Social Skills Inventory (Revised from Novotni Social Skills Checklist, see myADHD.com) Person Person Evalu Evaluat ated ed : Key: Key: 0 = Not Not a prob proble lem m or rarel rarely y a prob proble lem m Age: Date: 1 = Sometimes a problem or issue Evaluator: Relationship: 2 = Definitely a problem and needs improvement Score Basic Manners – The ability to do the Commmuncation Roadblocks following in social situations 0 1 2 Inatte Inattenti ntive ve - misses misses pieces pieces of inform informati ation on 0 1 2 Uses Uses polite polite words words like like plea please, se, thank thank you, you, and 0 1 2 Uses Uses clos closed ed que questi stions ons (ones (ones that that can be answere answered d you’re welcome with a “yes” or a “no”) 0 1 2 Expr Express esses es appr apprec ecia iati tion on 0 1 2 Voice Voice volume volume – speaks speaks too loud loud or or too soft soft 0 1 2 Receiv Receives es complim compliment ents s withou withoutt discou discounti nting ng them them 0 1 2 Speech Speech tem tempo po – s spea peaks ks too slowly slowly or too quickly quickly 0 1 2 Apologizes 0 1 2 Interr Interrupt upts s othe others rs – breaks breaks into into conv convers ersati ations ons 0 1 2 Acce Accept pts s the the apol apologi ogies es of other others s without considering the flow 0 1 2 Intr Introd oduc uces es hims himsel elf/ f/he hers rsel elff 0 1 2 Too quiet quiet – rarely rarely speaks speaks in conver conversat sation ions s 0 1 2 Uses Uses app appro ropr pria iate te greet greetin ings gs 0 1 2 Dom Domine ineeri ering ng - orders orders or bosses bosses others others around around 0 1 2 Has Has appr appropr opria iate te pho phone ne man manne ners rs 0 1 2 Critic Criticize izes s – judges judges or evalua evaluates tes others others 0 1 2 Uses Uses app appro ropr pria iate te endin ending g comme comment nts s 0 1 2 Is not consid considera erate, te, or minimi minimizes zes other’ other’s s ffeel eeling ings s 0 1 2 Eats Eats w with ith mou mouth th closed closed,, foll follows ows the the lead lead of the the Total Score Communication Roadblocks host/hostess 0 1 2 Will Will use nap napkin kins, s, ask for items items to be passes passes,, Self Control keep elbows off table 0 1 2 Asks Asks to be excu excuse sed d from from the the table table 0 1 2 Takes Takes turns, turns, waits waits for his or her turn turn 0 1 2 When When hosting hosting,, make makes s gues guests ts feel feel comfort comfortable able in 0 1 2 Abilit Ability y to han handle dle the frustr frustrati ation on of waitin waiting g his/her home 0 1 2 Effect Effective ively ly man managi aging ng conflic conflictt with with others others 0 1 2 Offe Offers rs to help help othe others rs 0 1 2 Is able able to to nego negoti tiate ate and comprom compromise ise with with oth others ers 0 1 2 Effect Effective ively ly man manage age ang anger er withou withoutt insult insult,, Total score Basic Manners intimidation or destruction 0 1 2 Ref Refrai rains ns from from fighti fighting, ng, aggress aggressive ive beh behavi avior or Verbal Communication Skills - In 0 1 2 Is able able to to asser assertt them themsel selves ves,, ask for wha whatt they they conversation with others, the ability to: want without bullying 0 1 2 Joins Joins a conver conversat sation ion smoothl smoothly, y, withou withoutt 0 1 2 Avoi Avoids ds impu impuls lsiv ive e spend spendin ing g disruption 0 1 2 Avoi Avoids ds impu impuls lsiv ive e decis decision ion-m -mak akin ing g 0 1 2 Ref Reflec lectiv tive e list listeni ening ng – rrepe epeats ats wha whatt anot another her says says 0 1 2 Avoids Avoids blurti blurting ng out things things that that hurt hurt others others and asks if they understood them right 0 1 2 Avoids Avoids inappr inappropr opriat iate e touchin touching g of others others 0 1 2 Tracki Tracking ng - Iden Identif tifies ies and reflect reflects s the the feel feeling ings s of of 0 1 2 Is able able to rel relax others 0 1 2 Is able able to sit still still and not fidget fidget 0 1 2 Refle eflect cts s cont conten entt and feelings of others Total Score Self Control 0 1 2 Uses Uses b brie rieff “encou “encourag ragers ers”” to to let let others others know they they are following the conversation (“I see”) Relationship Skills 0 1 2 Uses Uses open end ended ed que questi stions ons to keep keep the conversation going 0 1 2 Is sens sensit itiv ive e to the the need needs s of other others s 0 1 2 Asks Asks for for help help when when need needed ed or want wanted ed 0 1 2 Is patien patientt – can allow allow the other other to get their their nee needs ds met first at times Total Score Verbal Communication Skills 0 1 2 Is creative 0 1 2 Is fun fun to be with ith NonVerbal Communication Skills – Looking 0 1 2 Flex Flexibl ible e – can “go “go wit with h the the flow flow”” attentive when listening - When talking to 0 1 2 Resp Respec ects ts the the boun boundar darie ies s of othe others rs others, do you (they): 0 1 2 Trea Treats ts othe others rs with with resp respec ectt 0 1 2 Keep Keep an open open post postur ure e 0 1 2 Tole Tolera rate tes s diff differe erenc nces es in othe others rs 0 1 2 Face aces the the per person son 0 1 2 Init Initia iate tes s invi invita tati tion ons s to other others s 0 1 2 Lean Leans s forw forwar ard d to show show inte intere rest st 0 1 2 Tolera Tolerates tes closen closeness ess and intima intimacy cy without without runnin running g 0 1 2 Mainta Maintains ins app approp ropria riate te eye contact contact away 0 1 2 Looks relaxed 0 1 2 Has Has at leas leastt 3 close close frie friends nds Total Score NonVerbal Communication Skills
0 1 2 0 1 2 0 0 0 0
1 1 1 1
2 2 2 2
0 1 2
Self Care Is able able to nurtur nurture e himsel himselff or hersel herselff Is clean clean and nea neatt in in appe appeara arance nce,, appr appropr opriat iate e to to situation Is able able to to ident identify ify and express express his or her feeli feelings ngs Has Has good good self self-e -est stee eem m Part Partic icip ipat ates es in grou groups ps Has a sense sense of hum humor or (that (that doe doesn’ sn’tt den denigr igrate ate others) Hope Hope – has has a posi positi tive ve outl outloo ook k
Total Score Relationships Skills
0 1 2 0 1 2 0 0 0 0 0 0 0
1 1 1 1 1 1 1
2 2 2 2 2 2 2
Adult ADD Organizational Problems Diff Diffic icult ulty y with with dead deadli lines nes Diffic Difficult ulty y being being on time time for meeting meetings s and appointments Difficulty remembering special occasions Diff Diffic icult ulty y manag managin ing g mone money y Is too too orga organi nize zed d or rigi rigid d Diffic Difficult ulty y managin managing g mon money, ey, bills, bills, ban bank k account accounts s Disorg Disorgani anized zed with with his his or her posses possessio sions, ns, dom domici icile le Does Does not not do what what they they agre agree e to to do Does Does not not fini finish sh proj projec ects ts
Total Score Self Care Total Score AdultADD Organizational Problems
