Questions Asked

The following tables include guidance for the developmental questions that are asked for each age group. The questions must be read exactly as they are written. Clarity can be given if requested.

For 6 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 1. Does your child lift their head when laying on their back? Answer “Yes,” even if the child is only able to lift their head briefly. Include this information in the comments. Answer “Yes,” if the child is starting to do this, but not all the time. Include this information in the comments. 2. When your child is on their tummy, does s/he straighten both arms and push their whole chest off the bed or floor? Answer “Yes,” even if the child is only able to straighten both arms and push their whole chest off the bed or floor briefly. Include this information in the comments. Answer “No,” if the child in unable to be on their tummy due to medical or physical limitations. Include this information in the comments. 3. If you hold both hands just to balance your child, does s/he support their own weight while standing? (That is, can s/he bear weight?) This is a precursor skill for fine and gross motor skills. Answer “Yes,” even if the child can only bear weight and balance briefly. Answer “Yes,” if the child is walking around furniture while holding on with one hand. The child has moved beyond this stage to a higher level of development. Answer “Yes,” if assessing an older child who can bear weight and balance, even if it is only briefly. Add comments to explain anything that is atypical. 4. Does your child reach for OR grasp a toy? The child does not have to do both to achieve a “Yes” response. If an older child has a physical impairment and is unable to reach for an object but does grasp, the answer would be “Yes”. Include this information in the comments. If the child only uses one hand to complete this task, the answer would be “Yes”. Most children will have a dominant side and tasks will primarily be performed with that hand. If the child has the use of only one hand but can complete the task with that hand, the answer would be “Yes.” Include this information in the comments. 5. Does your child try to pick up a crumb or Cheerio by using their thumb and all their fingers in a raking motion, even if they aren't able to pick it up? (If they already pick up the crumb or Cheerio, check "yes" for this item.) Answer “Yes,” if the child tries to pick up a crumb or Cheerio. This question is asking if the child attempts to do the task, not if they can actually do it. 6. Does your child make high-pitched squeals? This is a precursor skill for saying words or speaking in phrases. If the parent is unsure, some follow up questions include: Does the child scream when upset or scared? Does the child cry making a high-pitched sound when sad, angry, or scared? 7. Does your child show two or more emotions? (For example, laughs, cries, screams, etc.) If the child does not do this consistently, include a description of when it does happen in the comment section. Include the emotions the child does show in the comment section. Other examples include, startled, angry, surprised, sad. 8. Does your child act differently toward strangers than s/he does with you and other familiar people? (Reactions to strangers may include, for example, staring, frowning, withdrawing, or crying.) Include the child’s reaction to strangers and the child’s reaction to familiar people in the comment section. When an in-person interview in conducted, include how the child responded to you in the comment section. 9. Does your child stiffen and arch their back when picked up? This is a Reverse Scoring Question used to establish typical neurological development or GI concerns. If a parent or caregiver does not understand the question, ask follow-up questions for clarification. For example: Is there a medical concern that causes the child’s muscle tone to change? Does the child pull away when you try to pick him up for no apparent reason? Does this behavior happen regularly or only at certain times? A “Yes” answer to this question could be an indicator of a serious neurological disorder or severe gastrointestinal problem. Include the medical condition in the comment section if applicable. This question is not assessing if a child does this because they are upset, do not want to stop what they are doing, or are resistive to being picked up.

