fomato interes juego niño.docx

8/11/2019 fomato interes juego nio.docx

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Alexis D. Henry, ScD, OTR/L

Directions

There are 50 activities in this booklet. For each activity, there are three questions.

1. Do You Do This Activity?

2. Do You Like This Activity?

3. Who Do You Do This Activity With?

If you answer Noto question 1, you do not need to answer questions 2 or 3. Just go on to the next activity.

You can color or circle your answers.At the end, you may add other activities that you do and that you werent asked about.

Name Date

Age Birthday Grade Check Boy Girl

Copyright 2000 by Therapy Skill Builders, a Harcourt Health Sciences Company. All rights reserved. Pediatric Interest Profiles,Alexis D. Henry / 076164010X / This page is reproducible.


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With With aYes No A Lot A Little Not at All By Myself Friends Grown-Up



Sports Activities

1. Play Baseball

2. Play Basketball

3. Play Soccer

Do You Do This Activity? Do You Like This Activity? Who Do You Do This Activity With?


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4. Play Catch

5. Ride a Bike

6. Play Dodgeball


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7. Play Frisbeeo

With With a8. Play Hide-and-Seek Yes No A Lot A Little Not at All By Myself Friends Grown-Up

9. Jump Rope


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With With aYes No A Lot A Little Not at All By Myself Friends Grown-Up10. Play Kickball

With With a11. Play on Playground Yes No A Lot A Little Not at All By Myself Friends Grown-Up

With With a12. Roller-Skate or In-Line Skate Yes No A Lot A Little Not at All By Myself Friends Grown-Up


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With With aYes No A Lot A Little Not at All By Myself Friends Grown-Up13. Play Tag


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With With a14. Play at Beach, Lake, or River Yes No A Lot A Little Not at All By Myself Friends Grown-Up

15. Go on Picnic

16. Swim


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17. Camp

18. Hike

19. Go Fishing


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With With aYes No A Lot A Little Not at All By Myself Friends Grown-Up20. Garden


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21. Go Sledding

22. Play in Snow

23. Ice-Skate


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With With a24. Ski or Snowboard Yes No A Lot A Little Not at All By Myself Friends Grown-Up


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25. Play Cards

With With a26. Play Board Games Yes No A Lot A Little Not at All By Myself Friends Grown-Up

27. Read


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28. Use Computer

29. Watch TV

30. Listen to Music


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31. Collect Things

32. Take Care of Pet


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33. Do Puzzles

34. Sing

35. Dance


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36. Build Things

37. Draw or Paint

38. Cook or Bake


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39. Music Lessons

With With a40. Swimming Lessons Yes No A Lot A Little Not at All By Myself Friends Grown-Up

41. Dance Lessons


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42. Gymnastics Lessons Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up

43. Arts and Carfts Lessons Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up

44. Martial Arts Lessons Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up


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With With a45. Hang Out With Friends Yes No A Lot A Little Not at All By Myself Friends Grown-Up

46. Go to Scouts

With With a47. Play Superheroes Yes No A Lot A Little Not at All By Myself Friends Grown-Up


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With With a48. Play School Yes No A Lot A Little Not at All By Myself Friends Grown-Up

With With a49. Play House Yes No A Lot A Little Not at All By Myself Friends Grown-Up

With With a50. Play Dress-Up or Make-Up Yes No A Lot A Little Not at All By Myself Friends Grown-Up


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51. Fill in YourOwn Yes No ALot ALittle Not at All By Myself WithFriends With aGrown-Up

52. Fill in YourOwn Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up

53. Fill in YourOwn Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up


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54. Fill in Your Own Yes No A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

55. Fill in Your Own Yes No ALot ALittle Not at All By MyselfWith

FriendsWith a

Grown-Up


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Date Tested

Date of Birth

Chronological Age

Kid Play ProfileAlexis D. Henry, ScD, OTR/L

Summary Score Sheet

Childs Name

School

Service Providers Name

Discipline

Gender Male Q Female

Grade

Year Month Day

The child receives the following service(s)

Conditions that may affect the childs play

Category ScoresInstructions

Transfer the following information from the childs KidPlay Profile to each corresponding category table.

Place a checkmark in the Yes column of each activityin which the child has participated.

In the next three columns, circle the score thatindicates how the child likes the activity (3 = a lot; 2 = a little; 1 = not at all).

Place a checkmark in one or more of the last three

columns to indicate with whom the child does theactivity.

Scoring

Add the checkmarks in the Yes column and place thisnumber in the box labeled Number of(Sports, Outside,etc.) Activities Child Participates in.

Divide the number of activities the child participates in by the total number of activities in the category. Then

multiply by 100 to calculate the percent of activities the child participates in. Place the percent in the box

labeled Percent of Activities the Child Participates in.

To calculate how much the child likes the categoryactivities, add the scores of the three columns. Dividethe total by the number of activities the childparticipates in. Place this number in the box labeledHow Much the Child Likes Activities. Scores will rangefrom 1 to 3. The closer the number is to 3, the more thechild likes the activities.

