Sectin I. Identifying Infrmatin Name DAP:I~ Female 0 Male 0 Draw-a-Persn Intellectual Ability Test fr Children, Adlescents, and Adults Administratin/Scring Frm Schl Date f Testing Date f Birth Test Age Grade Year Mnth Day Referred by Reasn fr Referral Examiner Sectin II. Recrd f Scres Raw Scre IQ Percentile Qualitative Descriptr ( ) Manual Table 3.1 (page 12) Sectin III. Testing Cnditins A. Place tested I. Other knwn impairments B. Setting 0 Individual Grup Interfering Nt Interfering J. Ntes and ther cnsideratins C. Nise level 2 3 4 5 D. In terru ptins 2 3 4 5 E. Distractins 2 3 4 5 F. Light 2 3 4 5 G. Temperature 2 3 4 5 H. Knwn mtr prblems Sectin IV. Directins Individual Directins: Place the Drawing Frm in the prtrait rientatin in frnt f the examinee alng with a pencil with an eraser. Say, I want yu t draw a picture f yurself. Be sure t draw yur whle bdy, nt just yur head, and draw hw yu lk frm the frnt, nt frm the side. D nt draw a cartn r stick figure. Draw the very best picture f yurself that yu can. Take yur time and wrk carefully. G ahead. If the examinee draws a side view r nly a head, repeat the instructins. A new Drawing Frm may be prvided if needed r requested. The examinee may erase as needed, but d nt prmpt the examinee t d s Hwever, if the examinee asks if it is kay t erase, respnd in the affirmative. Grup Directins: Pass ut the Drawing Frms t all examinees and demnstrate placement f the sheet in a prtrait rientatin. Be sure each examinee has a pencil with an eraser. Say, I want yu t draw a picture f yurself. Be sure t draw yur whle bdy, nt just yur head, and draw hw yu lk frm the frnt, nt frm the side. D nt draw a cartn r stick figure. Draw the very best picture f yurself that yu can. Take yur time and wrk carefull y. Nw g ahead. Raise yur hand if yu have a questin r when yu cmplete yur drawing. Be sure t walk amng the grup and in spect the drawings. If an examinee is bserved t draw a side view r nly a head, repeat the instructins sftly t the examinee. A new Drawing Frm may be prvided if needed r requested. Examinees may erase as needed, but d nt prmpt them t d s. Hwever, if an examinee asks if it is kay t erase, respnd in the affirmative. Once an examinee cmpletes the draw ing, be sure the name r ID number is OnAh t> [{rawing Frm, then cllect the drawing. D nt wait t cllect all the drawings at nce.
Scre Sectin V. Scring 1. Head N recgnizable head 1 Any shape recgnizable as a head 2 Oval shaped head, smaller than trunk in height 3 Meets criteria fr 2 pts., IS attached t trs, and has at least 1 feature Nne present 1 Hair present 2 Hair present, placement apprpriate t gender f drawing 3 Meets 2 pts., shws attempt at styling (includes n hair if examinee has shaved head r is bald), and is neatly drawn 3. Eyes Nne present 1 2 eyes present 2 2 val shaped eyes with pupils 2. Hair 2 3 3 Meets 2 pts., are prprtinately placed n tp f face, and are grssly symmetrical Nne r present n 1 eye Present n bth eyes 4. Eyelashes Nne r 1 present Present abve bth eyes 5. Eyebrws 6. Nse Nne present 1 Any recgnizable nse 2 Nse is depicted as having at least 2 dimensins (e.g., width, height, depth) and is apprximately centered n the face 3 Meets 2 pts. and clearly shws 2 nstrils I 3,,;},. \ 7. Muth Nne present 1 Any mark recgnizable r intended as a muth 2 Muth IS essentially crrectly placed 3 Tw lips are shwn 4 Meets criteria fr 2 pts. and shws sme attempt at expressin 3 4 8. Chin 0 Nne present 1 Any recgnizable chin 2 Chin shws dimensin and is clearly distinct frm neck and trs 9. Ears 0 Nne r ne present (includes lng hair with n ears evident) 1 2 ears are shwn 2 Ears are crrectly placed n sides f head relative t ther features [i: I CJ2 ~J. ;,r " - ~., ~,! ~ 0. 10. Neck 0 Nne present 1 Any Ime recgnizable as a neck is present 2 Neck shws dimensins (ie, nt single stick), but nt cntmuus with trs 3 Neck shws dimensin and is drawn cntmuusly with trs 11. Shu Iders 0 Nne r ne present 1 2 shulders shwing dimensin are present 2 Meets criteria fr 1 pi. and is placed crrectly r nearly crrectly n the bdy; arms are present DAPIQ 2