NOTE STOP HERE IF THE CHILD IS LESS THAN 9 MONTHS

For 9 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 10. Does your child roll from their back to their tummy, getting both arms out from under them? This is a precursor skill for standing, crawling, or walking. If the child is standing, crawling, or walking, they have progressed beyond this stage and the answer is “Yes” even though they may no longer roll from their back to their tummy. Answer “Yes,” if the child does this sometimes, and add the specific or estimated frequency, and when it is done to the comments. For example, the child only rolls from their back to their tummy with certain people. 11. When you stand your child next to furniture or the crib rail, does s/he stand, holding onto the furniture for support? This is a precursor skill for standing alone, walking, running, or climbing. If the child is standing alone, walking, running, or climbing, they have progressed beyond this stage and the answer is “Yes”. 12. Does your child creep or move on their stomach across the floor? This is a precursor skill for crawling or walking. If the child is walking, they have progressed beyond the creeping stage and the answer is “Yes” even though they may no longer creep or move across the floor on their stomach. If the parent indicates the child never crept, it would be inaccurate to answer “No” to this question if they are now walking. 13. Does your child sit supported (for example, in a chair with pillow, etc.) for at least 1 minute? This is a precursor skill for sitting independently. If the child is sitting independently, they have progressed beyond this stage and the answer is “Yes”. Include in the comment how long the child sits with supports. If the child sits without support for at least a minute, include that in the comments. If the child falls or slides after a minute, include that in the comments too. 14. When a loud noise occurs, does your child respond? (For example, act startled, cry or turn toward the sound.) Answer “Yes,” even if the child does not respond every single time a loud noise occurs. If the caregiver responds, “Sometimes” answer “Yes” and ask questions to clarify when the child does and does not respond. For example, the child does not respond to loud noises when watching her favorite movie. Include this information in the comments. 15. If you call your child when you are out of their line-of-sight, does s/he look in the direction of your voice? This question is not asking if the child goes to look for the person calling them or looks in their eyes once they find them. It is specifically asking if the child looks in the direction from where the voice is coming from. Answer “Yes,” if the child does this briefly or “sometimes” and include this information in the comments. 16. Does your child make non-word sounds? (That is, babble or jabber?) This is a precursor skill for talking. A child who now has meaningful words probably no longer babbles. The answer would still be “Yes”. In this case, there is no need to determine whether the child did babble or can babble because they have moved beyond this stage to a higher level of development. 17. Does your child look toward you (parent or caregiver) when hearing your (parent or caregiver’s) voice? This question is not asking if the child makes eye contact or looks into the parent’s eyes. Answer “Yes,” if the child looks in the direction of their parent or caregiver. Answer “Yes,” if the child does this briefly or “sometimes” and include this information in the comments. 18. Does your child enjoy playing peek-a-boo/pat-a-cake? This is a precursor skill to assess the child’s enjoyment of joint attention or reciprocity-based games. The question is asking if the child “enjoys” one of these games, not if they physically participate. The parent may be the one doing the activity, but the child still shows signs of enjoyment. A child who is older may no longer be interested in these types of games so follow-up questions should be asked for accuracy. Did the child enjoy peek-a-boo or pat-a-cake when they were younger but now enjoy more advanced interactive games? For example, Chutes and Ladders, Candy Land, or Connect 4. 19. Does your child feed themselves a cracker or cookie? This question is assessing the physical act of getting food from hand to mouth, chewing and swallowing. Answer “Yes,” if the child can begin feeding themselves a cracker or cookie, but then the parent finishes. Answer “Yes,” if the child does this inconsistently. Include this information in the comments. If the parent answers “No,” ask follow-up questions to find out if the child feeds themselves any other types of foods. For example, the child feeds themselves Cheerios. The answer would still be “Yes”.

