# Family Assessment of Child Skills (FACS)

## Child's Information
- **Child's name:** Marcus Greene  
- **Child's 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  
- **E-mail address:** greene.veronica@gmail.com  
- **Preferred method(s) of contact:** Email  
- **Language(s) spoken at home:** English

## Introduction
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.

## Assessment Instructions
For each question, observe your child use the skill first, then mark your rating:  
- **Y** (Yes) - If your child uses the skill or if your child previously was able to do the skill.  
- **S** (Sometimes) - If your child uses the skill sometimes, needs help, or does not consistently use it.  
- **N** (Not yet) - If your child does not yet use the skill.

---

## Fine Motor Skills 
Fine motor skills involve the movement and use of the hands, including grasping, using utensils, and drawing.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. |  |
| 1. Does your child move or wave their hands toward objects? (FM.A1) |  |
| 2. Does your child pick up pea-size objects with thumb and index finger? (FM.A2) |  |
| 3. Does your child stack three or more objects? (FM.A3) |  |
| 4. Does your child use one finger to turn toys on or off? (FM.B1) |  |
| 5. Does your child turn objects by turning wrist? (FM.B2) |  |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |

| 6. Does your child use two hands to manipulate objects? (FM.B3) |  |
| 7. Does your child use three fingers to hold objects? (FM.C1) |  |
| 8. Does your child use a finger to activate an electronic device? (FM.D1) |  |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |

### What fine motor skills do you want your child to learn?

---

## Gross Motor Skills
Gross motor skills involve movements for getting around, such as rolling, crawling, and jumping.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. |  |
| 1. Does your child move head, arms, and legs independently while lying on back? (GM.A1) |  |
| 2. Does your child put weight on one arm while reaching with another? (GM.A2) |  |
| 3. Does your child roll over in both directions? (GM.A3) |  |
| 4. Does your child move to sitting position from standing? (GM.A4) |  |
| 5. Does your child get out of a child-size chair without help? (GM.A5) |  |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |

| 6. Does your child crawl/creep forward 6 feet? (GM.B1) |  |
| 7. Does your child bend down to pick up objects? (GM.B2) |  |
| 8. Does your child walk around objects without bumping into them? (GM.B3) |  |
| 9. Does your child walk up/down stairs alternating feet? (GM.B4) |  |
| 10. Does your child run without bumping into things? (GM.B5) |  |
| 11. Does your child jump forward with feet together? (GM.B6) |  |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |

### What gross motor skills do you want your child to learn?

---

## Adaptive Skills
Adaptive skills are those that involve caring for oneself.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 1. Does your child take food off a spoon without choking? (AD.A1) | Y/S/N | Y/S/N | Y/S/N |
| 2. Does your child eat a variety of foods? (AD.A2) | Y/S/N | Y/S/N | Y/S/N |
| 3. Does your child eat with utensils without spilling? (AD.A3) | Y/S/N | Y/S/N | Y/S/N |
| 4. Does your child drink from a cup without spilling? (AD.A4) | Y/S/N | Y/S/N | Y/S/N |
| 5. Does your child eat socially appropriately? (AD.A5) | Y/S/N | Y/S/N | Y/S/N |
| 6. Does your child prepare food by removing inedible parts? (AD.A6) | Y/S/N | Y/S/N | Y/S/N |
| 7. Does your child use the toilet independently? (AD.B1) | Y/S/N | Y/S/N | Y/S/N |
| 8. Does your child bathe independently? (AD.B2) | Y/S/N | Y/S/N | Y/S/N |
| 9. Does your child brush teeth and comb hair? (AD.B3) | Y/S/N | Y/S/N | Y/S/N |
| 10. Does your child undress without help? (AD.C1) | Y/S/N | Y/S/N | Y/S/N |
| 11. Does your child choose appropriate clothing? (AD.C2) | Y/S/N | Y/S/N | Y/S/N |
| 12. Does your child act to relieve distress? (AD.D1) | Y/S/N | Y/S/N | Y/S/N |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 13. Does your child follow safety rules? (AD.D2) | Y/S/N | Y/S/N | Y/S/N |
| 14. Does your child avoid dangerous conditions without being told? (AD.D3) | Y/S/N | Y/S/N | Y/S/N |
| 15. Does your child report danger to a caregiver? (AD.D4) | Y/S/N | Y/S/N | Y/S/N |

