Early Development and Background

Early Development and Background
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Early Development and Home Background (EDHB) Form-Parent/Guardian
Questions P1-P19 ask about the early development and early and current home experiences of yourchild.Some questions require that you think as far back as to the birth of your child. Your response to these questions will help your child's clinician better understand and care for your child. Answer each question to the best of your knowledge or memory.
What is your relationship to the child receiving care?*
Early Development
P1. Was he/she born before he/she was due (premature)?*
P2. Were the doctors worried about his/her medical condition immediately after he/she was born?*
P3. Did he/she have to spend any time in a neonatal intensive care unit (NICU)?*
P4. Could he/she walk on his/her own by the age of18 months?*
P5. Has he/she ever had a seizure?*
P6. Did he/she ever lose consciousness for more than a few minutes after an accident?*
Early Communication

Early Development & Background
P7. By the time he/she was age 2, could he/she put several words together when speaking?*
P8. Could people who didn't know him/her understand his/her speech by the time he/she reached age 4?*
P9. Have you ever been concerned about his/her hearing or eyesight?*
P10.By the time he/she was age4, was he/she interested in playing with or being with other children?*
Home Environment
P11. Was there ever a time when he/she could not live at home and someone else had to look after him/her?*
P12. Has he/she ever been admitted to the hospital for a serious illness?*
P13. Does anyone at home suffer from a serious health problem?*
P14. Does anyone at home have a problem with depression?*
P15. Does anyone at home regularly see a counselor, therapist, or other mental health professional?*
Early Development and Background
P16. Does anyone at home have a problem with alcohol, drugs, or other substances?*
P17. Would you say that the atmosphere at home is usually pretty calm?*
P18. How often are there fights or arguments between people at home?*
P19. How often does your child get criticized to his/her face by other family members when he/she is at home?*
Reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. TM Copyright ©2013 American Psychiatric Association. All Rights Reserved. Unless authorized in writing by the APA, no part may be reproduced or used in a manner inconsistent with the APA's copyright. This prohibition applies to unauthorized uses or reproduction in any form. The American Psychiatric Association is not affiliated with and is not endorsing this product.
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Early Development and Background

Early Development and Home Background (EDHB) Form-Parent/Guardian

Early Development

Early Communication

Home Environment

Early Development and Background