NOTE STOP HERE IF THE CHILD IS LESS THAN 12 MONTHS

For 12 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 20. Does your child walk around the furniture while holding on with only one hand? This is a precursor skill for walking without holding onto anything. If the child is walking without holding onto anything, they have progressed beyond this stage and the answer is “Yes”. Answer “Yes,” if the child does this, but falls. Include this information in the comments 21. Does your child crawl at least 5 feet on hands and knees, without stomach touching the floor? This is a precursor skill for walking, running, or climbing. If the child never crawled, but is now walking, running, or climbing, answer “Yes,” UNLESS there is a physical impairment that keeps them from being able to crawl on their hands and knees. If so, answer “No,” and include this information in the comments. If the child is physically unable to perform this milestone, include what the limitations are in the comments. Also, include how they do move. For example, scoot on their bottom, creep, or the parent moves them. 22. Does your child hold a bottle or cup? This is a precursor skill for drinking from a cup or glass. Answer “Yes,” if the child drinks from a cup or glass, even if they never performed this skill. Answer “Yes,” if the child can hold a “sippy cup”. The cup does not have to be open for the answer to be “Yes”. 23. Does your child move an object from one hand to the other? This question is assessing whether the child can coordinate the two sides of their body together. If the child is unable to do this, describe what they do instead. For example, the child turns his whole body to get the object to avoid crossing the midline, or the child drops the object on the floor first and then picks it up with the other hand. 24. Does your child pick up a small object with thumb and fingers? Answer “Yes,” if the child only has the use of one hand but can complete the task with that hand. If the parent is not sure what the question means, ask if the child can pick up an object using a pincer grasp and show, or explain, what that means. 25. Does your child coo or laugh or make other sounds of pleasure? Ask how the child shows excitement or happiness to those they are comfortable around. If the parent or caregiver reports they do not show excitement or happiness, ask what the child does instead and include this information in the comments. 26. Does your child reach for familiar person when person holds out arms to them? This is to assess understanding and response of non-verbal communication. Answer “Yes,” if the child does it with only some familiar people, or sometimes, briefly. Include comments to explain. If the parent reports “sometimes” ask and include a more specific or average frequency. Explain under what circumstances a child might not do it. For example, the child doesn’t do it when they are mad or busy with another activity. Answer “No” if a child responds but cannot physically lift their arms. Include comments to explain that the child appears to understand and respond to non-verbal communication but has a physical barrier. 27. Does your child play with a doll or stuffed animal by hugging it? This is to assess if a child shows affection or self-soothes. Answer “Yes,” if the child initiates hugging other objects, toys, pets, or people. Include this information in the comments. Answer “No,” if the child hugs a doll or stuffed animal only because a parent tells them to but does not initiate it on their own. Include this information in the comments. 28. Does your child suck OR chew on finger foods? (For example, crackers, cookies, toast, etc.) This is to assess the child’s oral feeding abilities needed for swallowing. The child does not have to do both to achieve a “Yes” response. Answer “No,” if the child is tube-fed and unable to consume any food orally. Include this information in the comments. Answer “No,” if a child can only consume a meal that has been altered, for example pureed, to avoid choking or swallowing issues. Include this information in the comments.

