April 20, 202115-18 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. 16.5 months) [Physical Developmental Skills] My child can walk and stop self without falling. Yes No [Physical Developmental Skills] My child can walk up and down steps with a railing or a hand being held. Yes No [Physical Developmental Skills] My child is starting to run. Yes No [Physical Developmental Skills] My child climbs on furniture and up couches and chairs. Yes No [Physical Developmental Skills] My child can walk both forward and backward. Yes No 1 out of 3 [Occupational Developmental Skills] My child can build a 4 block tower. Yes No [Occupational Developmental Skills] My child is starting to mark and scribble. Yes No [Occupational Developmental Skills] My child is starting to participate in imaginative play. (A spoon is an airplane) Yes No [Occupational Developmental Skills] My child pushes their arms and legs through holes when dressing. Yes No [Occupational Developmental Skills] My child is interested in their image in the mirror. Yes No [Occupational Developmental Skills] My child can follow simple 1-step commands. Yes No 2 out of 3 [Speech Developmental Skills] My child can point to body parts when asked. Yes No [Speech Developmental Skills] My child is using at least 10 words and gestures to communicate. Yes No [Speech Developmental Skills] My child at times uses 1 word to convey an entire thought. Yes No [Speech Developmental Skills] My child adds more words each month to their vocabulary. 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. 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
