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Score ReportFOR EXAMINER USE ONLY
Parent/Primary Caregiver Form
Ages 0-5
Record of Input Data
Adaptive skill area Raw score Number of skipped items Number of guessed items
Communication 32 0 0
Community Use 32 0 0
Functional Pre-Academics 45 0 0
Home Living 34 0 0
Health and Safety 21 0 0
Leisure 21 0 0
Self-Care 14 0 0
Self-Direction 12 0 0
Social 16 0 0
Motor 43 0 0
Child Information
Grade
Black/African American
Sex
Male
2 years 7 months 09/26/2016
Disability or other limitation
None
Client ID
3 years 4 months
Name of child being evaluated (first, middle, last)
Jamie Sample
Age at testing Date of birth Age
School City State
Race/Ethnicity
Parent/Caregiver Information
Occupation
Parent
Nurse
3 or more
Julie Sample
Relationship to child Number of siblings at home
Describe relationship
Parent/Caregiver's name (first, last)
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 1 of 10
Sum of Scaled Scores to General Adaptive Composite (GAC) and Adaptive Domain Score Conversions
Sum of scaled scores Standard score Percentile rank Confidence interval: 95%
General Adaptive Composite (GAC) 47 70 2 67 - 73
Conceptual 20 79 8 74 - 84
Social 2 51 0.1 45 - 57
Practical 22 75 5 70 - 80
Score Summary
Year Month Day
Testing date 2019 4 29
Date of birth 2016 9 26
Age 2 7 3
Raw Score to Scaled Score Conversions
Adaptive skill area Raw score Scaled score Test-Age Equivalent
Communication 32 2 2 1:2-1:3
Community Use 32 11 11 2:6-2:8
Functional Pre-Academics 45 17 17 3:6-3:8
Home Living 34 7 7 1:10-1:11
Health and Safety 21 3 3 1:2-1:3
Leisure 21 1 1 0:09
Self-Care 14 1 1 0:07
Self-Direction 12 1 1 0:09
Social 16 1 1 0:07
Motor 43 3 1:0-1:1
Sum of scaled scores 47 20 2 22
Note: Motor is included in the GAC but not adaptive domains
GAC Conceptual Social Practical
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 2 of 10
Score Profile
Percentage of cases 2.2 6.7 16.1 50 16.1 6.7 2.2
Standard scores 70 80 90 100 110 120
Qualitative descriptions Extremely
low Low Below 
average Average Above
average High
Adaptive skill area
scaled scores
Score ranges = 15
Scale Name 
Graph
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
C
on
ce
pt
ua
l Communication X
Functional Pre-
Academics X
Self-Direction X
S
oc
ia
l Leisure X
Social X
P
ra
ct
ic
al
Community Use X
Home Living X
Health and Safety X
Self-Care X
Motor X
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Extremely low Low Below 
average Average Above 
average High
GAC and adaptive domain 
standard scores
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 3 of 10
Optional Analyses
Adaptive Domain Comparisons
Significance Base rate in
Domain comparison Standard score 1 Standard score 2 Difference Critical value .05 level standardization sample
Conceptual-Social 79 51 28 7.78 Y = 15
Scale Name 
Graph
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
C
on
ce
pt
ua
l Communication X
Functional 
Academics X
Self-Direction X
S
oc
ia
l Leisure X
Social X
P
ra
ct
ic
al
Community Use X
School Living X
Health and Safety X
Self-Care X
Work
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Extremely low Low Below 
average Average Above 
average High
GAC and adaptive domain 
standard scores
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 3 of 9
Optional Analyses
Adaptive Domain Comparisons
Significance Base rate in
Domain comparison Standard score 1 Standard score 2 Difference Critical value .05 level standardization sample
Conceptual-Social 56 68 -12 7.20 Y 15%
Scatter in Adaptive Skill Area Scaled Scores
Comparison used: Adaptive domains
Highest skill area Lowest skill area Difference Significance Base rate in 
GAC/Domain Name
Scaled 
score Name
Scaled 
score
 betweenscaled scores Critical 
value .05 level
standardization 
sample
GAC: All skill areas
Conceptual skill areas Self-Direction 3 Communication 2 1 2.04 N
Social skill areas Leisure 6 Social 1 5 2.04 Y = 15
Scale Name 
Graph
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
C
on
ce
pt
ua
l Communication X
Functional 
Academics X
Self-Direction X
S
oc
ia
l Leisure X
Social X
P
ra
ct
ic
al
Community Use X
Home Living X
Health and Safety X
Self-Care X
Work
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Extremely low Low Below 
average Average Above 
average High
GAC and adaptive domain 
standard scores
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 3 of 10
Optional Analyses
Adaptive Domain Comparisons
Significance Base rate in
Domain comparison Standard score 1 Standard score 2 Difference Critical value .05 level standardization sample
Conceptual-Social 87 92 -5 5.09 N
Conceptual-Practical 87 97 -10 5.88 Ycases 2.2 6.7 16.1 50 16.1 6.7 2.2
Standard scores 70 80 90 100 110 120
Qualitative descriptions Extremely
low Low Below 
average Average Above
average High
Adaptive skill area
scaled scores
Score ranges = 15
Scale Name 
Graph
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
C
on
ce
pt
ua
l Communication X
Functional 
Academics X
Self-Direction X
S
oc
ia
l Leisure X
Social X
P
ra
ct
ic
al
Community Use X
Home Living X
Health and Safety X
Self-Care X
Work
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Extremely low Low Below 
average Average Above 
average High
GAC and adaptive domain 
standard scores
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 3 of 10
Optional Analyses
Adaptive Domain Comparisons
Significance Base rate in
Domain comparison Standard score 1 Standard score 2 Difference Critical value .05 level standardization sample
Conceptual-Social 71 90 -19 6.57 Y 15%
Social skill areas Leisure 8 Social 8 0 1.76 N
Practical skill areas Home Living 3 Community Use 1 2 2.04 N
Strengths and Weaknesses in Adaptive Skill Areas
Comparison used: Adaptive domains
Calculate the mean scaled scores for adaptive skill areas
GAC Adaptive domain
9 skill areas
without Work
10 skill areas
with Work Conceptual Social Practical
without Work
Practical
with Work
Sum of scaled scores 13 16 7
Number of skill areas divide by 9 divide by 10 divide by 3 divide by 2 divide by 4 divide by 5
Mean scaled score 4.33 8 1.75
Determine strengths and weaknesses in adaptive skill areas
Skill area Mean scaled score Difference Significance Base rate in
Skill area scaled score from above from mean Critical value .05 level standardization sample
C
on
ce
pt
ua
l Communication 2 4.33 -2.33 1.86 Y >15%
Functional 
Academics 6 4.33 1.67 1.95 N
Self-Direction 5 4.33 0.67 1.76 N
S
oc
ia
l Leisure 8 8 0 1.76 N
Social 8 8 0 1.66 N
P
ra
ct
ic
al
Community Use 1 1.75 -0.75 2.12 N
Home Living 3 1.75 1.25 2.12 N
Health and Safety 2 1.75 0.25 2.28 N
Self-Care 1 1.75 -0.75 2.28 N
Copyright © 2015 by Western Psychological Services www.wpspublish.com 800.648.8857
Page 4 of 10
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