NOTE STOP HERE IF THE CHILD IS LESS THAN 18 MONTHS

For Ages 18 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 29. Does your child stand in the middle of the room by themselves and take several steps forward? This is a precursor skill for walking independently, climbing, jumping, and running. Answer “Yes,” if the child is able to take several steps forward and then falls. Include this information in the comments. 30. Does your child climb on furniture? Helpful follow-up questions include: How does the child get on and off a bed? How does the child get on and off a sofa? How does the child get on and off a chair? 31. Does your child turn the pages of a board, cloth, or paper book by himself/herself? (S/he may turn more than one page at a time.) Answer “Yes,” if the child can turn the pages of any type of book. Include what the child does and how they do it in the comments. 32. Without showing them how, does your child scribble back and forth when you give them a crayon (or pencil or pen)? This is a precursor skill for writing letters or words and making shapes. Answer “Yes,” if the child is able to make any type of back-and-forth scribble, regardless of how they hold the writing object. Answer “Yes,” if the child no longer scribbles because they are now writing letters or words and making shapes. The child has moved beyond this stage to a higher level of development. 33. Does your child stack a small toy, block, cup, dish, or other object on top of another one? This question is not asking for a specific number of objects or the length of time the child stacks objects. Answer “Yes,” if the child is beginning to stack objects, briefly stacks objects, or does so but inconsistently. Include this information in the comments. If question 49 is answered “Yes,” it would be incorrect to answer “No”. Confirm the scoring is consistent and correct. 34. Does your child respond to their name when you call? Answer “Yes,” even if the child does not respond every time their name is called. Include a comment to explain how often and the reasons the child might not respond. For example, the child is watching their favorite movie and does not respond to anything when he is watching it. Responses can include: Turning toward the person calling their name. The child does not need to make eye contact. Verbal acknowledgement Change in behavior once their name is called Head movement Pause in activity Eye contact Inquire to find out if there is another name or word, such as a nickname, that the child responds to. If so, include this information in the comments. If the child is hearing impaired, and does not respond because of it, answer “No”. Include this information in the comments. 35. When playing with sounds, does your child make grunting, growling, OR deep-toned sounds? This question is asking if the child makes these sounds, not what they are doing when they make the sounds. Answer “Yes,” if the child makes grunting, growling, OR deep-toned sounds. The child only needs to do at least one of the sounds for the answer to be “Yes”. Examples include the sounds of the following: A car; A motor; A train; or An animal. 36. Does your child say “Da-da” or “Ma-ma” or another name for parent or caregiver (including parents or caregiver’s first name or nickname)? This is a precursor skill for more advanced language. In nearly all cases, if question 36 is answered "Yes,” question 16 should also be answered "Yes". Confirm the scoring is consistent and correct. Answer “Yes,” if the child uses another name for the parent or caregiver consistently. For example, the child calls the parent by their first name, or a nickname. Answer “No,” if the child says “Da-da” or “Ma-ma” for every person they encounter. Answer “Yes,” if the child uses Sign Language or any other method of communication and can sign or identify the parent or caregiver’s name. Include this information in the comments. 37. When you ask your child to point to their nose, eyes, hair, feet, ears and so forth, does your child correctly point to at least one body part? (They can point to themselves, you, or a doll). Answer “Yes,” if the child is starting to learn how to point to their body parts but does not get it right all of the time. Include this information in the comments. 38. If you point at a toy across the room, does your child look at it? Answer “Yes,” if the child looks at a toy or object across the room when a parent points and asks them to look. The intent of this question is not asking if the parent is only pointing and not speaking. 39. Does your child ever use their index finger to point, to indicate interest in something? This question is specifically looking for the ability to isolate the index finger. Answer “Yes,” only if the child points with an index finger. Inquire to find out if the child has any motor limitations that may impact their ability to do this. If so, include this information in the comments. 40. Does your child ever bring objects over to you? Answer “Yes,” if the child takes the parent over to the object to show them. This question is intended to find out if a child shows interest in an item, so it is not specifically asking if the child only brings an object to the parent. 41. Does your child imitate you? For example, you make a face - will your child imitate it? The child can imitate people other than a parent and still score “Yes”. Include this information in the comments. Imitations can include: Imitation of faces Gesture or body movements Sound or word production 42. Does your child take interest in other children? Other children include siblings. A child does not need to interact with other children to show interest. Ways a child may show interest in other children include: Trying to imitate what another child is doing Observing, tracking, and monitoring other children with their eyes Responding to another child’s actions Getting excited when other children are around Use investigative interviewing skills to make sure the child is not just interested in an object another child is holding, like a toy. Answer “No,” if this is the case and include this information in the comments. 43. Does your child eat solid foods? (For example, cooked vegetables, chopped meats, etc. Not assessing nutritional value or adequate intake. ) Answer “Yes,” if the child is a picky eater and only eats specific solid foods. Include this information in the comments. Answer “No,” if the child is only eating pureed foods or is fed through a feeding tube. Include this information in the comments. 44. Does your child like being hugged or cuddled? A child does not have to like being hugged or cuddled by multiple people for the answer to be “Yes.” If a child only likes to be hugged or cuddled by one person, for example their mom, answer “Yes,” and include this information in the comments. A child does not have to enjoy being hugged or cuddled all the time for the answer to be “Yes.” There might only be certain times, for example, they like to be hugged or cuddled when they are happy or sad. Include this information in the comments Answer “Yes,” if a child seeks ANY close physical contact with another person, such as sitting in someone’s lap or wanting a quick embrace. The amount of time the child likes being hugged or cuddled is not factored into this question.

