April 20, 202118-24 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. 19 months) [Physical Developmental Skills] My child is mostly stable when they walk. Yes No [Physical Developmental Skills] My child can get self seated in a small chair. Yes No [Physical Developmental Skills] My child can throw a ball. Yes No 1 out of 3 [Occupational Developmental Skills] My child can scribble. Yes No [Occupational Developmental Skills] My child put small objects in small places. (Pegs into a peg board) Yes No [Occupational Developmental Skills] My child understands different types of touches. (Gentle vs. roughhousing) Yes No [Occupational Developmental Skills] My child tolerates different textures of clothing. (Jeans, sweats, leggings, etc.) Yes No [Occupational Developmental Skills] My child can play while next to another similar aged child. Yes No [Occupational Developmental Skills] My child can play alone or with another person for up to 15 minutes and remain focused on play. Yes No [Occupational Developmental Skills] My child can feed self with a spoon without much spilling. Yes No [Occupational Developmental Skills] My child undresses themselves in simple pull up clothing. Yes No [Occupational Developmental Skills] My child drinks from a cup. Yes No [Occupational Developmental Skills] My child is displaying most basic emotions. Yes No [Occupational Developmental Skills] My child has a favorite toy, object, or stuffed animal. Yes No 2 out of 3 [Speech Developmental Skills] My child knows body parts. Yes No [Speech Developmental Skills] My child can follow 2 step commands. Yes No [Speech Developmental Skills] My child has at least 50 words. Yes No [Speech Developmental Skills] My child adds more words each month to their vocabulary. 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 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
