18 Month – 1.5 Year 6.

Does your child say two or three words that    __

Developmental Questionnaire represent different ideas together, such as

SOMETIMES
nd
Ages & Stages Questionnaires (2 Edition) “See dog,” “Mommy come home,” or “Kitty

NOT YET
gone”? (Donʼt count word combinations that

YES
PROBLEM SOLVING OVERALL

YES

NO
By Diane Bricker and Jane Squires express one idea, such as “Bye-bye,” “All
gone,” “All right,” and “Whatʼs that?”) Be sure to try each activity with your child. Parents may use an additional sheet for comments.
with assistance from
Linda Mounts, LaWanda Potter, Robert Nickel, Elizabeth 1. Does your baby drop    __ 1. Do you think your child hears well?  
Twombly, and Jane Farrell several (6 or more) small
Copyright © 1999 by Paul H. Brookes Publishing Co. toys into a container such If no, explain:
as a bowl or box? (You may

SOMETIMES
show him how to do it.) 2. Do you think your child talks like other toddlers his  

NOT YET
CHILDʼS NAME: CHILDʼS BIRTHDATE:
age?
GROSS MOTOR

YES
2. After you have shown her how, does your    __
Be sure to try each activity with your child. If no, explain:
child try to get a small toy that is slightly out
NAME OF PARENT OR PROVIDER: TODAYʼS DATE:
Does your child bend over or squat to pick    of reach by using a spoon, stick, or similar
1. __ 3. Can you understand most of what your child says?  
up an object from the floor and then stand tool?
up again without any support? If no, explain:
CHILDʼS AGE: (TODAY) WAS YOU CHILD:   
❏ PREMATURE ---------LIST # WEEKS EARLY ___________ 3. After a crumb or Cheerio is dropped into a __
❏ TERM (BORN ON TIME) 2. Does your child move around by walking,    __ bottle, does your child purposely turn the  
4. Do you think that your child walks, runs, and climbs
❏ POSTMATURE --- LIST # WEEKS OVERDUE __________ rather than by crawling on her hands and bottle over to dump it out? (You may have
like other toddlers his age?
PERSON FILLING OUT THIS QUESTIONNAIRE: knees? to show him how to do this.) You can use a
plastic soda-pop bottle or baby bottle. If no, explain:
3. Does your child walk well and seldom fall?    __
YOUR RELATIONSHIP TO CHILD: 4. Without first showing her how, does your    __ 5. Does either parent have a family history of childhood  
4. Does your child climb on an object such as    __ child scribble back and forth when you give deafness or hearing impairment?
a chair to reach something he wants? her a crayon (or pencil or pen)?
LIST ANY OTHER PEOPLE ASSISTING IN QUESTIONNAIRE COMPLETION: If yes, explain:
5. Does your child walk down stairs if you hold    __ 5. After he watches you draw a line from the    __
onto one of his hands? top of the paper to the bottom with a crayon 6. Do you have concerns about your childʼs vision?  
(or pencil or pen), does your child copy you
6. When you show her how to kick    __ by drawing a single line on the paper in any If yes, explain:
On these two pages are questions about activities that children do. a large ball, does your child try direction? (Scribbling back and forth does
Your child may have already done some of the activities described here, to kick the ball by moving her not count as “yes.”) 7. Has your child had any medical problems in the last  
and there may be some your child has not begun doing yet. For each leg forward or by walking into it? COUNTS “YES” COUNTS “NOT YET” several months?
item, please check the box that tells whether your child is doing the (If your child already kicks a
activity regularly, sometimes or not yet. Be sure to try each activity ball, check “yes” for this item.) If yes, explain:
with your child before checking the box. Try to make completing this
questionnaire a game that is fun for you and your child. Make sure 8. Does anything about your child worry you?  
he/she is rested, fed, and ready to play.

SOMETIMES
After a crumb or Cheerio is dropped into a    If yes, explain:
6. __

NOT YET
small, clear bottle, does your child turn the
SOMETIMES

FINE MOTOR

YES
bottle upside down to dump out the crumb
NOT YET

Be sure to try each activity with your child. or Cheerio? (Do not show her how.)
COMMUNICATION
YES

Be sure to try each activity with your child. 1. Does your baby throw a    __
small ball with a forward arm THIS SECTION IS FOR OFFICE PERSONNEL
1. When your child wants something, does she    __

SOMETIMES
motion? (If he simply drops
tell you by pointing to it?

NOT YET
the ball, check “not yet” for
   this item.) PERSONAL-SOCIAL SCORING THE QUESTIONNAIRE

YES
2. When you ask him to, does your child go __
into another room to find a familiar toy or Be sure to try each activity with your child.
object? (You might ask, “Where is your 2. Does your child stack a small block or toy    __ 1. Be sure each item has been answered. If an item cannot be
on top of another one? (You could also use 1. While looking at himself in the mirror, does    __ answered, refer to the ratio scoring procedure in The ASQ User’s
ball?” or say, “Bring me your coat” or “Go your child offer a toy to his own image?
get your blanket.”) spools of thread, small boxes, or toys that Guide.
are about 1 inch in size.) 2. Score each item on the questionnaire by writing the appropriate
2. Does your child play with a doll or stuffed    __
3. Does your child imitate a two-word    __ number on the line by each item answer.
Does your child make a mark on the paper    animal by hugging it?
sentence? For example, when you say a 3. __
with the tip of a crayon (or pencil or pen) YES = 10 SOMETIMES = 5 NOT YET = 0
two-word phrase, such as “Mama eat,” Does your child get your attention or try to   
when trying to draw? 3. __
“Daddy play,” “Go home,” or “Whatʼs this?” show you something by pulling on your
does your child say both words back to
3. Add up the item scores for each area, and record these totals in
Does your child stack three small blocks or    hand or clothes?
you? (Check “yes” even if her words are 4. __ the space provided for area totals.
toys on top of each other by herself? (You 4. Indicate the child’s total score for each area by filling in the
difficult to understand.) 4. Does your child come to you when she    __
can also use spools of thread, small boxes, appropriate circle on the chart below. For example, if the total
or toys that are about 1 inch in size.) needs help, such as with winding up a toy?
4. Does your child say eight or more words in    __ score for the Communication area was 50, check the box below
addition to “Mama” and “Dada”? Does your child turn the pages of a book by    5. Does your child drink from a cup or glass,    __ 50 in the first row.
5. __
himself? (He may turn more than one page putting it down again with little spilling?
5. Without showing him first, does your child    __ 0 5 10 15 20 25 30 35 40 45 50 55 60
at a time.)
point to the correct picture when you say, 6. Does your child copy the activities you do,    __ COMMUNICATION
“Show me the kitty” or ask, “Where is the Does your child get a spoon into her mouth such as wipe up a spill, sweep, shave, or GROSS MOTOR
6.    __
dog?” (He needs to identify only one picture right side up so that the food usually doesnʼt comb hair? FINE MOTOR
correctly.) spill? PROBLEM SOLVING
PERSONAL-SOCIAL

Ages & Stages Questionnaires, Second Edition, Bricker et al. 18 Month – 1.5 Year Page 1 Ages & Stages Questionnaires, Second Edition, Bricker et al. 18 Month – 1.5 Year Page 2