Reinforcement Survey Please help up identify reinforcers for use with your child. Please take a few minutes to tell us the things your child likes so we will have an idea of what they will want to work for at school.

Toys

Does your child like to play with toys? q  q  q  q  q  q 

q  q  q  q  q  q  q  q  q  q  q  q 

cars puzzles dolls blocks Legos character toys What characters? ____________ ____________ ____________ ____________

q  q  q  q  q  q  q  q  q  q  q 

Tokens stickers points stars pictures __________ __________ __________ __________ __________ __________ __________ __________

Yes

No

music toys Barbies play dough __________ __________ __________ __________ __________ __________ __________ __________

Activities q  q  q  q  q  q  q  q  q  q  q  q 

blowing bubbles painting cleaning playing ball swinging art projects going on a walk reading books listen to music computer time watching movies help with chores

q  q  q  q  q  q  q  q  q  q  q  q 

cutting papers visiting school staff sliding cooking coloring/drawing singing __________ __________ __________ __________ __________ __________

Food

Is your child allowed to be reinforced with food? Yes No q  carrots q  gum q  raisins q  cheese q  pretzels q  popcorn q  goldfish q  grapes q  graham crackers q  water q  apple slices q  milk q  juice q  celery q  chips q  orange slices q  crackers q  __________ q  M&Ms q  __________ q  Skittles q  __________

Reinforcement Survey Social q  q  q  q  q  q  q  q  q  q  q  q  q  q 

high fives hugs praise smiling pat on head tickles _________ _________ _________ _________ _________ _________ _________ _________

Sensory q  q  q  q  q  q  q  q  q  q  q  q  q  q 

deep pressure lycra swing trampoline rice bin bean bin shaving cream lifting heavy items squeeze balls dancing lotion smelly markers beanbag chairs weighted vest weighted blanket

q  lava lamps q  massage q  “chilling out” q  rocking chair q  rubbing soft items q  jump rope q  __________ q  __________ q  __________ q  __________ q  __________ q  __________ q  __________ q  __________

Misc. What is your child’s favorite toy? ____________________________________________________ What does your child like to do at home? ____________________________________________________ What does your child like to eat for dinner? ____________________________________________________ What other items/activities does your child like? ____________________________________________________ ____________________________________________________

reinforcement survey.pdf

tell us the things your child likes so we will have an idea of what they will want to work. for at school. ... q apple slices. q juice. q chips ... reinforcement survey.pdf.

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