Appendix H - Child Early Intervention Medical Center
Appendix HThe Behavioural Language Assessment FormThe BLAFBy Sundberg & Partington (1998)Name: _______________Age: _______Date: __________CooperationRequestMotorVocalVocalMatchReceptiveLabelling RFFCConversationLetters Social ???ImitationPlay Imitation to Sample? ?and NumbersInteraction5????????????4????????????3????????????2????????????1????????????For the following question, indicate the level of performance that best describes the learner’s typical level of performance.COOPERATIONS WITH ADULTS _________ (enter score).How easy is it to work with the child?Always uncooperative, avoids work, engages in negative behaviour. Will do only one brief and easy response for a powerful reinforcer.Will give 5 responses without disruptive behaviour.Will work for 5 minutes without disruptive behaviour.Works well for 10 minutes at a table without disruptive behaviour.REQUEST (MANDS) ________How does the learner let his needs and wants be known?cannot ask for reinforcers; or engages in negative behaviourpulls people, points, or stands by reinforcing itemsuses 1-5 words, signs or pictures to ask for reinforcersuses 5-10 words, signs or pictures to ask for reinforcersFrequently requests using 10 or more words, signs, or pictures.MOTOR IMITATION __________Does the learner copy actions?cannot imitate anybody’s motor movementsimitates a few gross motor movements modelled by othersimitates several gross motor movements on requestimitates several fine and gross motor movements on requesteasily imitates any fine or gross movements, often spontaneouslyVOCAL PLAY ________Does the learner spontaneously say sounds and words?does not make any sounds (mute)makes a few speech sounds at a low ratevocalizes many speech sounds with varied notationsvocalizes frequently with varied intonation and says a few wordsvocalizes frequently and says many clearly understandable wordsVOCAL IMITATION _________Will the learner repeat sounds or words?cannot repeat any sounds or wordswill repeat a few specific sounds or wordswill repeat or closely approximate several sounds or wordswill repeat or closely approximate many different wordswill clearly repeat any word, or even simple phrasesMATCHING TO SAMPLE _______Will the learner match objects, pictures and designs to presented samples?cannot match any objects or pictures to a samplecan match 1 or 2 objects or pictures to a samplecan match 5 to 10 objects or pictures to a samplecan match 5 to 10 colours, shapes, or designs to a samplecan match most items and match 2 to 4 block designsRECEPTIVE _________Does the learner understand any words or follows directions?cannot understand any wordswill follow a few instructions related to daily routineswill follow a few instructions to do actions or touch itemscan follow many instructions and point to at least 25 itemscan point to at least 100 items, actions, persons or adjectivesLABELLING (TACTS) __________Does the learner label or verbally identify any items or actions?cannot identify any items or actionsidentifies only 1 to 5 items or actionsidentifies 6 to 15 items or actionsidentifies 16 to 50 items or actionsidentifies over 100 items or actions and emits short sentences RECEPTIVE BY FUNCTION, FEATURE, AND CLASS _________Does the learner identify items when given information about those items?cannot identify items based on information about themwill identify a few items given synonyms or common functionswill identify 10 items given 1 of 3 functions or featureswill identify 25 items given 4 functions, features, or classeswill identify 100 items given 5 functions, features or classesCONVERSATION SKILLS (INTRAVERBALS) _______Can the learner fill-in missing words or answer questions?cannot fill-in missing words or parts of songscan fill-in a few missing words or provide animal soundscan fill-in 10 non-reinforcing phrases or answer at least 10 simple questionscan fill-in 20 phrases or can answer 20 questions with variationcan answer at least 30 questions with variationLETTERS AND NUMBERS _______Does the learner know any letters, numbers, or written word?cannot identify any letters, numbers, or written wordscan identify at least 3 letters or numberscan identify at least 15 letters or numberscan read at least 5 words and identify 5 numberscan read at least 25 words and identify 10 numbersSOCIAL INTERACTION ________Does the learner initiate and sustain interactions with others?does not initiate interactions with othersphysically approaches others to initiate an interactionreadily asks adults for reinforcersverbally interacts with peers with promptsregularly initiates and sustains verbal interactions with peers ................
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