Denver Prescreening Developmental Questionnaire ll

Child's Name

Date of Birth

Person Completing PDQ-ll

Relationship to Patient

1. Mama/Dada, Non-Specific

2. Pulls To Stand

Does your baby make either "mama" or "dada" sounds?

Yes No

When in a crib or beside furniture, can your baby pull herself up to a standing position without help?

Yes No

3. Gets to Sitting

4. Combines Syllables

When crawling or lying down, can your baby get into a sitting position without help?

Yes No

Does your baby repeat the same sounds several times in a row like "dadadada," or "gagagaga"?

Yes No

5. Thumb Finger Grasp

6. Plays-Pat-A-Cake

When your baby picks up a tiny object, such as a raisin, does he do so by squeezing it between his thumb and at least one finger like either of these pictures?

Yes No

Can your baby play "pat-a-cake" with someone without any help, such as helping him clap his hands?

Yes No

7. Stands - 5 Seconds

8. Jabbers

Can your baby stand alone (without having to hold on to something for about 5 seconds?)

Yes No

When your baby is playing alone, does he jabber as though really talking? This jabbering does not have to be understandable.

Yes No

9. Indicates Wants

10. Mama / Dada Specific

Can your child let you know what she wants without crying or whining? Examples of this are pointing, or pulling on you.

Yes No

Does your child say "Dada" when he wants or sees his father? Does your child say "Mama" when he wants or sees his mother? Circle YES if your child says either one.

Yes No

11. Stands Alone

12. Puts Toy in Cup

Can your child stand alone (without having to hold on to something) for 15 seconds or move?

Yes No

Can your child put a small object (such as finger food or a toy) into a cup, letting go of it and leaving it there for at least a few seconds?

Yes No

13. Waves Bye-Bye

14. Stoops and Recovers

When you or someone else waves and says "bye-bye" to your child, can your child wave back without help?

Yes No

Without holding on to something or touching the floor, can your child bend over or stoop to pick up a toy or other object on the floor and stand up again?

Yes No

15. Walks well

16. One Word

Can you child walk all the way across a large room without falling or wobbling from side to side?

Yes No

Does your child say at least one other word besides "Mama," "Dada" and names of family members or pets?

Yes No

17. Plays ball

18. Scribbles

If you roll a small ball to your child, can she roll or throw it back to you? If your child only hands the ball to you, or if you have never tried this, Circle No.

Yes No

Without moving his hand or showing him how to do it, give your child a pencil and see if he will scribble on a piece of paper. If he bangs or mouths the pencil, Circle No. Circle Yes only if he scribbles without help.

Yes No

19. Two Words

20. Drinks from a Cup

Does your child say 2 or more words other than "Mama", "Dada" and names of family members or pets?

Yes No

Can your child hold a cup or glass by herself and drink from it without spilling much? The cup should not have a spout of lid.

Yes No

21. Helps in House

22. Three Words

Does your child do things to help you, such as picking up his toys or bringing something to you when asked?

Yes No

Does your child say three or more words other than, "Mama," "Dada" and names of family members or pets?

Yes No

23. Dumps Raisin

24. Uses Spoon/Fork

Can your child dump something small such as a raisin or piece of cereal from a small bottle, glass or cup? If she has not had the opportunity to try this, Circle NO.

Yes No

Does your child feed himself with a spoon or fork without spilling much?

Yes No

25. Runs

26. Tower of 3 Cubes

Can your child run across a room without falling or tripping?

Yes No

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

Yes No

27. Six Words

28. Kicks Ball Forward

Does your child say six or more words other than "Mama," "Dada" and names of family members or pets?

Yes No

Without holding on to anything, can your child kick a small ball (like a tennis ball)? Circle YES only if you have seen your child do this with a small ball.

Yes No

29. Removes Garment

Can your child take off any of his clothes, such as pajamas (tops or bottoms) or pants? Do not count diapers, hats, socks or shoes.

Yes No

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