### What adaptive skills do you want your child to learn?

---

## Social-Emotional Skills
Social skills involve interacting and participating with others.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 1. Does your child initiate positive social behavior? (SE.A1) | Y/S/N | Y/S/N | Y/S/N |
| 2. Does your child continue interaction with adults? (SE.A2) | Y/S/N | Y/S/N | Y/S/N |
| 3. Does your child get ready for routines without being asked? (SE.A3) | Y/S/N | Y/S/N | Y/S/N |
| 4. Does your child respond to others' emotions? (SE.B1) | Y/S/N | Y/S/N | Y/S/N |
| 5. Does your child recover from distress? (SE.B2) | Y/S/N | Y/S/N | Y/S/N |
| 6. Does your child make positive statements about themselves? (SE.B3) | Y/S/N | Y/S/N | Y/S/N |
| 7. Does your child play with other children? (SE.C1) | Y/S/N | Y/S/N | Y/S/N |
| 8. Does your child engage in imaginary play? (SE.C2) | Y/S/N | Y/S/N | Y/S/N |
| 9. Does your child work with peers to plan play? (SE.C3) | Y/S/N | Y/S/N | Y/S/N |
| 10. Does your child follow rules during games? (SE.C4) | Y/S/N | Y/S/N | Y/S/N |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 11. Does your child complete independent activities? (SE.D3) | Y/S/N | Y/S/N | Y/S/N |
| 12. Does your child resolve disagreements? (SE.D4) | Y/S/N | Y/S/N | Y/S/N |
| 13. Does your child seek solutions for needs? (SE.E1) | Y/S/N | Y/S/N | Y/S/N |
| 14. Does your child use social rules outside home/school? (SE.E2) | Y/S/N | Y/S/N | Y/S/N |
| 15. Does your child follow community-specific rules? (SE.E3) | Y/S/N | Y/S/N | Y/S/N |
| 16. Does your child know personal information? (SE.E4) | Y/S/N | Y/S/N | Y/S/N |

### What social-emotional skills do you want your child to learn?

---

## Social-Communication Skills
Social-communication skills involve listening and understanding conversational rules.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 1. Does your child look at someone who is talking? (SC.A1) | Y/S/N | Y/S/N | Y/S/N |
| 2. Does your child babble sound combinations? (SC.A2) | Y/S/N | Y/S/N | Y/S/N |
| 3. Does your child babble or use words in response? (SC.A3) | Y/S/N | Y/S/N | Y/S/N |
| 4. Does your child get attention and point? (SC.A4) | Y/S/N | Y/S/N | Y/S/N |
| 5. Does your child look in the same direction as others? (SC.B1) | Y/S/N | Y/S/N | Y/S/N |
| 6. Does your child point out familiar objects? (SC.B2) | Y/S/N | Y/S/N | Y/S/N |
| 7. Does your child follow two linked directions? (SC.B3) | Y/S/N | Y/S/N | Y/S/N |
| 8. Does your child respond to questions? (SC.B4) | Y/S/N | Y/S/N | Y/S/N |
| 9. Does your child use sentences of three words or more? (SC.C1) | Y/S/N | Y/S/N | Y/S/N |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 10. Does your child initiate social exchanges? (SC.D1) | Y/S/N | Y/S/N | Y/S/N |
| 11. Does your child use language to exchange information? (SC.D2) | Y/S/N | Y/S/N | Y/S/N |

