Developmental Screening Tool

Developmental Screening
Child's Name

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Child's Date of Birth*

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Today's Date

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Age*
Gender

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Questions or concerns regarding your child's development

Developmental Screening

This interactive screening was developed for children 6 years and under. But don't worry, we can provide services and support to children of ALL ages! Give our office a call 318-775-4164 to set up a free consultation or in person screening for any children older than age 6.

Thanks for using our developmental screening tool.

We will contact you within 48 hours to go over your screening results.
Should be Empty:

	Yes	No
Smiles back at you
Enjoys playing "peek-a-boo"
Turns his/her head towards a familiar voice
Produces a variety of facial expressions (e.g., happy, sad)
Squeals and babbles
Holds onto rattle when placed in his/her hands
Explores toys with his/her mouth
Drinks from the bottle or breast with no coughing or choking
Calms down when spoken to by familiar voice

	Yes	No
Turns head in response to his/her name
Enjoys listening to songs and nursery rhymes
Explores objects and toys with intent
Plays games like "peek-a-boo" and "pat-a-cake"
Shakes and bangs toys
Imitates simple actions and/or facial expressions
Understands "no"
Coos and squeals for attention
Waves bye-bye and claps
Imitates sounds like "mama" and "dada"
Voluntarily releases objects/toys from his/her hand
Picks up small things with finger and thumb
Recognizes and anticipates food
Self feeds finger foods
Often refuses foods other kids typically eat at daycare and/or school
Eats a variety of textures without difficulty
Drinks from a cup with minimal loss of liquid
Explores different textures (e.g., smooth, rough, wet) with hands and feet without difficulty

	Yes	No
Initiates affection
Uses a toy for its function (e.g., pushes a car)
Engages in simple pretend play (e.g., pretends to drink from a cup)
Understands simple commands (e.g., find the ball)
Gains your attention by vocalizing or pointing
Points to pictures or objects
Uses at least 5+ words
Waves bye-bye and claps
Releases objects into a small container
Stacks 2-3 blocks
Correctly places 1-2 pieces into a knob puzzle
Uses his/her fist to hold a crayon
Pulls off socks and shoes with assistance
Brings spoon to mouth to feed self with minimal spillage
Can easily bite through through a hard, crunchy snack
Often refuses foods other kids typically eat at daycare and/or school
Walks independently
Has an unusual sensitivity to lights, sounds, movement, and/or touch
Handles small changes in routines without melting down
Explores different textures (e.g., smooth, rough, wet) with hands and feet without difficulty

	Yes	No
Combining objects during play (e.g., using a spoon to scoop from a bowl and feed the baby)
Understands and follows simple directions
Understands concepts in and on
Identifies basic body parts (eyes, nose, mouth)
Points and uses words to communicate with you
Makes sounds during play (e.g., animal sounds "moo," environmental sounds "beep"")
Consistently imitates new words
Uses pronouns (my, mine)
Uses simple phrases like "more milk"
Uses at least 50 words at 2 and/or at least 10 words at 18 months
Speech is understood by listeners at least 25% (18 months)-50% (24 months) of the time
Imitates a vertical line using a pencil or crayon
Uses scissors to snip, making at least one cut
Independently pulls his/her pants down
Drinks independently from a cup
Eats a variety of textures without difficulty
Often refuses foods other kids typically eat at daycare and/or school
Climbs stairs with support
Has unusual sensitivity to lights, sounds, movement, and/or touch

	Yes	No
Shows early empathy and responds to others' emotions
Plays make-believe games
Follows two-step instructions such as "get your shoes and take them to daddy"
Understands concepts like in and out
Frequently uses 2 word phrases
Asks simple questions "eat cookie?"
Uses 100 (or more) words
Has a word for all familiar objects, toys, foods, etc.
Uses pronouns (I, you, my, me)
Answers simple what and where questions
Uses action words like "eating" and "sleeping"
Recognizes and and names colors
Understood by listeners 50% of the time
Uses scissors to snip paper
Matches and sorts most shapes and colors
Holds a crayon or pencil between fingers and thumb (not a fist)
Completes simple puzzles
Builds a tower of 4 or more blocks
Indicates when wet and soiled
Can take off socks and shoes
Takes off elastic waisted pants without help
Cleans up toys with help
Feeds self most foods independently
Often refuses foods other kids typically eat at daycare and/or school
Drinks independently from an open cup
Eats table foods with different textures
Has unusual sensitivity to lights, sounds, movement, and/or touch

