to Provide a Research Tool to Examine the Relationship Between

The Arc's Self-Determination Scale (Adolescent Version) is a student self—report measure of self-determination designed for use by adolescents with cognitive disabilities. The scale has two primary purposes: - To provide students with cognitive disabilities and educators a tool that assists them in identifying student strengths and limitations in the area of seif~cIetermination; and

- To provide a research tool to examine the relationship between

self-determination and factors that promote/inhibit this

important outcome. The scale has 72 items and is divided into four sections. Each section examines a different essential characteristic of self-determination: Autonomy, Sell-Regulation‘ Psychological Empowerment and SelfRealization. Each section has unique directions that should be read before completing the relevant items. Scoring the scale (see Procedural Guidelines for scoring directions) results in a total selfdetermination score and subdomain scores in each of the four essential characteristics of self-determination. A comprehensive discussion and exploration of self-determination as an educational outcome is provided in The Arc's Self-Determination Scale Procedural Guidelines, as well as detailed scoring procedures and a discussion about the use of selfreport measures in general. The scale should not be used until the administrator is thoroughly familiar with these issues.

The Arc's Self-Determination Scale (Adoiescent Version) was deveiopeci by The Arc National Headquarters with funding from the U. S. Department of Education, Office of Special Education Programs (OSEP), under Cooperative Agreement #1-l023J20012. Questions used in Section One (Autonomy) were adapted, with permission from the authors, from the Autonomous Funclionim Checklist. Questions used in Section 4 (Self-Realization) were adapted. with permission from the author‘ from the Short form of the Personal Orientation Inventory. Appropriate citations for both instruments are available in The Arc‘s Self—Determination Scale Procedural Guidelines. The Arc gratefully acknowledges the generosity of these researchers.

The Anr_:’s Self-Detc

H Adolescent Version

lion

By Michael Wehrneyer, Ph.D., Principal Investigator Kathy Kelchner, M.Ed., Project Director

Self-Determination Assessment Project

Student’s name

Date

School

Teacher’s name

by The Arc of the United States

The PC

‘Section One'

Autonomy

1. I make my own meals or snacks.

I care for my own clothes.

I do chores in my home.

I keep my own personal iiems together.

I keep goori personal care and groommg.

Directions:

Check the answer on each question that BEST tells how you act in that situation. There are no right or wrong answers. Check only one answer for each question. (if your disability limits you from actually performing the activity. but you have control over the

activity (such as a personal care attendant), answer like you performed the activity.)

I do n01 even it I have the chance

I do not even ii I have the chance

I do noi even if I have the Cl chance

CF13 VICE

I do nofeven if I have the chance

I do not even if I have {he chance

U I do not even ifl have the chance

1A. Independence: Routine personal care and family oriented functions

I do sometimes when I have the chance

I do sometimes when i have the chance

I do sometimes when I have the chance

I do sometimes when I have {he chance

I do most Oi the time I have the chance

1A. Subtotal

I do eve time I have chance |_I lhe chanrge

D I do most of the time I have U I do every time I have the chance the chanc

the chanée

D ldo mos! of the time I have ldo evexyiime I have ihe chance the chance

|:| Ida most ofthe time I have El ldo every time I have the chance the chanc

the chanée

D I do most oi the time I have I do every time I have the chance the chance

the chanée

U I do most of the time I have U I do every time I have the chance the chance

1B. Independence: Interaction with the environment

7. I make friends with other kids

my age. 8. luse the post office.

9. I keep my appointments and

meetings.

10. I deai withsalespeopie at

stores and restaurants.

I do not even if I have the chance

I do not even if I have the chance

I do not even if I have the chance

I do sometimes when I have the chance

I do sometimes when I have the chance

I do sometimes when l have the chance

I do sometimes when I have the chance

1B. Subtotal

[1 I do most of the time I have 1:] I do every time I have the chance the chance

the chanbe

ldo most of the time I have [1 ldo every time I have the chance the chance

the chanée

El 1 do most of the time I have U I do every time I have the chance the chance

the chanée

U I do most of the time I have El I do every time I have the chance the chance

the chants

1C. Acting on the basis of preferences, beliefs, interests and abilities: Recreational and leisure time

on my interesis.

12. I olan weekend activities that

13‘ I am involved in school-related activities.

14. My_fr_iends and I choose

activities that we want to do.

15. I write letlers, notes or talk on the phone to fnends and family.

I listen to music that I like.

U I do not even if I have the chance

{:1 I do not even if I have the chance

U i do not even if I have the chance

U I do not even if I have the chance

I do not even if I have the chance

I do sometimes when I have the chance

I do sometimes when I have the chance

I do sometimes when I have ihe chance

I do sometimes when I have the chance

—I I do sometimes when I have the chance

1C. Subtotal

I do most of the time I have I:] I do evatiPr1eTha_\:é' the chance the chance

I do most of the time I have C] I do every time I have the chance the chance

every time I have

I do most of the time I have the chance

the chance

the chance the chanée

|_do every time I have

I do most at the time I have the chance

the chance

I do every time I have the char

I do most of the time I have [1 I do every time I have the chance the chance

I do most of the time I have 3

18. I go to restaurants that! iike.

19. lo rnovies, concerts, and 20. I go shopping or spend time at S onninu centers or mails.

