Sibling Assessment Form Page 3
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7Sibling Assessment Form
SIBLING RELATIONSHIP CHECKLIST 2
Child A________________________________________________________DOB__________________
Child B________________________________________________________DOB__________________
Behavior of Child B to Child A
Frequency (select one)
A
Defends or protects
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
B
Recognizes sib’s distress and offers comfort
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
C
Accepts comfort from sib
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
D
Teaches or helps
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
E
Initiates play
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
F
Responds to overtures to play
1 Often
2 Sometimes
3 Never
Examples of this behavior
________________________________________________________________________________
________________________________________________________________________________
PSU-CWP-Salem/share drive/office
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