Child's Name

Date Month Dav Year

First Midd le

Birth Da te_

School Month Day Year

Grade

Age .

Sex: • Female • Male Other Data

Teacher Rating Scales- TRS-A Adolescent Ages

Computer-Entry Form I 12-21 Behavior Assessment System for Children, Second Edition

Cecil R. Reynolds, PhD, and Randy W. Kamphaus, PhD Your Name .

First Midd le Last

Position . What type of class do you teach?

How long have you known this child?

Instructions: On both sides of this form are phrases that describe how children may act. Please read each phrase, and mark the response that describes how this child has behaved recently (in the last several months).

Circle N if the behavior never occurs. Circle S if the behavior sometimes occurs. Circle O if the behavior often occurs. Circle A if the behavior almost always occurs.

Please mark every item. If you don't know or are unsure of your response to an item, give your best estimate. A "Never" response does not mean that the child "never" engages in a

1. Reads assigned chapters N S O A 2. Breaks the rules N S O A 3. Visits the school nurse N S O A 4. Is usually chosen as a leader N S O A 5. Shows interest in others' ideas N S O A 6. Has trouble staying seated N S O A 7. Seems lonely N S O A 8. Listens to directions N S O A 9. Acts strangely N S O A

10. Deceives others N S O A 11. Has trouble keeping up in class N S O A 12. Throws up after eating N S O A 13. Annoys others on purpose N S O A 14. Complains of shortness of breath N S O A 15. Acts without thinking N S O A 16. Has trouble getting information

when needed N S O A 17. Seems to take setbacks in stride N S O A 18. Tries to do well in school N S O A 19. Tries to bring out the best in other people N S O A 20. Is sad N S O A 21. Is easily distracted from class work N S O A 22. Threatens to hurt others N S O A 23. Seems out of touch with reality N S O A 24. Gets into trouble N S O A 25. Says, "I don't have any friends." N S O A

behavior, only that you have not observed the child to behave that way.

How to Mark Your Responses Be certain to circle completely the letter you choose, like this:

N S © A If you wish to change a response, mark an X through it, and circle your new choice, like this:

0 S ^ A

Before starting, be sure to complete the information above these instructions.

26. Worries about what other adolescents think N S O A 27. Cannot wait to take turn N S O A 28. Has headaches N S O A 29. Analyzes the nature of a problem before

starting to solve it N S O A 30. Uses others' things without permission N S O A 31. Is afraid of getting sick N S O A 32. Is creative N S O A 33. Congratulates others when good things

happen to them N S O A 34. Seeks attention while doing schoolwork N S O A 35. Is negative about things N S O A 36. Does not pay attention to lectures N S O A 37. Babbles to self N S O A 38. Has to stay after school for punishment N S O A 39. Has poor handwriting or printing N S O A 40. Says, "I'm afraid I will make a mistake." N S O A 41. Loses temper too easily N S O A 42. Gets sick N S O A 43. Calls out in class N S O A 44. Tracks down information when needed N S O A 45. Is a "good sport." N S O A 46. Uses the Internet effectively for schoolwork N S O A 47. Makes suggestions without offending others N S O A 48. Says, "1 hate myself." N S O A

Continue on the back >• Produc t N u m b e r 3 0 0 3 2

' TRS-A Ages 12-21

Remember: S - Sometimes Often Almost always O A O A O A O A O A O A O A O A O A

S O A S O A S O A

O A O A

49. Has a short attention span N S 50. Teases others N S 51. Has strange ideas N S 52. Steals at school N S 53. Complains about being teased N S 54. Worries N S 55. Has poor self-control N S 56. Complains about health N S 57. Asks to make up missed assignments N S 58. Responds appropriately when

asked a question N 59. Recovers quickly after a setback N 60. Makes decisions easily N 61. Encourages others to do their best N S O A 62. Acts out of control N S O A 63. Is pessimistic N S O A 64. Listens carefully N S O A 65. Sees things that are not there N S O A 66. Sneaks around N S O A 67. Gets failing school grades N 68. Worries about things that cannot be changed N 69. Defies teachers N 70. Avoids other adolescents N 71. Is overly active , N 72. Is unclear when presenting ideas N 73. Adjusts well to changes in routine N 74. Is well organized N 75. Offers help to other adolescents N 76. Is easily upset N S O A 77. Eats too much N S O A 78. Argues when denied own way N S O A 79. Seems unaware of others N S O A 80. Lies N S O A 81. Does not complete tests N S O A 82. Is fearful N S O A 83. Makes friends easily N S O A 84. Complains of pain N S O A 85. Completes homework N S O A 86. Is clear when telling about

personal experiences N S O A 87. Complains when asked to do

things differently N S O A 88. Works well under pressure N S O A 89. Says, "please" and "thank you." N S O A 90. Disrupts other adolescents' activities N S O A 91. Says, "1 want to die" or "1 wish 1 were dead." N S O A 92. Is easily distracted N S O A 93. Picks at things like own hair, nails, or clothing N S O A

O A O A O A O A

94. Disobeys N S 95. Complains that lessons go too fast N S 96. Refuses to join group activities N S 97. Bullies others N S 98. Quickly joins group activities N S 99. Interrupts others when they are speaking N S

100. Is able to describe feelings accurately N S 101. Adjusts well to new teachers N S 102. Has good study habits N S 103. Gives good suggestions for solving problems N S 104. Cries easily N S 105. Has a hearing problem N S 106. Seeks revenge on others N 107. Hears sounds that are not there N 108. Cheats in school N 109. Has spelling problems N 110. Says, "1 get nervous during tests" or

"Tests make me nervous." N 111. Plays alone N 112. Has stomach problems N 113. Eats things that are not food N 114. Communicates clearly N 115. Adjusts well to changes in plans N 116. Is easily annoyed by others N 117. Compliments others N

N , N , N , N . N . N . N . N . N . N

O A O A O A O A O A O A O A O A O A O A O A O A

S O A S O A S O A S O A

118. Disrupts the schoolwork of other children. 119. Has seizures 120. Pays attention 121. Says things that make no sense 122. Smokes or chews tobacco at school 123. Has reading problems 124. Refuses to talk 125. Calls other adolescents names 126. Has trouble making new friends 127. Eats too little 128. Has difficulty explaining rules

of games to others.

O A O A O A O A O A O A O A

S O A S O A S O A S O A

129. Gets upset when plans are changed N 130. Takes careful notes during lectures 131. Is good at getting people to work together. .., 132. Says, "Nobody likes me." 133. Has eye problems 134. Hits other adolescents 135. Falls down 136. Uses foul language 137. Has problems with mathematics 138. Is nervous 139. Is chosen last by other adolescents for games. .

O A O A O A O A O A O A O A

O A O A O A O A O A O A O A O A

S O A S O A S O A S O A

PEARSON Pearson Executive Office 5601 Green Valley Drive Bloomington, MN 55437 800.627.7271 www.PsychCorp.com Copyright © 2004 NCS Pearson, Inc. All rights reserved. Warning: No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanica l , including photocopy, recording, or any information storage and retrieval sys tem, without permiss ion in writ ing from the copyright owner Pearson, the PSI logo, PsychCorp, and BASC are t rademarks in the U.S. and/or other countr ies of Pearson Educat ion, Inc., or its aff i l iate(s). Printed in the United States of Amer ica . 13 14 15 16 17 18 19 20 21 22 23 24 A B C D E

® PsychCorp