skip Ages & Stages Questionnaires : A Parent Completed, Child-Monitoring System
Development Check for Children Ages Birth to 5 Years
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Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
       
Communication
*Be sure to try each activity with your child

Yes

Sometimes

Not Yet
         
1.
 Does your child name at least three items from a common category? For example, if you say to your child "Tell me some things that you can eat," does your child answer with something like "Cookies, eggs, and cereal"? Of if you say, "Tell me the names of animals," does your child answer with something like, "Cow, dog, and elephant"?
 
2.
 Does your child answer the following questions:

a. "What do you do when you are hungry?" (Acceptable answers include: "Get food," "Eat," "Ask for something to eat," and "Have a snack.")

Please write your child's response:


b. "What do you do when you are tired?" (Acceptable answers include: "Take a nap," "Rest," "Go to sleep," "Go to bed," "Lie down," and "Sit down,")

Please write your child's response:
 
3.
 Does your child tell you at least two things about common objects? For example, if you say to your child, "Tell me about your ball," does he say something like, "It's round, I throw it. It's big"?
 
4.
 Does your child use endings of words such as "s," "ed," and "ing"? For example, does your child say things like, "I see two cats," "I am playing," or "I kicked the ball"?
 
5.
 Without giving help by pointing or repeating, does your child follow three directions that are unrelated to one another? For example, you may ask your child to "Clap your hands, walk to the door, and sit down."
 
6.
 Does your child use all the word in a sentence (for example, "a," "the," "am, " "is," and "are") to make complete sentences, such as "I am going to the park," or "Is there a toy to play with?" or "Are you coming, too?"
 

Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
       
Gross Motor
*Be sure to try each activity with your child

Yes

Sometimes

Not Yet
         
1.
 Does your child catch a large ball with both hands? You should stand about 5 feet away and give your child two or three tries.
 
2.
 Does your child climb the rungs of a ladder of a playground slide and slide down without help?
 
3.
 While standing, does your child throw a ball overhand in the direction of a person standing at least 6 feet away? To throw overhand, your child must raise her arm to shoulder height and throw the ball forward. (Dropping the ball, letting the ball go, or throwing the ball underhand should be scored as "not yet.")
 
4.
 Does your child hop up and down on either the right or left foot at least one time without losing his balance or falling?
 
5.
 Does your child jump forward a distance of 20 inches from a standing position, starting with her feet together?
 
6.
 Without holding onto anything, does your child stand on one foot for at least 5 seconds without losing his balance and putting his foot down? You may give your child two or three tries before you mark the question.
 

Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
       
Fine Motor
*Be sure to try each activity with your child

Yes

Sometimes

Not Yet
         
1.
 Does your child put together a six-piece interlocking puzzle? (If one is not available, take a full-page picture from a magazine or catalog and cut it into six pieces. Does your child put it back together correctly?)
 
2.
 Using child-safe scissors, does your child cut a paper in half on a more or less straight line, making the blades go up and down? (Carefully watch your child's use of scissors for safety reasons.)
 
3.
 Using the shapes below to look at, does your child copy at least three shapes onto a large piece of paper using a pencil or crayon, without tracing? Your child's drawing should look similar to the design of the shapes below, but they may be different in size.
 
4.
 Does your child unbutton one or more buttons? Your child may use his own clothing or a doll's clothing.
 
5.
 Does your child draw pictures of people that have at least three of the following features: head, eyes, nose, mouth, neck, hair, trunk, arms, hands, legs, or feet?
 
6.
 Does your child color mostly within the lines in a coloring book?
Your child should not go more than 1/4 inch outside the lines on most
of the picture.
 

Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
       
Problem Solving
*Be sure to try each activity with your child

Yes

Sometimes

Not Yet
         
1.
 When you say, "Say five eight three," does your child repeat just the three numbers in the correct order? Do not repeat the numbers. If necessary, try another series of numbers and say "Say six nine two." Your child must repeat just one series of three numbers for you to answer "yes" to this question.
 
2.
 When asked, "Which circle is the smallest?" does your child point to the smallest circle? Ask this question without providing help by pointing, gesturing, or looking at the smallest circle.
 
3.
 Without giving help by pointing, does your child follow three different directions using the words "under," "between," and "middle"? For example, ask your child to put a book "under the coach," Then as her to put the ball "between the chairs" and the shoe "in the middle of the table."
 
4.
 When shown an object and asked, "What color is this?" does your child name five different colors like red, blue, yellow, orange, black, white, or pink? Answer "yes" only if your child answers the question correctly using five colors.
 
5.
 Does your child dress up and "play-act," pretending to be someone or something else? For example, your child may dress up in different clothes and pretend to be a mommy, daddy, brother or sister, or an imaginary animal or figure.
 
6.
 If you place five objects in front of your child, can he count them saying, "One, two, three, four, five," in order? Ask this question without providing help by pointing, gesturing, or naming.
 

Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
       
Personal-Social
*Be sure to try each activity with your child

Yes

Sometimes

Not Yet
         
1.
 Does your child serve herself, taking food from one container to another using utensils? For example, can your child use a large spoon to scoop applesauce from a jar to a bowl?
 
2.
 Does your child tell you at least four of the following:
a. First name
b. Age
c. City she lives in		 d. Last name
e. Boy or girl
f. Telephone number
 
3.
 Does your child wash his hands and face using soap and dry off with a towel without help?
 
4.
 Does your child tell you the names of two or more playmates, not including brothers or sisters? Ask this question without providing help by suggesting names of playmates or friends.
 
5.
 Does your child brush her teeth by putting toothpaste on the toothbrush and brushing all her teeth without help? You may still need to check and rebrush your child's teeth.
 
6.
 Does your child dress or undress himself without help (except for snaps, buttons, and zippers)?
 

Ages & Stages Questionnaire: A Parent Completed Child Monitoring System
48 Month Questionnaire
     
Overall
*Be sure to try each activity with your child

Yes

No
       
1.
 Do you think your child hears well?
If no, explain:
 
2.
 Do you think your child talks like other toddlers his age?
If no, explain:
 
3.
 Can you understand most of what your child says?
If no, explain:
 
4.
 Do you think your child walks, runs, and climbs like other toddlers her age
If no, explain:
 
5.
 Does either parent have a family history of childhood deafness or hearing impairment?
if yes, explain:
 
6.
 Has your child had any medical problems in the last several months?
If yes, explain:
       
  Does any thing about your child worry you?
If yes, explain:
 

If you have any questions or comments related to this site or have any technical difficulty please contact Kimberly Murphy at kamurphy@uoregon.edu
Ages & Stages Questionnaires : A Parent Completed, Child-Monitoring System
By Diane Bricker and Jane Squires
with assistance from Linda Mounts, LaWanda Potter, Robert Nickel, Elizabeth Twombly, and Jane Farrell
Copyright © 1999 by Paul H. Brookes Publishing Co.