NOTE STOP HERE IF THE CHILD IS LESS THAN 24 MONTHS

For Ages 24 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 45. Does your child run? Answer “Yes,” if a child can run but is clumsy or falls. Include this information in the comments. Answer “No,” if the child walks fast but does not actually run. 46. Does your child jump, with both feet leaving the floor at the same time? (That is, can s/he jump up?) This question is specifically asking if a child can jump up, off the floor. Other areas, such as on a trampoline or bed, are not considered here. Answer “No,” if the child is not able to jump with both feet leaving the floor at the same time, for example, only does a gallop or tries. Include this information in comments. 47. Does your child flip light switches off and on? If a parent says the child is too short and cannot reach, ask if the child can do this when picked up so they can reach. Ask follow-up questions to find out if the child understands cause and effect tasks like pushing a button to get a response. For example, if the child pushes a doorbell, they know the doorbell will ring. 48. Does your child put a small object in a cup and dump it out? (You may show them how.) Answer "No," if the child is unable to dump the object out. Ask follow up questions to find out what they do instead. For example, the child will put his hand in the cup to take the object out. Include this information in the comments. 49. Does your child stack at least four small toys, blocks, cups, dishes, or other objects on top of each other? Answer “No,” if the child is stacking some objects, but less than four. Include this information in the comments. Check question 33 to confirm the scoring is consistent and correct. 50. Does your child name at least three objects? (For example, bottle, dog, favorite toy, etc.) This question is asking if the child can identify at least three objects, either in spoken language, sign language, or any other method of communication. These objects can be the names of any person, place, or thing. Answer “Yes,” even if the child is not able to say the words accurately. An approximation of the word is ok if it is only used for that object. For example, the child says “baba” instead of “bottle”. Include the objects the child can name in the comments. Answer “No,” if the child just repeats sounds or words another person makes but is not actually identifying an object. Include this information in comments, clearly describing this type of behavior. 51. Does your child follow instructions with one action and one object? (For example, “Bring me the book,” “Close the door,” etc.) Answer “Yes,” if the child follows instructions, but not every time. Include times the child may not follow instructions in the comments. For example, when they are busy doing something else, or are not interested in following a certain instruction. Answer “Yes,’ if the child is able to follow instructions, but does so with a picture schedule rather than from verbal commands. Include this information in the comments. 52. Does your child demonstrate understanding of the meaning “no”, or word or gesture with the same meaning? (For example, stops current activity briefly.) Answer “Yes,” if the child demonstrates they understand the meaning of “no.” The child does not need to comply or actually stop what they are doing, to demonstrate they understand the meaning of “no.” Responses may include: Briefly stopping what they are doing Arguing, talking back, or showing resistance Asking why Answer “Yes,” if the child uses the word “no” in the right context. Include this information in the comments. Answer “Yes,” if the child demonstrates an understanding of the meaning “no,” but uses another word, such as nope, uh-uh, or stop. Include this information in the comments. 53. Does your child copy the activities you do, such as wipe up a spill, sweep, shave, or comb hair? Answer “Yes,” if the child copies the activities with prompts. Include this information in the comments. Answer “Yes,” if the child copies some activities but not others. Include this information in the comments. 54. Does your child play near another child, each doing different things? This question is assessing the child’s tolerance of others in their same space. This includes the same room or the same playground. The children do not need to be right next to each other. This is a base skill for more complex social development. Answer “Yes,” if the child plays near their siblings, but not near other children. Include this information in the comments. Answer “Yes,” if the child will tolerate playing close to another child, even if they are each doing something different and not interacting. The child does not need to initiate play or interact. Answer “Yes,” if the activity itself is the same as the activity other children are doing, but they are doing the activity individually, and not interacting. 55. Does your child hold and drink from a cup or glass? (Includes “sippy” cups.) If this question is answered “Yes,” check question 22 to confirm the scoring is consistent and correct. 56. Does your child look at you when you talk to them? Answer “Yes,” if the child does this, but only briefly. Duration is not a factor. Answer “Yes,” if the child does this sometimes, but not every time. Include times the child may not look at someone in the comments. For example, when they are busy doing something else, or are being disciplined.