	Yes	No
Shows empathy and responds to others' emotions
Is creative in their play activities (e.g., pretending to be a doctor and giving a "shot" with a stick)
Follows three-step instructions (such as get your car, put it in the basket, and come here)
Understands concepts like big and small
Speaks in full sentences
Engages in full conversations with others
Uses about 1,000 words
Has a word for almost everything
Uses pronouns (she, he, we)
Answers simple what and where questions
Uses action words like "eating" and "sleeping"
Recognizes and and names colors
Understands concepts like "some" and "all"
Asks what were and why questions
Holds scissors and snips paper
Understood by unfamiliar people most of the time
Completes simple puzzles
Matches shapes or objects
Holds a crayon or pencil between fingers and thumb (not a fist)
Copies a circle using a pencil or crayon
Can use scissors to cut along a straight line
Indicates when wet and soiled
Can take off and put on a t-shirt independently
Washes and dries hands well
Can take off and put on socks and shoes (excluding fasteners)
Can take off and put on elastic waisted pants
Feeds self with spoon and fork
Drinks from an open cup without support or spilling
Chews and swallows most adult foods
Often refuses foods other kids typically eat at daycare and/or school
Has unusual sensitivity to lights, sounds, movement, and/or touch

	Yes	No
Participates in dramatic play
Plays cooperatively with peers
Prefers to play with others
Follows multi-step instructions
Understands concepts behind, in front
Understands concepts same and different
Understands "when," "why," and "how"
Carries on entire conversations
Uses 1,000+ words
Speaks in 4+ word sentences
Answers what and where and who questions
Answers why and what if questions
Asks questions frequently (Mommy, why is it raining?)
Uses pronouns (they, them)
Talks about something that happened previously in their day
Speaks clearly
Uses a pencil to copy a square
Uses scissors to cut out a circle
Grasps marker with their thumb and pad of index finger
Dresses him/herself (excluding fasteners)
Can unbutton some buttons
Independently uses the toilet
Washes and dries hands well
Chews and swallows most adult food including raw veggies and steak
Often refuses foods other kids typically eat at daycare and/or school
Has unusual sensitivity to lights, sounds, movement, and/or touch

	Yes	No
Plays cooperatively with peers
Takes turns during play activities
Shows empathy towards others
Understands most of what is said to him/her
Understands sequential concepts first, middle, and last
Follows multi-step instructions
Answers simple questions following a story
Tells a story that has at least two events
Talks about something that happened previously in their day
Can list items in different categories
Uses 4 and 5+ word sentences
Uses sentences with many details
Speaks very clearly and is understood by unfamiliar listeners
Recognizes simple rhymes
Writes some letters in his/her name
Holds a marker between their thumb and pad of index finger with the marker resting on their middle finger
Uses scissors to cut a circle and square
Colors within the lines when instructed
Can open most fasteners
Puts shoes on correct feet
Helps with chores
Brushes teeth independently
Can bathe and dry self off with minimal help
Chews and swallows most adult food including raw veggies and steak
Often refuses foods other kids typically eat at daycare and/or school
Has strong outbursts of intense anger or frustration
Has unusual sensitivity to lights, sounds, movement, and/or touch
Excessive movement and difficulty staying still and on task

	Yes	No
Plays cooperatively with peers
Understands humor
Understands rhyming
Understands right and left?
Uses a variety of sentences
Asks questions to get more information
Describes objects
Formulates meaningful, grammatically correct sentences
Tells stories with a plot
Uses most speech sounds correctly
Understood by listeners 100% of the time
Recognizes and reads simple words
Holds a crayon or pencil with a tripod grip
Copies a few letters of the alphabet
Uses scissors to cut complex shapes
Writes numbers 1-10
Independently completes all dressing tasks
Can independently fasten all types of clothing fasteners
Can bathe and dry self off with minimal help
Independently completes all parts of toileting including wiping
Chews and swallows most adult food including raw veggies and steak
Often refuses foods other kids typically eat at daycare and/or school
Has unusual sensitivity to lights, sounds, movement, and/or touch
Has strong outbursts of intense anger or frustration
Excessive movement and difficulty staying still and on task

Developmental Screening

Developmental Screening

Thanks for using our developmental screening tool.