Development Name of the Child *Name of the Father / Mother *Contact Number *Date of Birth *Gender of the child & previous diagnosis by Psychiatrist or Psychologist *1. “crows”; laughs* (Vocalizes inarticulately (other than crying or fretting). Spontaneously gurgles or coos. Laughs spontaneously or when stimulated)YesPartiallyNo0 To 1 Year2. Balances HeadYesPartiallyNo3. Grasps object within reachYesPartiallyNo4. Reaches for familiar personsYesPartiallyNo5. Rolls over (unassisted)YesPartiallyNo6. Reaches for nearby objects* (Attempts to obtain objects nearby but beyond reach)YesPartiallyNo7. Occupies self unattended* (Plays with rattle or simple objects, for quarter hour or longer without need of attention)YesPartiallyNo8. Sits unsupportedYesPartiallyNo9. Pulls self uprightYesPartiallyNo10. “Talks”; imitates soundsYesPartiallyNo11. Drinks from cup or glass assistedYesPartiallyNo12. Moves about on floor (creeping, crawling)YesPartiallyNo13. Grasps with thumb and fingerYesPartiallyNo14. Demands personal attention* (Indicates desire to be ‘talked’ to or beyond mere handling or care for physical needs)YesPartiallyNo15. Stands alone.YesPartiallyNo16. Does not drool* (Has established control of saliva so that mouth or chin does not require wiping except when eating)YesPartiallyNo17. Follows simple instructions* (Comes when called; points to particular objects in pictures when asked; in general cooperates on verbal request in very simple activities)YesPartiallyNo18. Walks about room unattendedYesPartiallyNo1 to 2 Years19. Marks with pencil or crayonYesPartiallyNo20. Masticates (chews) solid or semi-solid foodYesPartiallyNo21. Removes shoes or sandals, pulls off socksYesPartiallyNo22. Transfers objects* (Pors from one vessel to another without messing; removes, transfers, replaces objects in somewhat purposeful manner).YesPartiallyNo23. Overcomes simple obstacles* (Open closed doors; climbs up on chair; uses stool for reaching; removing simple impediments)YesPartiallyNo24. Fetches or carries familiar objectsYesPartiallyNo25. Drinks from cup or glass unassistedYesPartiallyNo26. Walks or uses a go-cart for walking* (“go – cart” walks by pushing a cart on wheels)YesPartiallyNo27. Plays with other children* (Activity is individual rather than cooperative, when he “gets along” with other children)YesPartiallyNo28. Eats with own hands* (eats things like biscuit or bread holding in his own hand or uses spoon to eat from bowl, cup, plate)YesPartiallyNo29. Goes about house or yardYesPartiallyNo30. Discriminates edible substances from non-ediblesYesPartiallyNo31. Uses names of familiar objectsYesPartiallyNo32. Walks up stairs unassistedYesPartiallyNo33. Unwraps sweets, chocolatesYesPartiallyNo34. Talks in short sentencesYesPartiallyNo35. Signals to go to toilet* (By actions or speech expresses to go to urinate or ease himself. May be assisted at same)YesPartiallyNo2 to 3 Years36. Initiates own play activities* (Occupies self at play such as drawing or colouring with pencil, looking at books or pictures)YesPartiallyNo37. Removes shirt or frock if unbuttonedYesPartiallyNo38. Eats with spoonYesPartiallyNo39. Gets drink (water) unassistedYesPartiallyNo40. Dries own handsYesPartiallyNo41. Avoids simple hazards* (Comes in out of rain. Shows some caution regarding strangers; is careful as regards falling on stairs)YesPartiallyNo42. Puts on shirt or frock unassisted (need not button)YesPartiallyNo43. Can do paper foldingYesPartiallyNo44. Relates experiences* (Gives simple accounts of experiences or tells