CSBS DP Infant-Toddler Checklist

Childs name: Date of birth: Date filled out:

Was birth premature? If yes, how many weeks premature?

Filled out by: Relationship to child:

Instructions for caregivers: This Checklist is designed to identify different aspects of development in infants and toddlers. Many
behaviors that develop before children talk may indicate whether or not a child will have difficulty learning to talk. This Checklist
should be completed by a caregiver when the child is between 6 and 24 months of age to determine whether a referral for an
evaluation is needed. The caregiver may be either a parent or another person who nurtures the child daily. Please check all the choic-
es that best describe your childs behavior. If you are not sure, please choose the closest response based on your experience. Children
at your childs age are not necessarily expected to use all the behaviors listed.
Emotion and Eye Gaze
1. Do you know when your child is happy and when your child is upset?  Not Yet  Sometimes  Often
2. When your child plays with toys, does he/she look at you to see if you are watching?  Not Yet  Sometimes  Often
3. Does your child smile or laugh while looking at you?  Not Yet  Sometimes  Often
4. When you look at and point to a toy across the room, does your child look at it?  Not Yet  Sometimes  Often
Communication
5. Does your child let you know that he/she needs help or wants an object out of reach?  Not Yet  Sometimes  Often
6. When you are not paying attention to your child, does he/she try to get your
attention?  Not Yet  Sometimes  Often
7. Does your child do things just to get you to laugh?  Not Yet  Sometimes  Often
8. Does your child try to get you to notice interesting objectsjust to get you to look
at the objects, not to get you to do anything with them?  Not Yet  Sometimes  Often
Gestures
9. Does your child pick up objects and give them to you?  Not Yet  Sometimes  Often
10. Does your child show objects to you without giving you the object?  Not Yet  Sometimes  Often
11. Does your child wave to greet people?  Not Yet  Sometimes  Often
12. Does your child point to objects?  Not Yet  Sometimes  Often
13. Does your child nod his/her head to indicate yes?  Not Yet  Sometimes  Often
Sounds
14. Does your child use sounds or words to get attention or help?  Not Yet  Sometimes  Often
15. Does your child string sounds together, such as uh oh, mama, gaga, bye bye, bada?  Not Yet  Sometimes  Often
16. About how many of the following consonant sounds does your child use:
ma, na, ba, da, ga, wa, la, ya, sa, sha?  None  12  34  58  over 8
Words
17. About how many different words does your child use meaningfully
that you recognize (such as baba for bottle; gaggie for doggie)?  None  13  410  1130  over 30
18. Does your child put two words together (for example, more cookie, bye bye Daddy)?  Not Yet  Sometimes  Often
Understanding
19. When you call your childs name, does he/she respond by looking
or turning toward you?  Not Yet  Sometimes  Often
20. About how many different words or phrases does your child under-
stand without gestures? For example, if you say wheres your
tummy, wheres Daddy, give me the ball, or come here, without
showing or pointing, your child will respond appropriately.  None  13  410  1130  over 30
Object Use
21. Does your child show interest in playing with a variety of objects?  Not Yet  Sometimes  Often
22. About how many of the following objects does your child use appropriately:
cup, bottle, bowl, spoon, comb or brush, toothbrush, washcloth,
ball, toy vehicle, toy telephone?  None  12  34  58  over 8
23. About how many blocks (or rings) does your child stack? Stacks  None  2 blocks  34 blocks  5 or more
24. Does your child pretend to play with toys (for example, feed a
stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?  Not Yet  Sometimes  Often

Do you have any concerns about your childs development?  yes  no If yes, please describe on back.
Communication and Symbolic Behavior Scales Developmental Profile by Amy M. Wetherby & Barry M. Prizant
2002 by Paul H. Brookes Publishing Co., Inc. All rights reserved.
CSBS DP 3/26/03 2:08 PM Page 2

CSBS DP Infant-Toddler Checklist

Was birth premature? If yes, how many weeks premature?

Filled out by: Relationship to child:

Instructions for caregivers: This Checklist is designed to identify different aspects of development in infants and toddlers. Many
behaviors that develop before children talk may indicate whether or not a child will have difficulty learning to talk. This Checklist
should be completed by a caregiver when the child is between 6 and 24 months of age to determine whether a referral for an
evaluation is needed. The caregiver may be either a parent or another person who nurtures the child daily. Please check all the choic-
es that best describe your childs behavior. If you are not sure, please choose the closest response based on your experience. Children
at your childs age are not necessarily expected to use all the behaviors listed.
Emotion and Eye Gaze
1. Do you know when your child is happy and when your child is upset?
Not Yet
Sometimes
Often
2. When your child plays with toys, does he/she look at you to see if you are watching?
Not Yet
Sometimes
Often
3. Does your child smile or laugh while looking at you?
Not Yet
Sometimes
Often
4. When you look at and point to a toy across the room, does your child look at it?
Not Yet
Sometimes
Often
Communication
5. Does your child let you know that he/she needs help or wants an object out of reach?
Not Yet
Sometimes
Often
6. When you are not paying attention to your child, does he/she try to get your attention?
Not Yet
Sometimes
Often
7. Does your child do things just to get you to laugh?
Not Yet
Sometimes
Often
8. Does your child try to get you to notice interesting objectsjust to get you to look
at the objects, not to get you to do anything with them?
Not Yet
Sometimes
Often
Gestures
9. Does your child pick up objects and give them to you?
Not Yet
Sometimes
Often
10. Does your child show objects to you without giving you the object?
Not Yet
Sometimes
Often
11. Does your child wave to greet people?
Not Yet
Sometimes
Often
12. Does your child point to objects?
Not Yet
Sometimes
Often
13. Does your child nod his/her head to indicate yes?
Not Yet
Sometimes
Often
Sounds
14. Does your child use sounds or words to get attention or help?
Not Yet
Sometimes
Often
15. Does your child string sounds together, such as uh oh, mama, gaga, bye bye, bada?
Not Yet
Sometimes
Often
16. About how many of the following consonant sounds does your child use:
ma, na, ba, da, ga, wa, la, ya, sa, sha?
None
12
34
58
over 8
Words
17. About how many different words does your child use meaningfully
that you recognize (such as baba for bottle; gaggie for doggie)?
None
13
410
1130
over 30
18. Does your child put two words together (for example, more cookie, bye bye Daddy)?
Not Yet
Sometimes
Often
Understanding
19. When you call your childs name, does he/she respond by looking
or turning toward you?
Not Yet
Sometimes
Often
20. About how many different words or phrases does your child under-
stand without gestures? For example, if you say wheres your
tummy, wheres Daddy, give me the ball, or come here, without
showing or pointing, your child will respond appropriately.
None
13
410
1130
over 30
Object Use
21. Does your child show interest in playing with a variety of objects?
Not Yet
Sometimes
Often
22. About how many of the following objects does your child use appropriately:
cup, bottle, bowl, spoon, comb or brush, toothbrush, washcloth,
ball, toy vehicle, toy telephone?
None
12
34
58
over 8
23. About how many blocks (or rings) does your child stack? Stacks
None
2 blocks
34 blocks
5 or more
24. Does your child pretend to play with toys (for example, feed a
stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?
Not Yet
Sometimes
Often

Do you have any concerns about your childs development?
yes
no If yes, please describe on back.

Amy M. Wetherby & Barry M. Prizant 2002 by Paul H. Brookes Publishing Co., Inc. All rights reserved.
For ordering information on all components of the CSBS DP, visit www.brookespublishing.com/csbsdp.
CSBS DP 3/26/03 2:08 PM Page 3

CSBS DP Infant-Toddler Checklist: Screening Report

Childs name: Date filled out:

Date of birth:

Chronological age1:

1Ifchild is 4 or more weeks premature, use corrected age. Calculate chronological age by subtracting Date of birth from Date the
Checklist was filled out.

Checklist Results
Standard Percentile
Predictor Raw Score Scorea,b Rankb Concernc
Emotion and Eye Gaze

Communication

Gestures
SOCIAL COMPOSITE

Sounds

Words
SPEECH COMPOSITE

Understanding

Object Use
SYMBOLIC COMPOSITE

TOTAL

a The standard scores are based on a mean of 10 and SD of 3 for the Composite Scores and a mean of 100 and SD of 15 for
the Total Score. (Refer to the CSBS DP Manual, First Normed Edition, for standard scores and tables of norms.)
b Criterion levels for concern are set at more than 1.25 SD below the mean as follows: Standard Scores at or below 6 for the
Composite Scores and 81 for the Total Score; Percentiles at or below 10. (Refer to the CSBS DP Manual, First Normed Edition, for stan-
dard scores, percentiles, and tables of norms.)
c After filling in Standard Score and Percentile Rank, if below criterion level, write Yes in the Concern box. If at or above crite-
rion level, leave blank. A child should be referred for an evaluation if the Social Composite, Symbolic Composite, or the Total Score is
below criterion level. A child should be monitored carefully if the Speech Composite is below criterion level; administer a Checklist
again in 3 months, and if the childs scores remain below criterion level, refer for a developmental evaluation.

Recommendation
Based on the information provided on the Infant-Toddler Checklist and the results shown above, the following recom-
mendation is made at this time (check one):

This child currently communicates as expected for his or her age. Because new skills are emerging
each month, it is important to monitor this childs development by asking the childs caregiver to
complete the Checklist again in 3 months.

This child should be carefully monitored. Re-administer the Checklist in 3 months to determine if a
developmental evaluation will become advisable.

This child should be referred for a developmental evaluation.

Amy M. Wetherby & Barry M. Prizant 2002 by Paul H. Brookes Publishing Co., Inc. All rights reserved.
For ordering information on all components of the CSBS DP, visit www.brookespublishing.com/csbsdp.