #encoba &nt&k berko#&nikasi dengan kataC 44. 6&dah distractible kata ata& gerak t&b&h 45. Eelo#bang ata& getar ekstre#itas ber&lang 45. 6eng&langi kata ata& frase ber&lang 47. Perangko kaki ata& "oni benda ata& #e#banting 49. $er&s ber-alan ata& #elo#"at di sekitar r&angan "int& 4:. <ocks t&b&h bolakCbalik ber&lang kali 50. 4enga-a #en'akiti dirin'a / dirin'a sendiri 51. $idak #e#"erhatikan ketika berbicara 52. 1"akah kekerasan fisik diri 53. $idak aktif% tidak "ernah bergerak secara s"ontan 54. ,ender&ng terlal& aktif 55. 6eres"on negatif dengan kasih sa'ang 55. 4enga-a #engabaikan arah 57. 6e#iliki ledakan #arah ata& #enga#&k ketika tidak #enda"atkan cara sendiri Version 1 03/15/2012

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59. 6en&n-&kkan sedikit reaksi sosial &nt&k orang lain

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