18 Month Questionnaire

Ages & Stages Questionnaires: A Parent-Completed, Child-Monitoring System

Second Edition
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.

On the following pages are questions about activities children do. Your child may have already done some of the activities described here, and there may be some your child has not begun doing yet. For each item, please check the box that tells whether your child is doing the activity regularly, sometimes, or not yet.

Important Points to Remember:

Be sure to try each activity with your child before checking a box.
Try to make completing this questionnaire a game that is fun for you and your child.
Make sure your child is rested, fed, and ready to play.
Please return this questionnaire by ____.
If you have any questions or concerns about your child or about this questionnaire, please call: (773) 348-8300
Look forward to filling out another questionnaire in ____ months.

Complete By Date:

18 Month Questionnaire

Please provide the following information.

Child's name:

Child's date of birth:

Child's corrected date of birth (if child is premature, add weeks of prematurity to child's date of birth):

Today's date:

Person filling out this questionnaire:

What is your relationship to the child?

Your telephone:

Your mailing address:

City:

State:

Zip code:

List people assisting in questionnaire completion:

Administering program or provider:

At this age, many toddlers may not be cooperative when asked to do things. You may need to try the following activities with your child more than one time. If possible, try the activities when your child is cooperative. If your child can do the activity but refuses, score "yes" for the item.

COMMUNICATION

Be sure to try each activity with your child.

1. When your child wants something, does she tell you by pointing to it?

Yes

Sometimes

Not Yet

Score:

2. When you ask him to, does your child go into another room to find a familiar toy or object? (You might ask, "Where is your ball?" or say, "Bring me your coat" or "Go get your blanket.")

Yes

Sometimes

Not Yet

Score:

3. Does your child say eight or more words in addition to "Mama" and "Dada"?

Yes

Sometimes

Not Yet

Score:

4. Does your child imitate a two-word sentence? For example, when you say a two-word phrase, such as "Mama eat," "Daddy play," "Go home," or 'What's this?" does your child say both words back to you? (Check "yes" even if her words are difficult to understand.)

Yes

Sometimes

Not Yet

Score:

5. Without showing him first, does your child point to the correct picture when you say, "Show me the kitty" or ask, "Where is the dog?" (He needs to identify only one picture correctly.)

Yes

Sometimes

Not Yet

Score:

6. Does your child say two or three words that represent different ideas together, such as "See dog," "Mommy come home," or "Kitty gone"? (Don't count word combinations that express one idea, such as "Bye-bye," "All gone," "All right," and "What's that?")

Yes

Sometimes

Not Yet

Score:

Please give an example of your child's word combinations:

COMMUNICATION TOTAL:

GROSS MOTOR

Be sure to try each activity with your child.

1. Does your child bend over or squat to pick up an object from the floor and then stand up again without any support?

Yes

Sometimes

Not Yet

Score:

2. Does your child move around by walking, rather than by crawling on her hands and knees?

Yes

Sometimes

Not Yet

Score:

3. Does your child walk well and seldom fall?

Yes

Sometimes

Not Yet

Score:

4. Does your child climb on an object such as a chair to reach something he wants?

Yes

Sometimes

Not Yet

Score:

5. Does your child walk down stairs if you hold onto one of her hands? (You can look for this at a store, on a playground, or at home.)

Yes

Sometimes

Not Yet

Score:

6. When you show him how to kick a large ball, does your child try to kick the ball, does your child try to kick the ball by moving his leg forward or by walking into it? (If your child already kicks a ball, check "yes" for this item.)

Yes

Sometimes

Not Yet

Score:

GROSS MOTOR TOTAL:

FINE MOTOR

Be sure to try each activity with your child.

1. Does your child throw a small ball with a forward arm motion? (If he simply drops the ball, check "not yet' for this item.)

Yes

Sometimes

Not Yet

Score:

2. Does your child stack a small block or toy on top of another one? (You could also use spools of thread, small boxes, or toys that are about 1 inch in size.)

Yes

Sometimes

Not Yet

Score:

3. Does your child make a mark on the paper with the tip of a crayon (or pencil or pen) when trying to draw?

Yes

Sometimes

Not Yet

Score:

4. Does your child stack three small blocks or toys on top of each other by herself? (You can also use spools of thread, small boxes, or toys that are about 1 inch in size.)

Yes

Sometimes

Not Yet

Score:

5. Does your child turn the pages of a book by himself? (He may turn more than one page at a time.)

Yes

Sometimes

Not Yet

Score:

6. Does your child get a spoon into her mouth right side up so that the food usually doesn't spill?

Yes

Sometimes

Not Yet

Score:

FINE MOTOR TOTAL:

PROBLEM SOLVING

Be sure to try each activity with your child.

1. Does your child drop several (six or more) small toys into a container, such as a bowl or box? (You may show him how to do it)

Yes

Sometimes

Not Yet

Score:

2. After you have shown her how, does your child try to get a small toy that is slightly out of reach by using a spoon, stick, or similar tool?

Yes

Sometimes

Not Yet

Score:

3. After a crumb or Cheerio is dropped into a bottle, does your child purposely turn the bottle over to dump it out? You may show him how to do this. You can use a plastic soda-pop bottle or baby bottle.

Yes

Sometimes

Not Yet

Score:

4. Without first showing her how, does your child scribble back and forth when you give her a crayon (or pencil or pen)?

Yes

Sometimes

Not Yet

Score:

5. After he watches you draw a line from the top of the paper to the bottom with a crayon (or pencil or pen), does your child copy you by drawing a single line on the paper in any direction? (Scribbling back and forth does not count as "yes.")

Yes

Sometimes

Not Yet

Score:

6. After a crumb or Cheerio is dropped into a small, clear bottle, does your child turn the bottle upside down to dump out the crumb or Cheerio? (Do not show her how.)

Yes

Sometimes

Not Yet

Score:

PROBLEM SOLVING TOTAL:

If problem solving item 6 is marked "yes" or "sometimes," mark problem solving item 3 as "yes."

PERSONAL-SOCIAL

Be sure to try each activity with your child.

1. While looking at himself in the mirror, does your child offer a toy to his own image?

Yes

Sometimes

Not Yet

Score:

2. Does your child play with a doll or stuffed animal by hugging it?

Yes

Sometimes

Not Yet

Score:

3. Does your child get your attention or try to show you something by pulling on your hand or clothes?

Yes

Sometimes

Not Yet

Score:

4. Does your child come to you when she needs help, such as with winding up a toy?

Yes

Sometimes

Not Yet

Score:

5. Does your child drink from a cup or glass, putting it down again with little spilling?

Yes

Sometimes

Not Yet

Score:

6. Does your child copy the activities you do, such as wipe up a spill, sweep, shave, or comb hair?

Yes

Sometimes

Not Yet

Score:

PERSONAL-SOCIAL TOTAL:

OVERALL

Parents and providers may use the space at the bottom of this page for additional comments.

1. Do you think your child hears well?

Yes

If no, explain:

2. Do you think your child talks like other toddlers his age?

Yes

If no, explain:

3. Can you understand most of what your child says?

Yes

If no, explain:

4. Do you think your child walks, runs, and climbs like other toddlers her age?

Yes

If no, explain:

5. Does either parent have a family history of childhood deafness or hearing impairment?

Yes

If yes, explain:

6. Do you have concerns about your child's vision?

Yes

If yes, explain:

7. Has your child had any medical problems in the last several months?

Yes

If yes, explain:

8. Does anything about your child worry you?

Yes

If yes, explain:

Additional comments:

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