stories)YesPartiallyNo45. Walks down stairs, one step at a timeYesPartiallyNo3 to 4 Years46. Plays co-operatively at kindergarten level* (Participates in coordinated group activity as Kindergarten circle games, cooking group play)YesPartiallyNo47. Buttons shirt or frockYesPartiallyNo48. Helps at little household tasksYesPartiallyNo49. “Performs” for others* (Entertains others, as reciting, singing, dancing, something more than being “cute”)YesPartiallyNo50. Washes hands unaidedYesPartiallyNo51. Cares for self at toiletYesPartiallyNo4 to 5 Years52. Washes face unassistedYesPartiallyNo53. Goes about neighbourhood unattendedYesPartiallyNo54. Dresses self except for tyingYesPartiallyNo55. Uses pencils or crayon for drawing* (Draws forms like man, house, tree, animal etc)YesPartiallyNo56. Plays competitive exercise games* (Engages in tag, hide and seek, jumping rope, tops skipping, marbles)YesPartiallyNo57. Uses hoops, flies kites, rides tricycles* (Hoops i.e. ring pushed by hand or stick, cycle tyres)YesPartiallyNo5 to 6 Years58. Prints (writes) simple wordsYesPartiallyNo59. Plays simple table games* (Games with others requiring taking turns, observing rues without undue dissension; caroms, drafts snakes and ladder, ludo)YesPartiallyNo60. Is trusted with money* (Is responsible with small sums of money when sent to make payments or explicit purchases)YesPartiallyNo61. Goes to school unattendedYesPartiallyNo62. Mixes rice “properly” unassistedYesPartiallyNo6 to 7 Years63. Uses pencil for writing* (Writes (not print+) legibly with pencil a dozen or more simple words with correct spelling)YesPartiallyNo64. Bathes self assistedYesPartiallyNo65. Goes to bed unassisted* (Performs bedtime operations without help; goes to room alone, undresses, turns out light)YesPartiallyNo66. Tells time to quarter hourYesPartiallyNo7 to 8 Years67. Helps himself during meals* (After first serving of meals, helps himself to more according to need)YesPartiallyNo68. Refuses to believe in magic and fairy tales* ((Rejects intellectually action done by magic. Also fairies and personification of objects and events)YesPartiallyNo69. Participates in pre-adolescent play* ((Boys: games not requiring definite skill and with only loose rules such as unorganized hockey, football khokho, follow – the - leader, takes hikes or bicycles rides. Girsl: Engages in dramatic play symbolizing domestic or social situations such as playing house, school, doctor – nurse. NOTE: Sex differentiation in play at this stage and shift in girls play to more sedentary type. However credit item regardless of sex if this differentiation has not yet been established)YesPartiallyNo70. Combs or brushes hairYesPartiallyNo71. Uses tools or utensils.* (Makes some practical use of hammer, screw driver, house hold, sewing and garden tools)YesPartiallyNo8 to 9 Years72. Does routine household tasks.* (Helps effectively at simple tasks for which some continuous responsibility is assumed, dusting, arranging, cleaning, washing – dishes, making bed)YesPartiallyNo73. Reads on own initiative* (reads comic strips, movie titles, simple stories, notes simple instructions, elementary news items; for own entertainment or information)YesPartiallyNo74. Bathes self unaidedYesPartiallyNo75. Cares for self at table (meals)YesPartiallyNo9 to 10 Years76. Makes minor purchases. * (Buys useful articles, exercises some choice or discretion, in so doing, and is responsible for safety of articles, money and correct change)YesPartiallyNo77. Goes about home town freelyYesPartiallyNo78. Writes occasional short letters to friendsYesPartiallyNo10 to 11 Years79. Makes independent choice of shops.