NOTE STOP HERE IF THE CHILD IS LESS THAN 30 MONTHS

For Ages 30 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 57. While standing, does your child throw a ball or toy? This question is asking if the child can stand and throw an object. It is not asking if the child can throw the object far or straight. 58. Does your child ask questions beginning with what or where? (For example, “What’s that?” “Where doggie go?” etc.) This question is asking if the child can ask questions beginning with what or where. This applies to spoken language, sign language, or any other method of communication. 59. Does your child call themselves “I” or “me” more often than their own name? (For example, “I do it” more than “Mary (John) do it.”) This question applies to spoken language, sign language, or any other method of communication. If the child uses both I or me and their first name, ask to get a more specific frequency to determine the best scoring based on what they use more often. 60. Does your child take off clothing that opens in the front (for example, a coat or sweater)? (Does not have to unbutton or unzip the clothing, etc.) Answer “Yes,” if the child can perform the task with prompts, but no hands-on help. The child must be able to completely remove items without hands-on assistance for the answer to be “Yes.” Answer “No,” if the child needs hands on help to initiate or finish the task, except for unfastening the zipper or buttons. Include this information in the comments. 61. Does your child use a spoon to feed themselves? Answer “No,” if the child can use a fork but not a spoon. Include this information in the comments. Answer “No,” if the child requires hand over hand feeding with the spoon ALL the time. Include this information in the comments. Answer “Yes,” if the child starts the meal by spoon feeding independently or can use a spoon but prefers to use their hands or uses their hands more often than a spoon. Answer “Yes,” if the parent or caregiver puts the food in the spoon and then the child feeds themselves using the spoon. 62. Does your child sleep at least 8 hours in a 24-hour period? Answer “yes,” if the child is not sleeping through the night but takes a nap later that day to make up the time. Include how long the child sleeps in the full 24-hour period in the comments. 63. Does your child do things over and over and can’t seem to stop? (Examples are rocking, hand flapping or spinning.) * This is a Reverse Scoring Question used to assess a behavior that is atypical. This question is not assessing a behavior that occurs one time or on rare occasion. It is assessing repeated behaviors that go beyond normal “bad days,” “terrible twos,” sibling rivalry, or accidents. Describe the behavior in detail. Include: What does the child do; How often the behavior occurs; Under what circumstances the behavior occurs; and What is done to decrease, prevent, or stop behavior. If no intervention is needed, explain the reason for this. 64. Does your child destroy or damage things on purpose? * This is a Reverse Scoring Question used to assess Emotional Regulation. This question is not assessing a behavior that occurs one time or on rare occasion. It is assessing repeated behaviors that go beyond normal “bad days,” “terrible twos,” sibling rivalry, or accidents. Answer “Yes,” if the child has intentionally destroyed something on multiple occasions, and it is considered a consistent behavior. ONLY answer “Yes,” if actual damage was done with intent. Accidentally destroying or damaging something, should not be scored here. Describe the behavior in the comment section and score accordingly. Ask follow up questions to find out if the parent or caregiver has noticed a consistent trigger that occurs prior to these events. Include this information in the comments. Describe the behavior in detail. Include: What does the child do; How often the behavior occurs; Under what circumstances the behavior occurs; and What is done to decrease, prevent, or stop behavior. If no intervention is needed, explain the reason for this. 65. Does your child hurt themselves on purpose? * This is a Reverse Scoring Question used to assess Emotional Regulation. This question is assessing behavior that is intentional, not accidental. Answer “Yes,” if the child has intentionally hurt themselves and the behavior caused an injury. For example, draws blood, leaves bruise, causes red marks, or the child is taken to the ER or doctor for medical attention. Answer “Yes,” if the child experienced injuries in the past, but no longer does because the intervention prevents it. For example, the child no longer bruises their face because the caregiver puts a pillow between the child’s head and the floor to prevent it. Ask follow up questions to find out if the parent or caregiver has noticed a consistent trigger that occurs prior to these events? Include this information in the comments. Describe the behavior in detail. Include: What the child does to hurt themselves; How often the behavior occurs; Under what circumstances the behavior occurs; and What is done to decrease, prevent, or stop the behavior. If no intervention is needed, explain the reason for this.

