Denver Prescreening Developmental Questionnaire ll

Child's Name

Date of Birth

Person Completing PDQ-ll

Relation to Child

1. Equal Movements

When your baby is lying on his back, can he move each of his arms as easily as the other and each of his legs as easily as the other? Circle NO if your baby makes jerky or uncoordinated movements with one or both of his arms or legs.

Yes No

2. Respond to Sounds

Does your baby respond (with eye movements, change in breathing or other change in activity) to a new sound outside his line of vision?

Yes No

3. Regards Face

When your baby is lying on her back, does she look at you and watch your face?

Yes No

4. Vocalizes

Does your baby make sounds other than crying, such as uh, eh, or cooing?

Yes No

5. Smiles Responsively

When you smile and talk to your baby, does he smile back at you?

Yes No

6. Head Up 45 Degrees

When your baby is on her stomach on a flat surface, can she lift her head at least as far as this picture?

Yes No

7."Ooo"/"Aaa"

Does your baby make vowel sounds such as "ooo" or "aaa"?

Yes No

8. Head Up 90 Degrees

When your baby is on her stomach on a flat surface, can she lift her head and chest to look straight ahead like this picture?

Yes No

9. Hands Together

Does your baby play with his hands by touching them together?

Yes No

10. Regards Own Hand

Have you seen your baby stare at his own hand for at least 5 seconds?

Yes No

11. Squeals

Does your baby make happy, excited, high-pitched squealing sounds which are not crying?

Yes No

12. Bears Weight on Legs

When you stand your baby up, holding her under the arms, does she try to stand on her feet and support some of her own weight?

Yes No

13. Follows 180 Degrees

While your baby is on his back, move your hand from one side to the other above his face. Did your baby watch your hand by turning his head from one side a// the way to the other side like this picture?

Yes No

14. Chest Up-Arm Support

When your baby is on her stomach on a flat surface, can she lift her chest using her arms to hold herself up like this picture?

Yes No

15. Regards Small Object

Can your baby focus her eyes on small objects the size of a pea, a raisin or a penny?

Yes No

16. Rolls Over

Has your baby rolled over at least 2 times, from stomach to back, or back to stomach?

Yes No

17. Turns to Sound

Does your baby usually turn his head toward a soft sound, when the source of the sound is out of sight?

Yes No

18. Reaches

Can your baby pick up a toy if it is placed within her reach?

Yes No

19. Works For Toy

When your baby wants something that is out of easy reach, does your baby try to get it by stretching his arms or body?

Yes No

20. Feeds Self

Can your baby feed herself a cracker or cookie? If she has never been given one, Circle NO.

Yes No

21.Turns To Voice

When your baby is playing and you come up quietly behind him, does your baby usually turn his head as though he heard you?

Yes No

22. Sits, No Support

Without being propped by pillows, a chair, or a wall, can your baby sit by herself for at least 10 seconds?

Yes No

23. Looks For Yarn

Please follow directions carefully. Hold a tissue or some other soft object up high and shake or wave it. When your baby is looking at it, drop it to the floor. Did your baby look down to see where it went?

Yes No

24. Rakes Raisin

Can your baby pick up tiny objects, such as raisins or pieces of food with either his whole hand using a raking or grabbing motion, or with his thumb and fingers like any of these pictures?

Yes No

25. Single Syllables

Does your baby make sounds that have both consonants and vowels such as "da", "ba", "ga", or "ma"?

Yes No

26. Stands Holding On

Can your baby stand holding on to a chair or table for 10 seconds or more?

Yes No

27. Imitates Speech Sounds

Does your baby ever copy you when you make some speech sounds like kissing, coughing or saying a word?

Yes No

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