lfl The Arc's Seif-Determinatiori Scale (Adolescent Version . isa student self-report measure of self-determinaticin designed for use by adolescents with cognitive disabilities. The scale hag two primary purposes:

To provide sttdents with cognitive osabifities ante educators a. tool that assists them in identifying student strengths and limitations in the area of self ;-detertnination; and

• To provide a research tool to %Whine the relationship between sell-determination and factorS that promote/inhibit this important. outcome.

The scale has 72 items and IS divided into four sections. Each secbori examines a different essential characteristic of 60-c:1M:ermine-lion: Autonomy, Self-Regulation, Psychological Empowerment and. Self- Realization. Each section has unique directions that shOuld be read before completing the relevant items. Scoring the scale (see ProcedurQall-defines, for scoring Orations) results in a total self- determination score and subciomain scores in each of the four essential' characteristics of self-cletermination. A comprehensive discussion and exploration of self-detennination as an educational outcome Is provided in The Awls $elf,Petertninefion Scale Procedural: Guidelines, as well as detailed scoring procedures and a discusSian about the use of self- report measures in general. The scale shoiald not be used unlit the administrator is thoroughly familiar with these issues.

The Aces Setf-OeterrninatiCn Scal4 OatOlescent Vemionywastiswitoped try The Arb Material Headquarters with Aincing•fromthe U. S..Ospaltineht ..ct 4dticatOri, Office . Cif Special Educe8on Programs :(0$EP), under 'dooper4ive Aetrogrmat OHO3420012.; Oribetions..used in:cclictil One- (Abtorror4) wei r.e .aclar:od.. with .penissi.on from! ittP,

arittior, torn . the Atictegazul ftincoritcrcetCherAili$: Oueslicris used S.eacia4 (Salt-Realization) Were . ;adaOted, wt p iSstoil Ities'auttrat ti reir: -The Sbort form • at the Forsonal. Orion toll tOver:Amt .Appropriate citations for both ibstiurnerft are available in The • elf- I • th ,*.ovekiral epic/eke.% The Pu gratetuRy ackrioMedges he crenereEIt o tieae rese4cChie.t.a:.

By Michael Wehrneyer, Phi D, Princi nvestigator Kathy Kelchner, MEd, Project Director

Self-Deterrnination Assessment Project

S nt.'s name

Date

Teacher's na

0 1995 by The Arc of the United States

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tbere is only one answe for each question.

Each of the ng questions tail the beginning of .a story. and how the story ends. Your lob is to tell what happened in the trickle of story to connect the beginning and the end. Read the begtnning and ending for each question, then Mt in the BEST answer for the middle of the story. There are no right or wrong answers.

Remember, DR in the one answer that you think BEST completes the story. 2A. interpersoilat cjtithte probtern.solving • 33. Beginning: You are sitting in a planning meeting with your parents

and teachart, You want to take a class where you can team to Work as a cashier in a store, Your parents want you to take the Family and Child Care class. You can only take one of the classes.

are Beginning: Your friends are acting Re they are mad at .t.pset about this.

Ending: The story ends with you taking a vocOonal class wherayou nding: The story ends with you and your friends getting along lust will learn to be a cashier. tine.

Story Soo Story Score.

34. Beginning; You hear a friend talking about a new pp opening at the tocai book store You to books and want a jetk. You decide you would like to work . at the bookstOre.

•eglinnlng: Yotiço to your :English ciass one rnbining arid discover • your Erigileh bookis not in your backpack. You are upset because

you need that boa 'it,. yotir liorriework:

Ending: The story ends with you working at the bookstore.

Story Score

Ending: The story ends withusing.your English back for homework

Story Score

I

37, Beginning: You are in a club at school. The dub advisor announces that the club members will need to elect new officers at the next meeting. You want to be the president of the club,

28: Goal setting performance

Directions;

Middle:

The next.three questions ask -about our plans for the future. Again, there (4...ro no tight Or Wrong answers.. P9r each question, tell if, You have made plans for that Outcme and if So, what those plane ere and how to meet then/.

39,, Where do you want to We after you graduate?

I havefl not planned for that yet

I want to live

List fOctr things you should db to meet ihis goal:

Ending: The story ends wth you being elected as the 3) club president.

4, Story Score

Where do you want to work after you graduate?

Fit have not planned for that Yet.

Beginning: You are at a new school and you don't know anyone You want to have friends ri I waM to work

List four things you should do to meet this goal;

IL 2)

4)

41„ What type Of transportation do you plan to use after graduation?

