Scala de Dezvoltare Multiaxială P O R T A G E

NOTĂ: Itemii executaţi se încercuiesc pe grila de mai

 Nume beneficiar:.................................................................Vârsta................Data:.................. jos. După cinci itemi neexecutaţi consecutiv, fără ajutor,
 Diagnostic:................................................................................................................................. se va opri testarea!!!
...........................................................................................................................................................
 Coeficient de inteligenţă:........................Testat cu:.................................................................
 Psiholog:..........................................................................Semnătură:.......................................

 Evaluare psihologică multiaxială:

SOCIALIZARE:............................................................................................................................. Socializare
6 82 83 --- 6 97
Limbaj
98
Autoservire Cogniţie
99 6 103 104 105 6 106 107 108 6 139 140
Motricitate
---

......................................................................................................................................................... 79
76
80
77
81
78
94
91
95
92
96
93
100 101 102
97 98 99
103 104 105
100 101 102
136 137 138
133 134 135
73 74 75 88 89 90 94 95 96 97 98 99 130 131 132
......................................................................................................................................................... 5 70 71 72 5 85 86 87 91 92 93 94 95 96 127 128 129
67 68 69 82 83 84 5 88 89 90 91 92 93 124 125 126
......................................................................................................................................................... 64 65 66 79 80 81 85 86 87 88 89 90 121 122 123
4 61 62 63 76 77 78 82 83 84 5 85 86 87 118 119 120

LIMBAJ:......................................................................................................................................... 58
55
59
56
60
57 4 70
73 74
71
75
72
79
76
80
77
81
78
82
79
83
80
84
81
115 116 117
112 113 114
3 52 53 54 67 68 69 73 74 75 76 77 78 5 109 110 111
......................................................................................................................................................... 49 50 51 64 65 66 70 71 72 73 74 75 106 107 108
46 47 48 61 62 63 4 67 68 69 70 71 72 103 104 105
......................................................................................................................................................... 2 43 44 45 3 58 59 60 64 65 66 67 68 69 100 101 102
40 41 42 55 56 57 61 62 63 4 64 65 66 97 98 99
......................................................................................................................................................... 37 38 39 52 53 54 58 59 60 61 62 63 4 94 95 96
34 35 36 49 50 51 55 56 57 58 59 60 91 92 93

AUTOSERVIRE:........................................................................................................................... 1 28
31 32
29
33
30
46
43
47
44
48 3 52
45 49
53
50
54
51
55
52
56
53
57
54
88
85
89
86
90
87
25 26 27 40 41 42 46 47 48 49 50 51 82 83 84
......................................................................................................................................................... 22 23 24 37 38 39 43 44 45 46 47 48 3 79 80 81
19 20 21 34 35 36 40 41 42 43 44 45 76 77 78
......................................................................................................................................................... 16 17 18 31 32 33 37 38 39 3 40 41 42 73 74 75
13 14 15 2 28 29 30 34 35 36 37 38 39 70 71 72
........................................................................................................................................................ 10 11 12 25 26 27 31 32 33 34 35 36 67 68 69
7 8 9 22 23 24 28 29 30 31 32 33 64 65 66

COGNIŢIE:.................................................................................................................................... 0
4
1
5
2
6
3
19
16
20
17
21 2 25
18 22
26
23
27
24
28
25
29
26
30 2 61
27 58
62
59
63
60
13 14 15 19 20 21 2 22 23 24 55 56 57
......................................................................................................................................................... 1 10 11 12 16 17 18 19 20 21 52 53 54
7 8 9 1 13 14 15 16 17 18 49 50 51
......................................................................................................................................................... 4 5 6 10 11 12 1 13 14 15 46 47 48
0 1 2 3 7 8 9 10 11 12 1 43 44 45
......................................................................................................................................................... 0
4 5 6 7 8 9 40 41 42
1 2 3 4 5 6 37 38 39
0
MOTRICITATE:............................................................................................................................ 1 2 3 34
31
35
32
36
33
28 29 30
......................................................................................................................................................... 25 26 27
22 23 24
......................................................................................................................................................... 19 20 21
16 17 18
......................................................................................................................................................... 13 14 15
10 11 12
0 7 8 9
4 5 6
1 2 3