30 Month Questionnaire

Please correct the errors described below.

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.

30 Month Questionnaire

Please provide the following information.

COMMUNICATION

Be sure to try each activity with your child.

a. "Put the toy on the table." b. "Close the door:" c. "Bring me a towel." d. "Find your coat." e. ''Take my hand." f. "Get your book."

GROSS MOTOR

Be sure to try each activity with your child.

*If gross motor item 5 is marked "yes" or "sometimes," mark gross motor item 2 as "yes."

FINE MOTOR

Be sure to try each activity with your child.

PROBLEM SOLVING

Be sure to try each activity with your child.

PERSONAL-SOCIAL

Be sure to try each activity with your child.

a. Open and close your mouth. b. Blink your eyes. c. Pull on your earlobe. d. Pat your cheek.

OVERALL

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

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