Fl] I havenot planned for tat yet,

1.1$4

List tour things you should do to meet this goal:

•stoyends with yu having manykthatthP

Story Score•

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Directions: Tell whether you think each of these statements describes how you feel about yourself

or not. There are no right or wrong answers. Choose only the answer that BEST fits you.

58. 1 do not feci athame of any of my emotions.

fl

Don't agree

I.00n't accept my own limitations.

Agree Agree Don't agree

59. I feel free to be angry I for.

67.. IteeI I cannot do any things. at people care

Agree Don't agree •AgTee tagree

60. i can show my feelings even when people might see me,

68,, like myself.

Dott agree Agree Agree Dorftagree

61. 1 can like people wen if I don't agree with them_

Don't agree

69. I am ntt an important n,.

D•n't agree -4f0e Agree

62. I am afraid of doing things wrong.

Don

70, I know Now to make up for my liirnitations,

Agree agree Agree Don't agree

63, It is better to be your f than to be popular.

71 Other people like me.

n agree Agree D Agree Don't agree

64. I am loved because I give love.

72 lain confident lfl my abilities

Agree Dct.agree Agree Don't agree

65 1 know what I do best , ,

Z.~44-Art A laszkirArIti ,

Don't agree

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Name Date

Self-Determination Student Scale ©1995, 2004

Alan Hoffman, Ed.D. Sharon L. Field, Ed.D. Shlomo S. Sawilowsky, Ph.D.

Directions: Read each statement carefully. If the statement describes you or your beliefs, place an "X" in the box labeled "That's me." If the statement does not describe you or your beliefs, place an "X" in the box labeled "That's not me."

For example, if the statement below describes you, an "X" is placed in the square "That's me."

A. I prefer sporting activities to academic studies

That's me That's not me

x

That's me That's not me

3. I have the right to decide what I want to do.

4. When I do not get something I want, I try a new approach. n

I for,,iiet to take care of my needs

ii with rev friends

Tr} help rite the heat time. I evaluate how; turned out

7. There are no interesting possibilities in my future.

8. Nothing is important to me.

No one has the right to tell me what to do.

10 I can only think of one way to iiet something.

11. I can be successful even though I have weaknesses.

12. I can figure out how to get something if I want it.

I"). Sometimes I need to take risks.

14. 1 do not have am, iloals for school this year.

15. I would not practice in my mind giving a speech to a

class because it would just make me nervous. 16. I do not know my weaknesses.

Please turn to NEXT PAGE

EJ

turned out the wa

2 Idrearn about what mv life will he like after I finish school.

23. I tell others what I want.

24. If I want something, I keep at it.

trunk abut

-)6. I tinake dec_winns without'

27. 1 forget to think about what is good for me when I do things.

30 I ani too,scared to take risks.

31. Criticism makes me angry.

32. I am embarrassed when I succeed. H

I ant too shy to tell others -‘,\ , hat ant.

I 9. I know my strengths.

20. I do not know where to find help when I need it.

33. I am frequently surprised by what happens when I do things.

I'iblan to explore many optionS before choosing a career.

4. I prefer to negotiate rather than to demand OF give en.

35. I would rather have the teacher assign me a

topic for a project than to create one myself.

36.1 am unhappy with who I am.

s17. 113T1'1 10.44.

39. I like to know my options before making a decision.

40.1 think about what is good for me when I do things.

e 1 Jo somethinv, I think about what might happen.

1\1:, friends are lucky to knov, me.

Please turn to NEXT PAGE

1 In

Per i;onal Iry rgicne is important to rile.

55 If I am unable to solve a puzzle quickly,

I Li,ct Frustriitcd and stop.

56. I make chttiges to improve my rcliition',hip with

That's me That's not me

45. When I want something different from my friend,

we find a solution that makes us both happy.

46. It is important for me to know what I do well in

being a good friend.

47. in an unn.tment, I am responsible for how I act on riml, fccliir~ 4.

48. I wish

one would tell me \\Lrliat to lo when I finish school.

49. I like who I am.

50. Goals give my life direction

53. My experiences in school will not affect my career choice.

54. When I am with friends, I tell them what I want to do.

57. I do not know if my parent's beliefs are important to me.

58. If I need help with a school project,

I can figure out where to get it.

..cliEicotir

60.1 do thin g the same way even if there might be a better way.

61. I know what is important when choosing my friends.

62. I could not describe my strengths and weaknesses in school.

63. I like to solve puz/les

64. Nothin4 good could come From admitting to triy;elf that Up havin g, difficulty in a eliiss.

65. At the end of the marking period,

I compare my grades to those I expected.

66. It is silly to dream about what I will do when I finish school.

Please turn to NEXT PAGE 0

hell we go out.

to be called on in class.