Community invoivement and interaction

I volunteer in things that I am I do not even ii I have the interested in. chance

interested in. " chance

U I do not even ii I have the chance

E] I do not even if I have the chance

10. Acting on the basis of preferences, beliefs, interests and abiiities:

I do sometimes when I have the chance

I do sometirnes when I have the chance

do sometimes when H have the chance

I do someiimas when I have the chance

1 D. Subtotal

I do mos! of the time I have the chance

I do most of the time I have chance

I do most of lhe time I have the chance

I do most oi the time I have the chance

I do most of the time I have the chance

[1 Ida every time I have the chance

[:1 I do every time I have the chance

[:1 I do every ume I have the chance

[1 I do every time I have the chance

III I do every time I have the chance

22‘ I do school and free time

23. I work on school work that wilk 24. I _make Iong-range career

25. I work or have worked 10 earn 26. I am in or have been in career

interests.

I do not even if I have the

1 do not even if I have the

I do not even if I have the

I do not even if I have ihe

or job classes or training. L_l chance

I do not even if I have the

Id peoplé in that lob.

1E. Acting on the basis of preferences, beliefs, interests and abilities: Post-school directions

I do sometimes when l have C] the chance

I do sornetimes when I have the chance

I do sometimes when I have the chance

I do most of the time I have the chance

I do most of the Mme 1 have the chance

I do mosi of the time I have the chance

ldo most of the time I have the chance

I do most oi the time I have the chance

. Subtotal

CI I do every time I have the chance

‘:1 I do every time I have the chance

I do every time I have the chance

El I do every time I have the chance

U I do every time I have the chance

D I do every time I have the chance

29. I choose my own hair style.

30. I choose

31. I decorate my own room. 32. I ch005e_ how to spend my

chance

28. I choose my clothes and the U I do not even if I have the nersonal iierns I use everv day. chance

personal iie'ms I use every

1 do not even if I have the chance

1 do noi even if I have the chance

I do not even if I have the chance

III

1 F. Acting on the basis of preferences, beliefs, Interests and abilities: Personal expression

I do sometimes when I have the chance

1F. Subtotal

I do most of the time I have the chance

1 do most of the time I have the chance

I do most ofthe iime I have the chance

1 do most of the time I have the chance

i do most oi the time I have the chance

‘:1 I do every time I have the chance

I do every time I have the chance

El I do every time I have the: chance

E] I do every time I have the chance

Please check Section One, A thru F, to make sure there is only one answer for each question.

Directions:

7 Q Sectlon Two

_Se|f-Regulation

Each of the following questions telithe beginning of a story and how the story ends. Your job is to tell what happened in the middle of the stoqg to connect the beginning and the end. Read the beginning and endingior each question, t en fill in the BEST answer for the middle of the story. __There are no rig tor wrong answers.

Remember} fill in the one anéwer that ydu think BEST completes the story.

2A. Interpersonal cognitive probiem-soiving

33.

34.

Beginning: You are sitting in a planning meeting with your parents 35. Beginning: Your friends are acting like they are mad at you. You are and teachers. You want to take a class where you can learn to work upset about this.

as a cashier in a store. Your parents want you to take the Family and

Child Care class. You can only take one of the classes. Middle: Middte: Ending: The story ends with you taking a vocational class where you Ending: The story ends with you and your friends getting aiong just will learn to be a cashier. fine.

Story Score Story Score Beginning: You hear friend talking about a new job opening at the Beginning: You go to your English class one morning and discover

local book store. You love books and want a job. You decide you would like to work at the bookstore.

Middle:

Ending: The story ends with you working at ihe bookstore.

Storyr Score

your English book is not in your backpack. You are upset because you need that book to do your homework.

Middle:

Ending: The story ends with you using your English book for homework.

Story Score

37. Beginning: You are in a club at school. The club advisor 2B: Goal setting and task performance announces ihat the club members will need to eleci new officers at the next meeting. You want to be lhe presideni of the club. Directions:

Middle: The next three questions ask about your plans for the future. Again, there are no right or wrong answers. For each question. teti it you have made plans for that outcome and, if so. what those plans are and how to meet them.

Where do you want to live after you graduate?

I have not planned for Thai yet.

I want to live

List four things you should do to meet this goal:

Ending: The story ends with you being elected as the club president.

Story Score

Where do you want to work after you graduate?

I have not planned for that yet.

Beginning: You are at a new school and you don't know anyone. You want to have friends. I want to work

Middle: List four things you should do to meet this goal:

What type of transportation do you plan to use after graduation?