NOTE STOP HERE IF THE CHILD IS LESS THAN 36 MONTHS

For Ages 36 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 66. Does your child stand (balance) on one foot for about 1 second without holding onto anything? Answer “Yes,” if the child can balance on one foot without holding onto someone or something for at least 1 second. Include in the comments how long the child can do this. 67. Does your child walk up stairs, using only one foot on each stair? (The left foot is on one step, and the right foot is on the next.) S/he may hold onto the railing or wall. If the child is able to move up stairs alternating feet AND not holding onto anything, check question 66 to make sure the answers are consistent. Answer “No,” if the child is unable to use one foot on each step while going up stairs. Include how the child does move up the stairs in the comment. 68. Does your child turn the pages of a book one at a time? If the question is answered “Yes,” check question 31, which should also be answered “Yes”. Answer “Yes,” if the child turns the pages of any type of book one at a time. Examples include, cloth, board, paper, magazine. Include what type of book in the comments. 69. Does your child use simple words to describe things? (For example, dirty, pretty, big, loud, etc.) This question is asking if the child can use simple, descriptive words. This applies to spoken language, sign language, or any other method of communication. Answer “No,” if the child just repeats descriptive words another person uses but is not actually using the word to describe something. Include this information in the comments, clearly describing this type of behavior. 70. Does your child state their own first name OR nickname? This question is asking if the child can state their own name or nickname. This applies to spoken language, sign language, or any other method of communication. The child does not need to state both their first name and nickname for the answer to be “Yes”. Answer “No,” if the child just repeats their first name or nickname when another person says it but is not actually associating the word with their name. Include this information in the comments, clearly describing this type of behavior. 71. Does your child follow instructions with two actions or an action and two objects? (For, example, “Bring me the crayons and the paper”, “Sit down and eat your lunch”, etc.) Use investigative interviewing skills to determine if the child is actually following two step instructions, rather than associating activities by habit and repetition. For example, the child is told “put on your socks and shoes” and does so because the child only puts shoes on when he has socks on. But when asked, “bring me the pen and pad of paper” the child only brings the pen and has to be told again to bring the pad of paper. 72. Does your child pretend objects are something else? (For example, does your child hold a cup to their ear, pretending it is a telephone? Does s/he put a box on their head, pretending it is a hat? Does s/he use a block or small toy to stir food?) This question is asking if the child can pretend an object is something else, not if the child can play pretend games, such as being superheroes, playing dress-up, tea parties, or playing “mommy” or “daddy”. 73. Does your child know if s/he is a boy or a girl? This question is assessing the child’s self-awareness and knowledge of how they view themselves. If the parent is unsure, because the child is non-verbal, ask follow-up questions. For example, ask the parent if the child can point to a picture of a boy or a girl, or shake their head “yes” or “no” when asked if they are a boy or a girl. If the parent, answers by saying “Yes” because the child prefers colors or toys that are associated with the opposite gender, ask more questions to make sure the child actually understands gender. For example, ask the parent to show the child a picture of a boy, point to the picture and ask, “Are you a boy?” Show a picture of a girl, point to the picture and ask, “Or are you a girl?” 74. Does your child pull up clothing with elastic waistbands? (For example, underwear or sweatpants) Answer “No,” if the child needs hands-on help to initiate or complete the task. Include this information in the comments. Answer “Yes,” if the child is able to perform the task with verbal prompts. Include this information in the comments. 75. Does your child suck from a straw? Answer “Yes,” if the child can suck from a straw even if the parent is holding the cup. Answer “Yes,” if the child can perform the task using any type of straw and include the information in the comments. 76. Does your child cry, scream, or have tantrums that last for 30 minutes or longer?* This is a Reverse Scoring question used to assess Emotional Regulation. Describe the behavior in detail. Include: What the child does when they have a tantrum. For example, throw themselves on the floor, scream. How often the behavior happens. How long the episodes last. What the triggers are, if any, that cause the tantrums. What is being done to decrease, prevent, or stop the behavior. If there is no intervention, explain the reason. For example, when the parent intervenes the behavior escalates. How the child stops the behavior. For example, falls asleep, gets distracted by something else, or parent gives the child a treat. 77. Does your child act physically aggressive? (For example, hits, kicks, bites, etc)* This is a Reverse Scoring question used to assess Emotional Regulation. This question is not assessing a behavior that occurs one time or on rare occasion. It is assessing repeated behaviors that go beyond normal “bad days”, “terrible twos”, sibling rivalry, or accidents. Describe the behavior in detail. Include: What the behavior looks like. Who it is directed towards. How often the behavior happens. What the triggers are, if any, that cause the behavior. If the behavior caused any injuries. If so, what the injuries are, and how the situation is dealt with. What is being done to decrease, prevent, or stop the behavior. 78. Does your child have eating difficulties? (For example, eats too fast or too slowly, hoards food, overeats, refuses to eat, etc.)* This is a Reverse Scoring question used to assess atypical behavior. Many children eat a little too fast, slow, or refuse certain foods and are considered “picky eaters”. Use investigative interviewing skills to assess if the behavior puts the child at risk or disrupts the family. Include this information in the comments. Ask if the child is being treated by a physician, nutritionist, or speech therapist because of eating difficulties. 79. Does your child sometimes stare at nothing or wander with no purpose?* This is a Reverse Scoring question used to assess Self-Management, dysregulation by disengaging with the environment, and repetitive wandering behaviors. Examples include, walking the perimeter without intention to go somewhere, or pacing. Describe the behavior in detail. Include: How often the behavior occurs How long the behavior lasts. What is done to decrease, prevent, or stop behavior. If no intervention is needed, explain the reason for this.

