April 20, 20212-4 Years – 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. [Physical Developmental Skills] My child can walk up and downstairs independently Yes No [Physical Developmental Skills] My child can run well. Yes No [Physical Developmental Skills] My child can catch a large ball. Yes No [Physical Developmental Skills] My child can walk up and down stairs with alternating feet. Yes No [Physical Developmental Skills] My child can stand on their tiptoes. Yes No [Physical Developmental Skills] My child can stand on one foot for 3-5 seconds Yes No [Physical Developmental Skills] My child can ride a tricycle. Yes No [Physical Developmental Skills] My child can jump forward, over, and off objects with 2 footed take off and landing Yes No 1 out of 3 [Occupational Developmental Skills] My child can build a tower with 6-10 blocks. Yes No [Occupational Developmental Skills] My child can unscrew loose lids on jars. Yes No [Occupational Developmental Skills] My child can snip with scissors. Yes No [Occupational Developmental Skills] My child can draw a vertical line. Yes No [Occupational Developmental Skills] My child can draw a horizontal line. Yes No [Occupational Developmental Skills] My child can draw a circle. Yes No [Occupational Developmental Skills] My child can easily play next to other kids. Yes No [Occupational Developmental Skills] My child can pull on shoes and take them off. Yes No [Occupational Developmental Skills] My child can use a fork and a spoon. Yes No [Occupational Developmental Skills] My child is starting to help with tooth brushing and hair brushing. Yes No [Occupational Developmental Skills] My child draws people with at least a head and legs. Yes No [Occupational Developmental Skills] My child can take turns with a peer. Yes No 2 out of 3 [Speech Developmental Skills] My child can put things in/on/up/or down with simple commands. Yes No [Speech Developmental Skills] My child can touch their nose when asked and not shown. Yes No [Speech Developmental Skills] My child can raise their hand when asked and not shown. Yes No [Speech Developmental Skills] My child can listen and attend to full books and longer stories. Yes No [Speech Developmental Skills] My child has 300-1000 words in their vocabulary. Yes No [Speech Developmental Skills] My child talks in 2-4+ word phrases. Yes No [Speech Developmental Skills] My child can label their age, name, and gender. Yes No [Speech Developmental Skills] My child knows basic colors. Yes No [Speech Developmental Skills] My child knows basic shapes. Yes No [Speech Developmental Skills] My child recognizes labels for family members. (Where is mom?) Yes No 3 out of 3 Please fill in the comment box below. First Name Last Nae Zip Code Your Email Phone Number w/ Area Code Child's Age (e.g. 3 years, 2 months) Time's up
