Denver Prescreening Developmental Questionnaire ll

Child Name

Person Completing PDQ-ll

Relationship to Patient

2 - 4 Years (PDQ-ll)

COMBINED WORDS

1. Does your child put two words together when she speaks, such as "Want drink" and "Get down"? Do not count "thank you" and "bye-bye".

Yes No

NAMES ONE PICTURES

2. Point to the pictures below, one at a time, and say, "What is this?" If your child does not know what the picture is, do not name it for him. Did your child name at least one picture correctly (cat, horse, bird, dog, man)? (The name of a pet counts, but animal sounds like meowing and barking do not count.)

Yes No

BODY PARTS

3. Circle the body parts your child points to on you, without help, as you name them one at a time: eye--ear--nose--mouth--hand- foot--tummy--hair. Did your child point to all 8 parts correctly?

Yes No

JUMPS UP

4. Without letting your child take a running jump, tell him to jump over a piece of paper placed on the floor. Did he get both feet off the floor at once when trying to jump over the paper?

Yes No

PUTS ON CLOTHING

5. Can your child put on any of her own clothing such as shoes, pants or T-shirt?

Yes No

POINTS TO 4 PICTURES

6. Show your child the pictures in #2 again, and tell him, one at a time, "Point to the: bird--man --dog--cat--horse." Did your child Time, Point to at least 4 pictures correctly?

Yes No

TOWER OF 8 CUBES

7. Can your child stack 8 or more small blocks on top of each other? If she has never tried this, Circle NO.

Yes No

SPEECH HALF-UNDERSTANDABLE

8. When your child talks to people who don't know him well, do they usually understand at least half of what your child is saying?

Yes No

NAMES 4 PICTURES

9. For #2, did your child name at least 4 pictures correctly?

Yes No

WASHES AND DRIES HANDS

10. Can your child wash and dry her hands well enough so you don't have to do them over? If you do not allow her to wash and dry her ands by herself, Circle NO

Yes No

NAMES FRIEND

11. Ask your child to tell you the name of one of his friends. Did your child name someone who is not a family member or pet?

Yes No

IMITATES VERTICAL LINE

12. Do not help or correct your child with this task. Draw a straight vertical line similar to the one illustrated below. Say to your child, "Draw a line like I did." Your child should not trace the line.

Look at these examples and score your child's drawing.

Check (If like one of these.)

KNOWS 2 ACTIONS

13. Show your child the pictures in #2, and ask her to point to the correct picture as you ask, one at a time, "Which one flies -- says meow -- talks -- barks -- gallops?" Did your child point to 2 or more pictures correctly?

Yes No

BROAD JUMP

14. Without letting your child take a running jump, tell her to jump length-wise over a piece of paper. Did she do this without landing on the paper?

Yes No

BALANCES - EACH FOOT 3 SECONDS

15. Have your child balance on the right foot as long as he can without holding on to anything. Show him how, if necessary.

Now have your child balance on his left foot.

Did your child balance 3 seconds or more on the right foot and on the left foot?

Yes No

KNOWS 2 ADJECTIVES

16. Write your child's answer to the following questions. Give no help except to repeat the question.

What do you do when you are cold?

What do you do when you are tired?

What do you do when you are hungry?

Examples of correct answers: Cold- "shiver," "put on a coat'', "go inside" (not "take medicine" or "cough"} Tired- ·'yawn", "go to sleep", "lie down", "take a nap" Hungry- "eat", "ask for something to eat", "have lunch"

Did your child answer at least 2 questions correctly with words, not with just motions or gestures?

Yes No

THUMB WIGGLE

17. Make a fist with your thumb pointing up, as in the picture below, and wiggle your thumb. Have your child imitate you, first with one hand and then with the other. Did your child make a fist and wiggle the thumb of either hand without moving any other finger?

Yes No

NAMES ONE COLOR

18. Point to colors one at a time, and ask your child to name each color. Do not let your child know if his responses are right or wrong. Did your child name one or more colors correctly?

Yes No

USE OF 2 OBJECTS

19. Write your child's answer to the following questions. Ask the questions one at a time and wait for your child to answer. Give no help except to repeat the question.

What do you do with a cup?

What is a chair used for?

What is a pencil used for

Count any action word (such as "drink" for cup) as correct. An answer like "milk" for cup is not correct. Did your child answer at least 2 question correctly?

Yes No

COUNTS 1

20. Tear 4 small pieces off a piece of paper. Tell your child to give you one piece of paper. If he gives you more than one, circle NO. If your child gives you only one, ask him, "How many pieces of paper do I have?" If he answered "one", circle YES. If he answered anything else, circle NO.