To calculate the percent of activities that the child does

alone, with friends, or with an adult, add thecheckmarks in each column. Divide the total for eachcolumn by the number of activities the child participatesin. Multiply each total by 100 and place the percent inthe appropriate place in the box labeled Percent ofActivities the Child Does By Myself, With Friends, orWith a Grown-Up. Because children may give morethan one answer for this question (for example, childrenmay do an activity both bymyselfand withfriends"),the total for the 3 responses may exceed 100%.


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Sports Activities Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

1. Play Baseball

2. Play Basketball

3. Play Soccer

TotalNumber of Sports Activities ChildParticipates in

How Much the Child Likes SportsActivities

Percent of Activities the ChildDoes

By Myself

With Friends

With a Grown-UpPercent of Sports Activities ChildParticipates in

Play Interview

Outside Activities Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

4. Play Catch 3 2 1

5. Ride a Bike 3 2 1

6. Play Dodgeball 3 2 1

7. Play Frisbee 3 2 1

8. Play Hide-and-Seek 3 2 1

9. Jump Rope 3 2 1

10. Play Kickball 3 2 1

11. Play on Playground 3 2 1

12. Roller-Skate orIn-Line Skate

3 2 1

13. Play Tag 3 2 1

Total

Number of Outside Activities ChildParticipates in

Percent of Outside Activities ChildParticipates in

How Much the Child Likes OutsideActivities


By Myself

With Friends

With a Grown-Up

Play Interview


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Summer Activities Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

14. Play at Beach,

Lake, or River

3 2 1

15. Go on Picnic 2 1

16. Swim 2 1

17. Camp 2 1

18. Hike 2 1

19. Go Fishing 2 1

20. Garden 2 1

Total

Number of Summer Activities ChildParticipates in

How Much the Child Likes SummerActivities


By MyselfWith FriendsWith a Grown-Up

Percent of Summer Activities ChildParticipates in

Play Interview

inter Activities Yes A Lot A Little Not at AllWith With a

ByMyself Friends Grown-Up

21. Go Sledding

22. Play in Snow

23. Ice-Skate

24. Ski or Snowboard

Total

Number of Winter Activities ChildParticipates in

Percent of Winter Activities ChildParticipates in

How Much the Child Likes WinterActivities


By Myself

With Friends

With a Grown-Up

Play Interview


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Indoor Activities Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

25. Play Cards 3 2 1

26. Play Board Games 3 2 1

27. Read 3 2 1

28. Use Computer 3 2 1

29. Watch TV 3 2 1

30. Listen to Music 3 2 1

31. Collect Things 3 2 1

32. Take Care of Pet 3 2 1

Total

Number of Indoor Activities ChildParticipates in

How Much the Child Likes IndoorActivities


By MyselfWith Friends

With a Grown-UpPercent of Indoor Activities ChildParticipates in

Play Interview

Creative Activities Yes A Lot A Little Not at AllWith With a

By Myself Friends Grown-Up

33. Do Puzzles

34. Sing

35. Dance

36. Build Things

37. Draw or Paint

38. Cook or Bake

Total

Number of Creative Activities ChildParticipates in

Percent of Creative Activities ChildParticipates in

How Much the Child Likes CreativeActivities


By MyselfWith FriendsWith a Grown-Up

Play Interview


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Lessons/Classes Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

39. Music Lessons 3 2 1

0. Swimming Lessons 3 2 1

1. Dance Lessons 3 2 1

2. Gymnastics Lessons 3 2 1

3. Arts and Crafts

Lessons

3 2 1

4. Martial Arts Lessons 3 2 1

Total

Number of Lessons ChildParticipates in

How Much the Child LikesLessons

Percent of Lessons the ChildDoes

By Myself

With FriendsWith a Grown-Up

Percent of Lessons ChildParticipates in

Play Interview

Socializing Activities Yes A Lot A Little Not at All By MyselfWith

FriendsWith a

Grown-Up

5. Hang Out With Friends 3 2 1

6. Go to Scouts 3 2 1

7. Play Superheroes 3 2 1

8. Play School 3 2 1

9. Play House 3 2 1

50. Play Dress-Up or

Make-Up

3 2 1

Total

Number of Socializing Activities ChildParticipates in

Percent of Socializing Activities ChildParticipates in

How Much the Child Likes SocializingActivities


By Myself

With FriendsWith a Grown-Up

Play Interview


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Other Activities

51.

52.

53.

54.

55.

Total

YesWith With a

A Lot A Little Not at All By Myself Friends Grown-Up

Number of Other Activities ChildParticipates in

Percent of Other Activities ChildParticipates in

Play Interview

How Much the Child Likes Other Percent of Activities the ChildActivities Does

By MyselfWith Friends

With a Grown-Up

TOUR (Exclude other activities when calculating totals)

Number of Activities ChildParticipates in (sum the totals of

the 8 categories)Percent of Activities ChildParticipates in (divide the abovenumber by 50)

Play Interview Summary

Play Observations

How Much the Child Likes All Activities Percent of All Activities the Child DoesHe or She Participates in (sum the By Myself

scores for the 8 categories and divide With Friendsthe number by 8) With a Grown-Up

(add final percentages from eachcolumn and divide by 8)

Interpretations/Recommendations

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