April 20, 202112-15 Months – Developmental Questionnaire This quiz should take a maximum of 5 minutes. The final question will allow you to add comments for any questions you have not discussed or covered in the quiz. Depending on the child’s age within the range, answering “NO” isn’t necessarily a cause for concern. The difference between a 2 week old and a 2-month-old is significant. With that in mind, we will ask about your child's birthday and have a specialist look over your responses. We are happy to reach out to you if there's anything we see that the computer may have overlooked. First Name Last Name Zip Code Your Email Phone Number w/ Area Code Child's Age (e.g. 14.5 months) [Physical Developmental Skills] My child can lower themselves to sitting without support Yes No [Physical Developmental Skills] My child is starting to take steps for at least 5 steps Yes No [Physical Developmental Skills] My child can squat to retrieve objects without losing balance Yes No [Physical Developmental Skills] My child will imitate me by rolling balls and throwing objects. Yes No [Physical Developmental Skills] My child can crawl up and downstairs. Yes No 1 out of 3 [Occupational Developmental Skills] My child can put objects in containers and take them out. Yes No [Occupational Developmental Skills] My child can help me with cleaning up by putting toys into containers. Yes No [Occupational Developmental Skills] My child is often interested in opening and closing things. Yes No [Occupational Developmental Skills] My child likes to play with and explore objects with all different textures. Yes No [Occupational Developmental Skills] My child is starting to play with toys in functional way. (Holds phone to ear, feeds doll with a spoon or bottle, etc.) Yes No [Occupational Developmental Skills] My child tries to assist with dressing by pulling off socks, hats, or gloves. Yes No [Occupational Developmental Skills] My child can feed themselves with utensils with some spills. Yes No [Occupational Developmental Skills] My child sometimes resists naps and throws tantrums. Yes No [Occupational Developmental Skills] My child can complete a simple 3 piece puzzle. Yes No 2 out of 3 [Speech Developmental Skills] My child has at least 1-2 words. Yes No [Speech Developmental Skills] My child adds more words each month to their vocabulary. Yes No [Speech Developmental Skills] When asked my child can point to some body parts. Yes No [Speech Developmental Skills] My child can follow simple directions. (kick the ball) Yes No [Speech Developmental Skills] My child can listen and show interest in books and music. Yes No [Speech Developmental Skills] My child is starting to point at objects in books when named (animals, toys, etc.). Yes No [Speech Developmental Skills] My child smiles at peek-a-boo. Yes No [Speech Developmental Skills] My child recognizes commonly used words. (bottle or juice) Yes No [Speech Developmental Skills] My child listens when spoken to. Yes No [Speech Developmental Skills] My child turns head and points towards interesting sounds. Yes No 3 out of 3 Please fill in the comment box below. Time's up