Yes No

4 - 6 Years (PDQ-ll)

Copies Circle

1. Have your child draw this figure in the space below. Do not say "circle". Say, "Draw a picture just like this one," and point to the picture below. Do not help or correct your child. Give 3 chances

Yes No

Look at these examples and score your child's best drawing.

Click YES above if like one of these

Click NO above if like one of these

Use of 3 Objects
2. Write your child's answers to the following questions. Ask the questions one at a time and wait for your child to answer. Give no help except to repeat the question.

What do you do with a cup?

What is a chair used for?

What is a pencil used for?

Count any action word (such as "drink" for cup) as correct. An answer like "milk" for cup is not correct.

Did your child answer all 3 questions correctly?

Yes No

Knows 4 Actions

3. Show your child the pictures below and ask her to point to the correct picture as you ask, one at a time, "Which one flies--says meow--talks--barks--gallops?" Did your child point to 4 or 5 Pictures Correctly?

Yes No

Speech All-Understandable

4. When your child talks to people who don't know him well, do they usually understand everything he is saying?

Yes No

Hops on One Foot

5. Have your child hop on one foot several times without holding on to anything. Skipping does not count. Did she hop 2 or more times?

Yes No

Dresses, No Help

6. Can your child pick out clothes to wear and dress himself completely without help?

Yes No

Copies +
7. Do not tell your child the name of this picture. Do not give help. Say, "Draw a picture just like this one," and point to the picture below. Give 3 chances.

Look at these examples and score your child's best drawing.

Click YES below if one of these

Click NO below if one of these

Did your child draw a cross?

Yes No

Understands 4 Prepositions
8. Give your child a piece of paper or some small object. Do not point or look when giving your child the following directions.

"Put the paper (or object) under the chair."

"Put the paper behind you."

"Put the paper on the chair."

"Put the paper in front of you."

Did your child follow all four directions correctly?

Yes No

Names 4 Colors

9. Point to four different colors, one at a time, and ask your child to name each color. Do not let your child know if her responses are right or wrong. Did your child name all four colors correctly?

Yes No

Brushes Teeth, No Help

10. Does your child brush his own teeth alone, including putting toothpaste on the brush and brushing all front and back teeth?

Yes No

Defines 5 Words
11. Write your child's answers to the following questions. Ask the questions one at a time and wait for an answer after each one. Give no help except to repeat questions.

What is a ball?

What is a lake?

What is a desk?

What is a house?

What is a banana?

What is a curtain?

What is a fence?

What is a ceiling?

Correct answers are those that tell something about the object's use, shape, what it is made of, or general category (such as, banana is "fruit").

Did your child define at least 5 words correctly?

Yes No

Picks Longer Line

12. Do not correct your child or give her help. Do not use the word bigger. On a piece of paper, draw two lines one being slightly longer than the other as shown in the picture to the right. Show your child the picture and say, "Point to the line that is longer." After she points, turn the drawing upside down and say, "Point to the line that is longer." After she points, turn the drawing upside down again and say a third time, "Point to the line that is longer." Did your child point to the longer line all 3 times?

Yes No

Knows 3 Adjectives
13. Write your child's answers to the following questions. Give no help except to repeat the question.

What do you do when you are cold?

What do you do when you are tired?

What do you do when you are hungry?

Examples of correct answers: Cold- "shiver," "put on a coat", "go inside" (not "take medicine" or "cough") Tired- "yawn", "go to sleep", "lie down", "take a nap" Hungry- "eat", "ask for something to eat", "have lunch"

Did your child answer all 3 questions correctly with words, not with just emotions or gestures?

Yes No

Draws Person - 6 Parts

14. Have your child draw on a separate sheet of paper. Say, "Draw a picture of a person (or man, woman, boy, girl)." Do not give any help or ask about any missing parts. When your child is finished, count the parts (head, eyes, mouth, hair, etc.). Count a pair (eyes, arms, legs, ears, etc.) as one part. If there is only one of a pair (eye, arm, leg, ear, etc.), do not count it. Did your child draw a person with 6 or more parts?

Yes No

Balances - Each Foot 8 Seconds
15. Have your child balance on the right foot as long as he can without holding on to anything. Show him how, if necessary. Estimate seconds by counting slowly.

How many seconds did your child balance?

Now have your child balance on his left foot.

How many seconds did your child balance?

Did your child balance 8 seconds or more on the right foot and on the left foot?

Yes No

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