Ages & Stages Questionnaire for 18 Month Old

Northwest Suburban Pediatrics

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18 Month ASQ-3 Ages and Stages Questionnaires

17 months 0 days through 18 months 30 days 18 Month Questionnaire Please provide the following information.

Child's information

Person filling out questionnaire

Program Information

18 Month Questionnaire

On the following pages are questions about activities children may 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 select the circle that indicates whether your child is doing the activity regularly (yes), sometimes, or not yet.

Important Points to Remember: 1. Try each activity with your child before marking a response. 2. Make completing this questionnaire a game that is fun for you and your child. 3. Make sure your child is not tired or hungry. 4. Please bring this questionnaire with you to your child’s health and development review.

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, mark “yes” for the item.

COMMUNICATION

GROSS MOTOR

FINE MOTOR

PROBLEM SOLVING

* If Problem Solving Item 6 is marked “yes” or “sometimes,” mark Problem Solving Item 3 “yes.”

PERSONAL-SOCIAL

OVERALL

Parents and providers may use the space below for additional comments.

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