PEAK assessment

PEAK Direct Training Pre-Assessment: Assessor Script and Scoring Guide Learner: Assessment Date: Assessor: Assessment and Scoring Directions: Present the following items from each factor to the participant, repeating only the script in quotation marks aloud. Place the “Pre-Assessment Script and Stimuli” book between the learner and the assessor; present each item in sequence. Record the participant’s responses on the accompanying scoring guide. Complete each item on the assessment. For each item presented to the participant, circle “1” for a correct response or circle “0” for an incorrect response. Example responses are provided. Add the total number of correct responses for each section to sum the score for that relation. Add the total for each relation to obtain the total score. Score Summary: Factor Score Max Score Factor Score Max Score Foundational Learning Skills 16 Verbal Comprehension Skills 16 Perceptual Learning Skills 16 Verbal Reasoning, Memory, and Math Skills 16 Total Score: 64 Score Factor Score Profile 16 • • • • 15 • • • • 14 • • • • 13 • • • • 12 • • • • 11 • • • • 10 • • • • 9 • • • • 8 • • • • 7 • • • • 6 • • • • 5 • • • • 4 • • • • 3 • • • • 2 • • • • 1 • • • • 0 • • • • Factor FLS PLS VCS VMS

Foundational Learning Skills (FLS) Item Script Correct Response Score Notes FLS-1 Say, “Look at me.” Eye contact for 2 seconds 1 0 FLS-2 Present the image of three cups, the left with a block below it (FLS-2a), then the image of three cups (FLS-2b). Say, “Where did the block go?” Left cup 1 0 FLS-3 Present the of 5 stars in an array. Say, “Do this,” and touch each star one at a time from your right to left. Counts 1-5 while pointing 1 0 FLS-4 Present the images of a block, a ball, and a cookie. Say , “Choose one.” Selects an item 1 0 FLS-5 Say, “Do this,” and touch your nose. Touches nose 1 0 FLS-6 Say, “Do this,” and make a pincer grasp (pinching motion) with your fingers. Makes pincer grasp 1 0 FLS-7 Say, “Do this,” and purse your lips. Purses lips 1 0 FLS-8 Say, “Do this,” and raise your right arm, then touch your stomach. Raises arm, touches stomach 1 0 FLS-9 Say, “Say…Ahh.” Says, “Ahh” 1 0 FLS-10 Say, “Say…Book.” Says, “Book” 1 0 FLS-11 Say, “Stand up.” Stands up 1 0 FLS-12 Present the image of a man waving. Say, “Jim says, ‘Hi!’ What do you say?” Says a greeting 1 0 FLS-13 Say, “Say…The dog is big!” Says, “The dog is big!” 1 0 FLS-14 Point to the block at the top of the page, with a block, a ball, and a pencil in an array below. Say, “Show me same.” Block 1 0 FLS-15 Point to the apple at the top of the page, with a car, tree, and an apple in an array below. Say, “Show me same.” Apple 1 0 FLS-16 Point to the T at the top of the page, with a B, 2, and T in an array below. Say, “Show me same.” T 1 0 Total: /16

Verbal Comprehension Skills (VCS) Item Script Correct Response Score Notes VCS-1 Say, “Say…ribbit.” Says, “Ribbit” 1 0 VCS-2 Say, “Stand up, turn around, and clap your hands.” Stands, turns, and claps 1 0 VCS-3 Say, “What comes next? L-M-N-O-…” Says, “P” 1 0 VCS-4 Present the image of a 5. Say, “What number is this?” Says, “Five” 1 0 VCS-5 Present the letters D, M, and A in an array. Say, “Which letter says ‘mmm’?” M 1 0 VCS-6 Present the images of swimming, crawling, and crying in an array. Say, “Which one is crying?” Crying 1 0 VCS-7 Say, “Tell me something that has spots.” Example: Says, “Ladybug” 1 0 VCS-8 Present the image of a doctor. Say, “Who is this?” Says, “Doctor” 1 0 VCS-9 Present the images of a person wearing a jacket, a person in the rain, and a person acting sad in an array. Say, “Which one is feeling wet?” Person in the rain 1 0 VCS-10 Present the images of a banana, a hat, and grapes. Say, “Which one doesn’t belong?” Hat 1 0 VCS-11 Say, “Bob’s balloon popped. What might he be feeling?” Example: Says, “Sad” 1 0 VCS-12 Present the images of clocks showing 9:30, 12:00, and 4:15 in an array. Say, “Which one is 9:30?” 9:30 1 0 VCS-13 Present the word TOY. Say, “What does it say?” Says, “Toy” 1 0 VCS-14 Present the image of a tiger. Say, “What group does this belong to?” Says, “Animal” 1 0 VCS-15 Present the image of a children at school. Say, “Where are they?” Says, “School” 1 0 VCS-16 Present an image of a boy and a girl. Say, “ Show me his head.” Boy’s head 1 0 Total: /16

Verbal Reasoning, Memory, and Math Skills (VMS) Item Script Correct Response Score Notes VMS-1 Present images of a dime, a nickel, and a quarter. Say, “Show me 5 cents.” Nickel 1 0 VMS-2 Present images of three pennies, a dime and a nickel, and a quarter in an array. Say, “Which one is fifteen cents?” Dime and nickel 1 0 VMS-3 Present the image of 3 dots (VMS-3a), and say, “How many dots are there?” Present 4 more (VMS-3b) and say, “How many are there now?” Says, “Seven” 1 0 VMS-4 Present the equation 2 + 3. Say, “How much is it?” Says, “Five” 1 0 VMS-5 Present the image of a tornado. Say , “If you were this tornado, how would you feel?” Says, “Mad” 1 0 VMS-6 Present an array of numbers 2, 5, and 4. Say, “What is 4 + 0?” Four 1 0 VMS-7 Present the image of a container of objects. Say, “Guess how many items are inside.” States a quantity 1 0 VMS-8 Present the image of a bunny. Say , “Give the bunny a name based on what he looks like.” Example: Says, “Floppy” 1 0 VMS-9 Present the image of a present. Say, “What do you think is inside?” Example: Says, “A toy” 1 0 VMS-10 Present the images of a backpack, a house, and a lamp in an array. Say, “Show me the traveler.” Backpack 1 0 VMS-11 Present the sentence, and say, “The fast car is red” (VMS-11a). Turn the page (VMS-11b) and wait ten seconds. Say, “Tell me what I said.” Says, “The fast car is red” 1 0 VMS-12 Point to the image of an airplane at the top, with a bird, a jacket, and dog in an array at the bottom. Say, “What else is the same?” Bird 1 0 VMS-13 Present the image of a toy car. Say, “Tell me three things about this.” Example: Says, “You can drive it” 1 0 VMS-14 Present the image of a pillow, with images of mad, happy, and tired in an array below. Say, “Choose what I might be feeling right now.” Tired person 1 0 VMS-15 Present the image of a person holding their head. Say , “What might he be feeling right now?” Example: Says, “Headache” 1 0 VMS-16 Show the image of a child and a birthday cake. Say, “What do you think happens next?” Examples: Says, “Blow out the candles” 1 0 Total: /16