Art Therapy Assessment

Art Therapy Assessment
Client Name*

First NameLast Name
DOB*

MonthDayYear
Date
Assessment Period

6 months
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Rating Scale:
- Never/Rarely – Does not do the action, does so infrequently, skill is not present, etc.
- With Support – Does the action given verbal prompts, physical prompts, visual supports, etc.
- Independently – Does the action when appropriate, does not need support, skill is present, etc.
- Not observed – Not age appropriate, not addressed in assessment, etc.

Social*

	Never/Rarely	With Support	Independently	Nor Observed
Established eye contact
Maintains eye contact
Avoids eye contact
Takes turns
Interacts with adults/therapists
Interacts with same-age peers
Disruptive behaviors/verbalizations
Imaginative/creative play
Demonstrates spatial awareness/boundaries

Emotional*

	Never/Rarely	With Support	Independently	No Observerd
Labels emotions (self)
Expresses emotions
Uses emotional vocabulary
Demonstrates a range of emotions
Makes negative self-statements
Makes statements of hope/happiness
Makes statements of harm about self or others

Art Therapy Assessment
Overall Strengths:
Overall Needs:
Treatment Recommendations:
The art therapist recommends that Name of the client continues services with 60 minutes sessions How many? times per week. The following goals and objectives are suggested to target during the first part of the treatment plan:
Goal 1:*
Objective(s)
Goal 2:*
Objective(s)
Therapist Name*

First NameLast Name
Date:*

MonthDayYear
Date
Please verify that you are human*
Therapist Signature*

Clear
Should be Empty:

	Never/Rarely	With Support	Independently	No Observed
Attends to task
Follows 1-2 step directions
Follows 3+ step directions
Sequences 2+ items
Problem solves
Makes choices
Motivated by incentives
Able Read
Able to Write
Demonstrates organized thought process
Demonstrates tangential thoughts
Transitions successfully between activities
Transitions successfully between spaces
Oriented to time and location

	Never/Rarely	With Support	Independently	Not Observed
Communicates verbally
Initiates communication
Uses sign language (including adapted)
Uses a communication device
Approximates words
Has incoherent speech
Communicates using 1-2 word phrases
Communicates using 3+ word phrases
Communicates in full sentences
Uses appropriate vocal volume
Articulates words
Responds to name
Responds to questions

	Never/Rarely	With Support	Independently	Not Observed
Imitates motor movements
Demonstrates fine motor control & coordination
Manipulates objects with hands
Isolates fingers individually
Demonstrates gross motor control
Demonstrates gross motor coordination
Balances when sitting
Balances when standing
Balances when walking
Uses an assistive mobility device
Crosses midline
Demonstrates hand-eye coordination
Range of motion within normal limits (right upper)
Range of motion within normal limits (left upper)
Range of motion within normal limits (right lower)
Range of motion within normal limits (left lower)

	Never/Rarely	With Support	Independently	Not Observed
Vision within normal limits
Visually tracks
Hearing within normal limits
Discriminates between auditory stimuli

	Never/Rarely	With Support	Independently	Not Observed
Sensory integration/perception within normal limits
Proprioception (body awareness) within normal limits
Remains in area/seat
Wiggles/rocks in seat
Body constantly in motion
Seeks containment
Seeks deep pressure
Seeks textured objects
Avoids textured objects
Wears headphones
Covers ears/puts fingers in ears
Creates loud sounds
Avoids specific sounds
Avoids specific art techniques
Avoids/turns off lights
Picks at skin
Pulls fingers
Bites nails
Sucks thumb/fingers
Twists or pulls hair
Smells or licks objects

	Never/Rarely	With Support	Independently	Not Observed
Chewing objects / gum
Uses comfort item
Uses fidgeting strategies
Squeezes stress ball / squish toy
Follows visual schedule
Engages in preferred activity
Uses deep breathing
Tears paper / punches pillow as outlet
Draws, colors, or does crafts
Drums, taps, or uses rhythm
Uses guided imagery / visualization
Writes or journals
Practices meditation / mindfulness
Moves or dances
Listens to music
Progressive muscle relaxation
Stomping, screaming, or aggressive outlets
Swinging
Practices yoga / stretching

	Never/Rarely	With Support	Independently	Not Observed
Agitation
Anger
Anxiety
Confidence
Cooperation
Appropriate emotional expression
Curiosity
Restlessness
Excitement / Elevated mood
Flexibility
Aggressive or oppositional behaviors
Shows optimism / positive outlook
Rigidity
Timid, shy, or socially withdrawn behaviors

	Never/Rarely	With Support	Independently	Not Observed
Demonstrates start/stop
Demonstrates curiosity for new art activities
Demonstrates working with the materials
Open to change between art activities
Demonstrates creativity
Active listen and follow instructions
Know the colors
Know the materials and how to use it
Open to imitates shapes and techniques
Ability to read and write
Open to learn new techniques
Demonstrates ability for work with others
Uses body and voice in artistic activities
Learns new things with the art
Uses art for relaxation
Improvise with the materials
Creates news artistic works
Uses art for expression
Uses art for emotion regulation
Uses art for distraction

Assessment Period