NOTE STOP HERE IF THE CHILD IS LESS THAN 48 MONTHS

For Ages 48 months and older

Question (Answer Yes or No) Helpful Hints and Things to Consider 80. Does your child hop up and down on one foot? Answer “Yes,” if the child only hops up and down a few times and then falls. Answer “No,” if the child performs the task while holding on to someone or something. Include this information in the comments. 81. Does your child pedal a tricycle or other three-wheeled toy at least 6 feet? Answer “Yes,” if the child is now riding a bike with or without training wheels. Answer “Yes,” if the child is able to pedal six feet or more but is not doing it consistently. Include this information in the comments Answer “No,” if the child moves the tricycle by using their feet, but not actually pedaling. Include this information in the comments. 82. Does your child walk down stairs, using only one foot on each stair? (The left foot is on one step, and the right foot is on the next.) S/he may hold onto the railing or wall. Answer “No,” if the child is unable to use one foot on each stair while going down stairs, and include how they do move down stairs in the comments. Check question 67 to make sure the answers are consistent. Explain in the comments if they are different. 83. Does your child wiggle their thumb, for example when using a TV remote control or video game controller? This question is asking about the child’s functional use of their thumb. Answer “Yes,” if the child is able to do other tasks that involve the thumb. For example, the child is able to use their thumb to push buttons on a tablet. 84. Does your child unbutton one or more buttons, OR unfasten one or more Velcro straps? Your child may use their own clothing or a doll’s clothing. Answer “Yes,” if the child is able to unbutton buttons OR Velcro straps. They do not need to do both. Answer “Yes,” if the child is only able to do one button or one Velcro strap, but not the rest. Include this information in the comments. 85. Does your child use in, on, or under in phrases or sentences? (For example, “Ball go under chair,” “Put it on the table,” etc.) This question applies to spoken language, sign language, or any other method of communication. Answer “No,” if the child just repeats what another person says but is not actually saying the phrase or sentence on their own. Include this information in the comments, clearly describing this type of behavior. 86. Does your child say their first AND last name? This question applies to spoken language, sign language, or any other method of communication. Answer “Yes,” if the child is asked what their name is and responds accurately. Answer “Yes,” if the child does not respond when asked, but has been heard to say their first and last name in the right context. 87. Does your child follow instructions in “if-then” form? (For example, “If you want to play outside, then put your things away,” etc.) Answer “Yes,” if the child only follows the instructions when it is a preferred activity, but other times does not because they are not motivated by the “if” part. The child does not need to do it all the time for the answer to be “Yes.” 88. Does your child share toys or possessions when asked? Answer “Yes,” if the child shares, but is not happy about doing so. Include this information in the comments. Answer “Yes,” if the child only shares with certain playmates or siblings. Include this information in the comments. 89. Does your child tell you the names of two or more playmates, including brothers and sisters? (Ask this question without providing help by suggesting names of playmates or friends.) This question applies to spoken language, sign language, or any other method of communication. Answer “Yes,” even if the child is not able to say the names accurately. An approximation of the name or nickname is ok if it is understood. 90. Does your child brush their teeth? Answer “Yes,” if the child starts the task, for example only brushes the front teeth, or does the task but the parent brushes again because the child does not do an adequate job. Answer “No,” if the child only performs the task with hand over hand assistance. 91. Does your child urinate in a toilet or potty chair? Answer “Yes,” if the child does urinate in a toilet or potty chair, but still has some accidents. Answer “Yes,” if the child urinates in the toilet or potty chair with prompts. Answer “Yes,” if a parent sits the child on a toilet or potty chair, and the child urinates. 92. Does your child defecate in a toilet or potty chair? Answer “Yes,” if the child defecates in a toilet or potty chair, but still has some accidents. Answer “Yes,” if the child defecates in the toilet or potty chair with prompts. Answer “Yes,” if a parent sits the child on a toilet or potty chair, and the child defecates. 93. Does your child put on clothing that opens in the front (for example, a coat or sweater)? (Does not have to button or zip the clothing.) Answer “Yes,” if the child can perform the task with verbal prompts. Include this information in the comments. Answer “No,” if the child needs hands-on assistance to initiate or complete the task.

NOTE STOP HERE IF THE CHILD IS LESS THAN 60 MONTHS

For Ages 60 months old, but less than 72 months old

Question (Answer Yes or No) Helpful Hints and Things to Consider 94. Does your child open doors by turning doorknobs? (Includes doors that open and close with levers rather than traditional round knobs). Answer “Yes,” if the child is unable to reach the knobs but can open doors if picked up to reach the knob. Answer “Yes,” if the child can open doors sometimes. Include this information in the comments. Answer “No,” if the child is only able to open doors turning doorknobs with hand over hand assistance. 95. Does your child identify and name most common colors (that is, red, blue, green, and yellow)? This question applies to spoken language, sign language, or any other method of communication. Answer “No,” if the child just repeats the names of colors when another person says them but is not actually associating the word with the color. Include this information in the comments, clearly describing this type of behavior. 96. Does your child follow three-part instructions? (For example, “Brush your teeth, get dressed, and make your bed,” etc.) Answer “Yes,” if the child follows some three-part instructions and understands them. Include this information in the comments. Answer “No,” if the instructions have to be broken down and given one at a time in order for the child to follow them. Include this information in the comments. 97. Does your child take turns when asked while playing games or sports? Answer “Yes,” if the child does this when asked. They do not have to initiate the turn taking. Answer “Yes,” if the child only takes turns when playing some games, but not others. Include this information in the comments. 98. Does your child play informal group games? (For example, hide-and-seek, tag, jump rope, catch, etc.) Answer “Yes,” if the child plays and participates in these types of games. They do not have to initiate the play, and caregivers or friends can tell them what to do. 99. Does your child put shoes on correct feet? (Does not need to tie laces.) Answer “No,” if the child can physically perform the task, but is unable to identify which shoe goes on which foot. Answer “No,” if the child has to be told which shoe goes on which foot. 100. Does your child wash their hands using soap and water? (May be reminded.) Answer “Yes,” if the child can start or finish washing their hands, but the parent re-washes to make sure their hands are clean. Include this information in the comments. 101. Does your child use the toilet by themselves? (S/he goes to the bathroom, sits on the toilet, wipes, and flushes. May be reminded.) Answer “No,” if the child is not able to perform all parts of this task independently. Include what tasks the child in unable to perform, how they are being helped, and by whom in the comments.