I my ricndS, I talk with than about it

78. I knout. ho\y to ge \\ nee; 't.

79 prefer to flip thiough pages, rather than to use the index.

80. I think about how well I did something.

I do [wt knovy, where to get help to decide

11: hat l should do after I finish school.

8.3 my friend's cinicize something I mn \yearing,

I .\vould not wear it ag2Iii.

84. I do not like to review my test results.

•

That's me That's not me

68. I accept some criticism and ignore some. n 69. I give in when I have differences with others.

72. I know how to compensate for my weaknesses in sports.

73.1 ask directions or look at a map before going to a new place. Fl

76. I like it when my friends see me do well.

77. When going through the cafeteria line, I pick the first thing.

81. I do not volunteer in class because

I will be embarrassed if I am wrong.

78. Before I give a report in class, I go over it in my mind.

iX ILalb about

Itoy\ ii might atIcct them.

Lptottd when I succeed.

88. When we are deciding what to do,

I just listen to my friends.

89. When deciding what to do with my friend,

it is not possible for both of us to be satisfied. n

When I want good guides until I get them

ifi niv team wum, there 1.3 nothing to be gained revie \ in g my performance.

92. Before starting a part-time job or extracurricular

activity, I think about how it might affect my school work.

Self-Determination Parent Perception Scale

© 1995, 2004 Alan Hoffman, Ed. D. Sharon L. Field, Ed.D.

Shlomo S. Sawilowsky, Ph.D.

Student name:

Name of person completing this form:

Relationship to student:

Date:

Rate your perception of your daughter or son based on your accumulated knowledge of her or him and place an "X" in the appropriate box. The rating scale ranges from 0 (very low) to 4 (very high).

For example, to what degree does your daughter or son:

Very Low Medium High Very Low

High

2

3

4

A. communicate for herself/himself?

B. communicate for herself/himself?

Please turn to NEXT PAGE

0 1 2 3 4

krio\vherthis stre igths'

find stiti7011trtlint conic front. ackno)1viedging-weaknesscs?

10. recognize het tight?

11. recognize her/his responsibilities?

12. take care of herself/himself?

14. plan?

15. anticipate consequences?

16. demonstrate creativity?

1'7: take risks?

18 demonstrate appropriate communication ski] f<,'

19. access resources and support?

. use humor`?:

deal appropriately with conflict':

To what degree does your daughter or son:

Very Low Medium High Very Low High

I 1 3. know his/her weaknesses?

4. know his/her preferences?

know hisiller need

expi orQ opti ohs

7. make decisions?

8. accept and value herself/himself?

9. negotiate?

Please turn to NEXT PAGE

29. adjust behavior to improve performance?

30. express self-determination

nnn

To what degree does your daughter or son:

Very Low Medium High Very Low High

I 2

25. persist until a goal is accomplished?

26. compare outcomes to expectations?

End of Scale, Thank you!

Self-Determination Teacher Perception Scale mummismommiumemommi

© 1995, 2004 Alan Hoffman, Ed. D. Sharon L. Field, Ed.D.

Shlomo S. Sawilowsky, Ph.D.

Student name:

Name of person completing this form:

Date:

Rate your perception of the student based on your accumulated knowledge of her or him and place an "X" in the appropriate box. The rating scale ranges from 0 (very low) to 4 (very high).

For example, to what degree does the student:

Very Low Medium High Very Low

High

3

A. communicate for herself/himself? x

I

B. use self-management strategies? n

Please turn to NEXT PAGE

0 I 2

3 71 1

3. know his/her weaknesses?

4. know his/her preferences?

kn_ow his/be' needs

6 eNplorc options'

7.

make decisions?

8. accept and value herself/himself?

) find strength that come,'s from

10. teeotmize lierliis itOtts

11. recognize her/his responsibilities?

12. take care of herself/himself?

.'set toals?

14

15. anticipate consequences?

16. demonstrate creativity?

w 1,er his strengths?

18. demonstrate a caw in wit cation

To what degree does the student:

Very Low Medium High Very Low High

19. access resources and support?

20. negotiate?

I se humor?

22. ilea! appropriately \vial conflict'

Please turn to NEXT PAGE

2

'7'3, deal appropriately \vilit criticisni?

4. initiate Lietions?

3

To what degree does the student:

Very Low Medium High Very Low High

25. persist until a goal is accomplished?

26. compare outcomes to expectations?

evaluate per fk alliance .

aoknoivieclge he :his successes?

29. adjust behavior to improve performance?

30. express self-determination

End of Seale, Thank you!