* (Able to decide for self which shop to go for purchasing different articles)YesPartiallyNo80. Does small remunerative work; makes articles.* (Makes articles for self use, e.g. making simple garments, stitching, buttons, preparing tea for self, doing small repairs, taking care of own cabinet, table and room or performs occasional work on own initiative such as odd jobs house work, helping in care of children, sewing, selling magazines, caring newspapers for which some money is paid)YesPartiallyNo81. Answers ads; writes letter for information.* (Writes letters to get information regarding some books, magazines or toys)YesPartiallyNo82. Does simple creative work.* (Makes useful articles; cooks, bakes, raises pets, writes simple stories or poems; produces simple drawings or paintings)YesPartiallyNo11 to 12 Years83. Is left to care for self or others.* (is sometimes left alone and is successful in looking after own immediate needs or those of others who may be left in his care)YesPartiallyNo84. Enjoys reading books, newspapers, magazinesYesPartiallyNo85. Plays difficult games* (Participates in skilled games and sports as card games, Basket ball, tennis, hockey, badminton, understanding rules and methods of scoring)YesPartiallyNo12 to 15 Years86. Exercises complete care of dress.* (Includes washing and drying hair, care of nails, proper selection of clothing according to occasion and weather)YesPartiallyNo87. Buys own clothing accessories* (Selects and purchases minor articles of personal clothing with regard for appropriateness, cost and fit, such as ribbons, underwear, linen, shoes etc)YesPartiallyNo88. Engages in adolescent group activities.* (Is an active member of a cooperative group, athletic team, club, social or literary organization. Plans or participates in picnic trips, outdoor sports, etc.)YesPartiallyNo89. Performs responsible routine chores.* (Such as assisting in house – work, caring for garden cleaning car, washing window, waiting at table, bringing water.)YesPartiallyNo3 Months - 1. Birth cry present (Speech item)YesPartiallyNo3 Months - 2. Equal bilateral movementsYesPartiallyNo3 Months - 3. Responds to bellYesPartiallyNo3 Months - 4. Vocalises sound (Speech item)YesPartiallyNo3 Months - 5. Smiles spontaneouslyYesPartiallyNo3 Months - 6. Eyes follow moving objectYesPartiallyNo3 Months - 7. Head steadyYesPartiallyNo6 Months - 8. Reaches for objectsYesPartiallyNo6 Months - 9. Laughs aloud (Speech item)YesPartiallyNo6 Months - 10. Recognises motherYesPartiallyNo6 Months - 11. Vocalises for pleasure / babbles (Speech item)YesPartiallyNo6 Months - 12. Carries objects to mouthYesPartiallyNo6 Months - 13. Rolls overYesPartiallyNo9 Months - 14. Imitates speech sounds (Speech item)YesPartiallyNo9 Months - 15. Sits by selfYesPartiallyNo9 Months - 16. Thumb finger graspYesPartiallyNo9 Months - 17. Shows curiosityYesPartiallyNo1 Year - 18. Says 3 words, ‘dada’, ‘mama’ etc (Speech item)YesPartiallyNo1 Year - 19. Stands alone wellYesPartiallyNo1 Year - 20. Follows simple instructions (Speech item)YesPartiallyNo1 Year - 21. Cooperates for dressingYesPartiallyNo1 Year 6 Months- 22. Many intelligible words (Speech item)YesPartiallyNo1 Year 6 Months - 23. Walks, runs wellYesPartiallyNo1 Year 6 Months - 24. Indicates wantsYesPartiallyNo1 Year 6 Months - 25. Scribbles spontaneouslyYesPartiallyNo2 Years - 26. Says sentences of 2/3 words (Speech item)YesPartiallyNo2 Years - 27. Points out objects in