Client’s Name ___________________ D.O.
B _____________ Age _____________
Assessor’s Name ____________________ Date _____________
Reinforcer’s Checklist
Snacks/ Edible Reinforcers Toys/ Tangibles Social Reinforcers
M&Ms ● Yogurt ● Play doh ● Swing ● Kitchen set Shaking arms
Gummies ● Marshmallow ● Bubbles ● Slime ● Bubble machine Kisses
Smarties ● Cheese ● Glue tac ● Counters ● Roller Blade Playing with others
Lollipops ● Peanut butter ● Boats ● Plushies ● Airplanes Piggie back
Choco pops ● Sandwich ● Cars ● Jewelry ● Nail Polish Hide and seek
Cereal ● Cake ● Stamps ● Slide ● Sensory Bottles Chasing
Raisins ● Donuts ● Stickers ● Bicycle ● Water Beads Peak-a-boo
Apples ● Crackers ● Shaker ● Scooter ● Light toys Tickles
Grapes ● Chips ● Crayons ● Drums ● Spinning Toys High Fives
Bananas ● Popcorn ● Beads ● Piano ● Whiteboard Praise
Plum ● Cheetos ● Balloon ● Animals ● Xylophone Hugging
Peach ● Carrots ● Ball ● Lego ● Shape sorter Phone calls
Apricots ● Cucumbers ● Books ● Blocks ● Sound toys Whistling
Plain Milk ● Pepper ● Puzzles ● Markers ● Rubber ducks Dancing
Flavored Milk ● Nuggets ● Train ● Sand ● Water Play Spinning
Fresh Juice ● French Fries Songs
Boxed Juice ● Pudding Wrestling
Chocolate ● Cookies
Client’s Name ___________________ D.O.B _____________ Age _____________
Paired Stimulus Preference Assessment
A B C D E F G
Assessor’s Name: ___________________________________ Date of Assessment: ____________________________
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
A C A C A C A C A D A B D B B D B E B E F
B D C E D F E G F E G F G G E F D F C G G
Assessor’s Name: ___________________________________ Date of Assessment: ____________________________
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
A C A C A C A C A D A B D B B D B E B E F
B D C E D F E G F E G F G G E F D F C G G
How many times is each of the preferences selected? List preferred items in order
A. ___ 1. __________________________________
B. ___ 2. __________________________________
C. ___ 3. __________________________________
D. ___ 4. __________________________________
E. ___ 5. __________________________________
F. ___ 6. __________________________________
G. ___ 7. __________________________________
Client’s Name ___________________ D.O.B _____________ Age _____________
Multiple Stimulus without Replacement Preference Assessment
A B C D E F G
Assessor’s Name: _________________________ Assessor’s Name: _________________________
Assessment Date: _________________________ Assessment Date: _________________________
1 2 3 4 5 6 7 1 2 3 4 5 6 7
Assessor’s Name: _________________________ Assessor’s Name: _________________________
Assessment Date: _________________________ Assessment Date: _________________________
1 2 3 4 5 6 7 1 2 3 4 5 6 7
Assessor’s Name: _________________________
Assessment Date: _________________________
1 2 3 4 5 6 7
Rank each item from the lowest score to the highest score by summing up the ranking of each preferred item.
Sum of Trials for A:___ Most Preferred Items: _______________, _______________, ______________
Sum of Trials for B:___ Moderately Preferred Items: _______________, _______________
Sum of Trials for C:___ Least Preferred Items: _______________, _______________
Sum of Trials for D:___
Sum of Trials for E:___
Sum of Trials for F:___
Client’s Name ___________________ D.O.B _____________ Age _____________
Multiple Stimulus with Replacement Preference Assessment
A B C D E F G H
Trial # 1 2 3 4 5 6 7 8 9 10
Selected
Item
Trial # 1 2 3 4 5 6 7 8 9 10
Selected
Item
Trial # 1 2 3 4 5 6 7 8 9 10
Selected
Item
Trial # 1 2 3 4 5 6 7 8 9 10
Selected
Item
Trial # 1 2 3 4 5 6 7 8 9 10
Selected
Item
Total number of times each item was selected
A B C D E F G H
Client’s Name ___________________ D.O.B _____________ Age _____________
Single Stimulus Preference Assessment
Assessor’s Initials: ____________ Assessor’s Initials: ____________ Assessor’s Initials: ____________
Date:_______________________ Date:_______________________ Date:_______________________
Item Given Duration Item Given Duration Item Given Duration
Arrange the items from the most preferred to the least preferred.
__________, __________, __________, __________, __________, ___________, __________, __________