### What social-communication skills do you want your child to learn?

---

## Cognitive Skills
Cognitive skills involve mental processes and reasoning.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 1. Does your child turn toward noises/objects/people? (CO.A1) | Y/S/N | Y/S/N | Y/S/N |
| 2. Does your child use two or more simple actions together? (CO.A2) | Y/S/N | Y/S/N | Y/S/N |
| 3. Does your child copy gestures? (CO.B1) | Y/S/N | Y/S/N | Y/S/N |
| 4. Does your child imitate unfamiliar words? (CO.B2) | Y/S/N | Y/S/N | Y/S/N |
| 5. Does your child relate previous events? (CO.B3) | Y/S/N | Y/S/N | Y/S/N |
| 6. Does your child search for things not in usual places? (CO.C1) | Y/S/N | Y/S/N | Y/S/N |
| 7. Does your child recognize symbols? (CO.C2) | Y/S/N | Y/S/N | Y/S/N |
| 8. Does your child sort objects based on features? (CO.C3) | Y/S/N | Y/S/N | Y/S/N |
| 9. Does your child compare common concepts? (CO.C4) | Y/S/N | Y/S/N | Y/S/N |
| 10. Does your child use an object to get another out of reach? (CO.D1) | Y/S/N | Y/S/N | Y/S/N |
| 11. Does your child use different actions with objects? (CO.D2) | Y/S/N | Y/S/N | Y/S/N |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 12. Does your child try different methods to solve a problem? (CO.D3) | Y/S/N | Y/S/N | Y/S/N |
| 13. Does your child make reasonable predictions? (CO.D4) | Y/S/N | Y/S/N | Y/S/N |
| 14. Does your child ask questions based on observations? (CO.E1) | Y/S/N | Y/S/N | Y/S/N |
| 15. Does your child share their conclusions? (CO.E2) | Y/S/N | Y/S/N | Y/S/N |

### What cognitive skills do you want your child to learn?

---

## Literacy Skills
Literacy skills involve prereading and reading.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. |  |
| --- | --- |
| 1. Does your child pay attention during reading time? (LI.A1) |  |
| 2. Does your child understand writing direction? (LI.A2) |  |
| 3. Does your child recognize printed words? (LI.A3) |  |
| 4. Does your child say rhyming words? (LI.B1) |  |
| 5. Does your child separate compound words? (LI.B2) |  |
| 6. Does your child break words into syllables? (LI.B3) |  |
| 7. Does your child break words into sounds? (LI.B4) |  |
| 8. Does your child name several letters? (LI.C1) |  |
| 9. Does your child describe pictures in books? (LI.D1) |  |
| 10. Does your child retell stories? (LI.D2) |  |
| 11. Does your child write and draw? (LI.E2) |  |
|  | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |
|  | Y/S/N | Y/S/N | Y/S/N |

### What literacy skills do you want your child to learn?

---

## Math Skills
Math skills involve number recognition and manipulation.

| Name: Marcus Greene |  |
| --- | --- |
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 | DATE 2: | DATE 3: |
| --- | --- | --- | --- |
| 1. Can your child count 3 items aloud? (MA.A1) | Y/S/N | Y/S/N | Y/S/N |
| 2. Can your child count 10 items aloud? (MA.A2) | Y/S/N | Y/S/N | Y/S/N |
| 3. Can your child count 20 items aloud? (MA.A3) | Y/S/N | Y/S/N | Y/S/N |
| 4. Can your child count by tens to 100? (MA.A4) | Y/S/N | Y/S/N | Y/S/N |
| 5. Can your child compare 2 small sets of items? (MA.B1) | Y/S/N | Y/S/N | Y/S/N |
| 6. Can your child compare 2 medium sets of items? (MA.B2) | Y/S/N | Y/S/N | Y/S/N |
| 7. Can your child compare 2 large sets of items? (MA.B3) | Y/S/N | Y/S/N | Y/S/N |
| 8. Can your child read and write numerals for up to 5 items? (MA.C1) | Y/S/N | Y/S/N | Y/S/N |
| 9. Can your child read and write numerals for 6 to 10 items? (MA.C2) | Y/S/N | Y/S/N | Y/S/N |
| 10. Can your child read and write numerals for 11 to 20 items? (MA.C3) | Y/S/N | Y/S/N | Y/S/N |

### What math skills do you want your child to learn?

---

## Intervention Priorities

Date: 9/30/21
1. Getting dressed and undressed by himself  
2. Holding a pencil correctly  
3. ____  
4. ____

Date: 
1. ____  
2. ____  
3. ____  
4. ____

Date: 
1. ____  
2. ____  
3. ____  
4. ____