picturesYesPartiallyNo2 Years - 28. Shows body partsYesPartiallyNo2 Years - 29. Participates in playYesPartiallyNo3 Years - 30. Copies 0YesPartiallyNo3 Years - 31. Relates experiences (Speech item)YesPartiallyNo3 Years - 32. Knows names, uses of common objectsYesPartiallyNo3 Years - 33. Begins to ask ‘why’?YesPartiallyNo3 Years - 34. Takes food by selfYesPartiallyNo3 Years - 35. Toilet control presentYesPartiallyNo4 Years - 36. Buttons upYesPartiallyNo4 Years - 37. Comprehends ‘hunger’, ‘cold’YesPartiallyNo4 Years - 38. Plays cooperatively with childrenYesPartiallyNo4 Years - 39. Repeats 3 digits (Speech item)YesPartiallyNo4 Years - 40. Tells stories (Speech item)YesPartiallyNo5 Years - 41. Defines words (Speech item)YesPartiallyNo5 Years - 42. Makes simple drawingsYesPartiallyNo5 Years - 43. Dresses with no supervisionYesPartiallyNo5 Years - 44. Describes actions in pictures (Speech item)YesPartiallyNo5 Years - 45. Gives sensible answers to questions (Speech item)YesPartiallyNo5 Years - 46. Goes about neighbourhoodYesPartiallyNo6 Years - 47. Can name primary coloursYesPartiallyNo6 Years - 48. Plays games governed by rulesYesPartiallyNo6 Years - 49. Writes simple words (Speech item)YesPartiallyNo6 Years - 50. Gains admission to schoolYesPartiallyNo6 Years - 51. Enjoys constructive playYesPartiallyNo7 Years - 52. Adapts to home schoolYesPartiallyNo7 Years - 53. Tells differences of objectsYesPartiallyNo7 Years - 54. Spells, reads, writes simple words (Speech item)YesPartiallyNo7 Years - 55. Enjoys group playYesPartiallyNo7 Years - 56. Knows comparative value of coinsYesPartiallyNo8 Years - 57. Combs hair by selfYesPartiallyNo8 Years - 58. Makes small purchasesYesPartiallyNo8 Years - 59. Competition in school / playYesPartiallyNo8 Years - 60. Tells timeYesPartiallyNo9 Years - 61. Tells day, month year (Speech item)YesPartiallyNo9 Years - 62. Reads on own initiative (Speech item)YesPartiallyNo9 Years - 63. Recognised property rightsYesPartiallyNo9 Years - 64. Favourite of fairy tales (Speech item)YesPartiallyNo9 Years - 65. Muscle coordination games (marbles)YesPartiallyNo9 Years - 66. Bathes self unaidedYesPartiallyNo10 Years - 67. Cooperates keenly with companionsYesPartiallyNo10 Years - 68. Has various hobbies, collectionsYesPartiallyNo10 Years - 69. Goes about town freelyYesPartiallyNo10 Years - 70. Sex differences in play become markedYesPartiallyNo10 Years - 71. Can stay away from home (camps)YesPartiallyNo11 Years - 72. Writes occasional short letters (Speech item)YesPartiallyNo11 Years - 73. Comprehends social situationsYesPartiallyNo11 Years - 74. Physical feats likedYesPartiallyNo11 Years - 75. Able to discuss problems (Speech item)YesPartiallyNo12 Years - 76. Enjoys books, newspapers, magazines (Speech item)YesPartiallyNo12 Years - 77. More independent in spendingYesPartiallyNo12 Years - 78. Capable of self criticismYesPartiallyNo13 Years - 79. Shows foresight, planning, judgementYesPartiallyNo13 Years - 80. Learns from experienceYesPartiallyNo13 Years - 81. Plays difficult gamesYesPartiallyNo13 Years - 82. Interested in dressing upYesPartiallyNo13 Years - 83. Understands abstract ideas (justice)YesPartiallyNo15+ Years - 84. Makes sensible plans for future (job)YesPartiallyNo15+ Years - 85. Follows current events (Speech item)YesPartiallyNo15+ Years - 86. Buys own clothingYesPartiallyNo15+ Years - 87. Systematises own workYesPartiallyNo15+ Years - 88. Purchases for othersYesPartiallyNoVSMS - Social AgeDST - Developmental AgeSend MessageSave as DraftPlease do not fill in this field.