Scre 12. Arms Nne r 1 shwn 1 2 arms are present 2 Arms shw dimensin and are attached at r near where shulders wuld be crrectly lcated Nne r 1 present Elbws shwn n bth arms 13. Elbws 14. Hands Nne r 1 present 1 Tw hands are shwn 2 Tw hands with fingers 3 Tw hands shwing dimensin, with fingers and distinct thumb 15. Trs Nne present r n shape distinguishable frm head and neck 1 Any shape belw and distinguishable frm head and neck 2 Shape at least 2 times the length f head, belw head, and n mre than 5 times the length f the head 16. Waist Nne present Apparent narrwing r divisin f trs at apprximate midline r Just belw midline (may be shwn by clth ing) Nne r 1 present Recgnizable hips present 17. Hips 18. Legs Nne r 1 leg present 2 legs present 2 Legs shw dimensin and are attached t lwer trs at r near bttm f hips Nne r 1 present Knees present n bth legs 19. Knees 20. Ankles Nne r 1 present ~~ Bth an kles present ~~ 21. Feet Nne r 1 present 1 Any shape recgnizable fr 2 feet present 2 2 feet With tes (r shes) present 3 Meets criteria fr 2 pts. and has 10 tes (r shes with at least 2 details) 22. Clthing Nne present 1 Any article f clthing present 2 Clthing with any details present (e.g., buttns, zippers, pckets, lgs) 3 Meets 2 pts., and there are n transparencies unless required by style f clthing 1 2 23. Accessries Nne present Any accessries present Mre than 3 accessries present (accessr ies may inc lude extraneus articles, such as Jewelry, purses, backpacks, CD players, bicycles, watches, skates r ther sprts equ ipment, flwers, birds, etc.) " 3 D Raw Scre (frm pages 2 and 3) DAPIQ 3
...-.- Name r ID number: Drawing Frm Additinal cpies f this frm (# 10698) may be purchased frm 2004 by PRO-EO, PRO-ED, 8700 Shal Creek Blvd, Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fax 8001397-7633, www,predinccm
DRAW-A-PERS[]N Name r ID number: ~~~ ~~~ ~~~L-~~ L-+--L~-L-L 2004 by PRO-ED, Inc. 1 2 3 4 5 07 06 05 04 03 Additinal cpies f this frm (# 1 0698) may be purchased frm PRO-ED, 8700 Shal Creek Blvd, Austin, TX 78757-6897 800/897-3202, Fax 800/397-7633, www.predinc.cm
DRAW-A-PERSON t \V1. G- 3 rd Drawing Frm Name r ID number: --------g-j.---d.l.=.::'..(:!.</~c;"_ii_b-\:::;i--'--_~ 1 I q ' q _ Additinal cpies f this frm (#10698) may be purchased frm 2004 by PRO-EO, Inc. PRO-EO, 8700 Shal Creek Blvd., Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fax 800/397-7633, www.predinccm
DRAW-A-PERSON Additinal cpies f this frm (#10698) may be purchased frm 2004 by PRO-ED, Inc. PRO-ED, 8700 Shal Creek Blvd., Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fax 800/397-7633, www.predinc.cm
DRAW-A-PERSON Dr~wing Frm ------l.lh~u~ C)'..L. Lf----L-+h Name r ID ------'-'1J'----'n~~f...!.L2._ number: I' " U"' 6v ~-'-!.) I_""'bL:Ke_'_ ' r~2x)...t_"'_i()q Additinal cpies f this frm (#10698) may be purchased frm 2004 by PRO-ED, Inc. PRO-ED, 8700 Shal Creek Blvd, Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fax 800/397-7633, vvvvw.predinc.cm
DRAW-A-PERSON Drawing Frm Name r ID number: D'w \.gq J b, b Additinal cpies f this frm (#10698) may be purchased frm 2004 by PRO-EO, Inc. PRO-EO, 8700 Shal Creek Blvd, Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fax 800/397-7633, wwwpredinc.cm
Drawing Frm NamerlDnumber: - ----- Additinal cpies f this frm (# 10698) may be purchased frm 2004 by PRO-ED, Inc. PRO-ED, 8700 Shal Creek Blvd, Austin, TX 78757-6897 1 2 3 4 5 07 06 05 04 03 800/897-3202, Fa x 800/397-7633, www.predinc.cm