ASQ 18 months
Child's Name
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First Name
Last Name
Parent/Guardian filling out form
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First Name
Last Name
Email
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example@example.com
Child's Birthday
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Month
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Day
Year
Date
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Communication Section
When your child wants something, do they tell you by pointing to it?
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Yes
Sometimes
Not yet
When you ask your child to, do they go into another room to find a familiar toy or object? (You might ask, “Where is your ball?” or say, “Bring me your coat,” or “Go get your blanket.”)
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Yes
Sometimes
Not yet
Does your child say eight or more words in addition to “Mama” and“Dada”?
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Yes
Sometimes
Not yet
Does your child imitate a two-word sentence? For example, when you say a two-word phrase, such as “Mama eat,” “Daddy play,” “Go home,” or “What’s this?” does your child say both words back to you? (Mark “yes” even if their words are difficult to understand.)
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Yes
Sometimes
Not yet
Without your showing them, does your child point to the correct picture when you say, “Show me the kitty,” or ask, “Where is the dog?” (They need to identify only one picture correctly.)
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Yes
Sometimes
Not yet
Does your child say two or three words that represent different ideas together, such as “See dog,” “Mommy come home,” or “Kitty gone”? (Don’t count word combinations that express one idea, such as “bye-bye,” “all gone,” “all right,” and “What’s that?”)
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Yes
Sometimes
Not yet
Score For Communication Section
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Gross Motor
Does your child bend over or squat to pick up an object from the floor and then stand up again without any support?
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Yes
Sometimes
Not yet
Does your child move around by walking, rather than by crawling on their hands and knees?
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Yes
Sometimes
Not yet
Does your child walk well and seldom fall?
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Yes
Sometimes
Not yet
Does your child climb on an object such as a chair to reach something they want (for example, to get a toy on a counter or to “help” you in the kitchen)?
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Yes
Sometimes
Not yet
Does your child walk down stairs if you hold onto one of their hands? They may also hold onto the railing or wall. (You can look for this at a store, on a playground, or at home.)
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Yes
Sometimes
Not yet
When you show your child how to kick a large ball, do they try to kick the ball by moving their leg forward or by walking in to it? (If your child already kicks a ball, mark “yes” for this item.)
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Yes
Sometimes
Not yet
Score For Gross Motor Section
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Fine Motor
Does your child throw a small ball with a forward arm motion? (If they simply drops the ball, mark “not yet” for this item.)
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Yes
Sometimes
Not yet
Does your child stack a small block or toy on top of another one? (You could also use spools of thread, small boxes, or toys that are about 1 inch in size.)
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Yes
Sometimes
Not yet
Does your child make a mark on the paper with the tip of a crayon (or pencil or pen) when trying to draw?
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Yes
Sometimes
Not yet
Does your child stack three small blocks or toys on top of each other by themself?
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Yes
Sometimes
Not yet
Does your child turn the pages of a book by themself? (They may turn more than one page at a time.)
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Yes
Sometimes
Not yet
Does your child get a spoon into their mouth right side up so that the food usually doesn’t spill?
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Yes
Sometimes
Not yet
Score for Fine Motor section
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Problem Solving
Does your child drop several small toys, one after another, into a container like a bowl or box? (You may show them how to do it.)
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Yes
Sometimes
Not yet
After you have shown your child how, do they try to get a small toy that is slightly out of reach by using a spoon, stick, or similar tool?
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Yes
Sometimes
Not yet
After a crumb or Cheerio is dropped into a small, clear bottle, does your child turn the bottle over to dump it out? (You may show them how.) (You can use a soda pop bottle or a baby bottle.)
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Yes
Sometimes
Not yet
Without your showing them how, does your child scribble back and forth when you give her a crayon (or pencil or pen)?
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Yes
Sometimes
Not yet
After watching you draw a line from the top of the paper to the bottom with a crayon (or pencil or pen), does your child copy you by drawing a single line on the paper in any direction? (Mark “not yet” if your child scribbles back and forth.)
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Yes
Sometimes
Not yet
After a crumb or Cheerio is dropped into a small, clear bottle, does your child turn the bottle upside down to dump out the crumb or Cheerio? (Do not show them how.)
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Yes
Sometimes
Not yet
Score for Problem Solving Section
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Personal-Social
While looking at themself in the mirror, does your child offer a toy to their own image?
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Yes
Sometimes
Not yet
Does your child come to you when they need help, such as with winding up a toy or unscrewing a lid from a jar?
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Yes
Sometimes
Not yet
Does your baby play with a doll or stuffed animal by hugging it?
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Yes
Sometimes
Not yet
While looking at themself in the mirror, does your child offer a toy to their own image?
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Yes
Sometimes
Not yet
Does your child get your attention or try to show you something by pulling on your hand or clothes?
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Yes
Sometimes
Not yet
Does your child copy the activities you do, such as wipe up a spill, sweep, shave, or comb hair?
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Yes
Sometimes
Not yet
Score for Personal-Social section
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Overall
Do you think your child hears well?
If yes, leave blank. If no, explain.
Do you think your child talks like other toddlers their age?
If yes, leave blank. If no, explain.
Can you understand most of what your child says?
If yes, leave blank. If no, explain.
Does either parent have a family history of childhood deafness or hearing impairment?
If no, leave blank. If yes, explain.
Do you have concerns about your child’s vision?
If no, leave blank. If yes, explain.
Do you have any concerns about your toddler's behavior?
If no, leave blank. If yes, explain.
Has your baby had any medical problems in the last several months?
If no, leave blank. If yes, explain.
Do you have any concerns about your toddler's behavior?
If no, leave blank. If yes, explain.
Does anything about your toddler worry you?
If no, leave blank. If yes, explain.
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