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Child’s Age
2 - 2.5
3 - 3.5
4 - 4.5
5
I prefer not to enter my Child’s age
Yes
Child’s Gender
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OBSERVATION SKILLS:

This section tries to assess your child’s observation and cognitive skills. The questions here apply to all ages. All questions are mandatory

1.Your toddler usually looks at you when you call his/her name
Always
Usually
Sometimes
Rarely
Never
2.Your toddler usually makes eye contact when engaged in a conversation
Always
Mostly
Sometimes
Rarely
Never
3.How long do you think your toddler usually spends looking at a spinning object?
Several hours a day
More than 30 mins a day
Approx 10 to 15 minutes
Approx 2 to 5 minutes
Hardly
4.If you point at something, your toddler is usually able to follow where you are looking at, or what you are pointing to
Several times a day
Only few times a day
Several times a week
Less than 5 times a week
Hardly ever
5.Does your toddler make unusual finger movements in front of his/her eyes?
Very Frequently
Many times during the day
Sometimes
Rarely
Never
6.How would you rate your child’s sensitivity to noise?
7.Your toddler points at things to share that she/he might find interesting
Several times a day
Few times a day
Several times a week
Less than 5 times a week
Hardly
8.Your toddler can usually understand if you, or someone in the immediate family (your partner, siblings, etc) are visibly upset and she/he attempts to comfort you (or the other member)
Always
Usually
Only Sometimes
Rarely
Never
9.Your toddler is usually good at interpreting simple gestures and would return the same
Almost always
Few times a day
Several times a week
Less than 5 times a week
Hardly
10.Your toddler spontaneously looks at you when faced with an unfamiliar situation
Strongly agree
Slightly agree
Neither agree nor disagree
Slightly disagree
Strongly disagree
11.Is your child MORE than 3 years old?
Yes
No
12. Your toddler’s approximate vocabulary size (number of words your child can say) would be closest to which of the following.
>100
50-100
30-50
10-30
<10
Non Verbal

 COMMUNICATION SKILLS:

The aim of this section is to score your child’s communication skills. Some questions will automatically show/hide based on your child’s age. For example, certain questions may apply for 3 year olds but not a 2 year old toddler.

You and immediate family members can easily understand what your toddler may be trying to say (even though s/he may not have fully developed speech skills yet)
Always
Usually
Sometimes
Rarely
Never
13. Your toddler is adept at using sign language to point out what s/he wants
Several times a day
Few times everyday
Several times a week
Less than 4-5 times a week
Hardly ever
14. The best way to describe YOUR emotion when you heard your toddler’s first few words would be?
Level 1
Level 2
Level 3
Level 4
Level 5
15.Does your toddler have a habit of repeating words exactly the way they are told?
Several times a day
2 to 3 times a day
Several times a week
Less than 3 times a week
Hardly ever

BEHAVIOR, SENSORY & MOTOR SKILLS:

This area of evaluation targets the sensory functions, behavioral patterns and the motor skills that your child has. Scores are weighed based on the age of your toddler.


Your toddler always likes to line up his/her toys, or arrange them in ‘a’ specific order, every time!
Always
Usually
Sometimes
Rarely
Never
16.Your toddler is usually good at pretending while playing
Strongly agree
Slightly agree
Neither agree nor disagree
Slightly disagree
Strongly disagree
17.Your toddler has a habit of licking unusual objects or sniffing at things
Several times a day
2-3 times a day
Several times a week
2-3 times a week
Rarely
18.Your toddler is usually good at using his/her hands in the right way when he/she needs to do something
Several times a day
3 to 5 times a day
Several times a week
Less than 5 to 7 times a week
Hardly ever
19.Does your child do tiptoe and/or Flaps hand are regular frequencies?
Neither
Very Occasionally
Only Tiptoes
Only Hand Flaps
Tiptoes and Hand Flaps
20.How does your child react when there is a sudden change in plan or some objects are out of their usual place?
Level 1
Level 2
Level 3
Level 4
Level 5
21.Your toddler has an odd habit of doing the same thing over and over again
Strongly agree
Slightly agree
Neither agree nor disagree
Slightly disagree
Strongly disagree
22.For how long is your toddler’s interest maintained in just one or two objects that he/she can’t seem to get his/her mind off
Several hours a day
Approx 30 mins a day
About 10 mins
Normal
Very short attention span
23.Your toddler enjoys spending a lot of time twiddling objects repeatedly
Strongly agree
Slightly agree
Neither agree nor disagree
Slightly disagree
Strongly disagree
24. Your toddler spends time staring at something (or nothing) for too long without any apparent reason
Strongly agree
Slightly agree
Neither agree nor disagree
Slightly disagree
Strongly disagree

MISC QUESTIONS:

The questions asked in this section are used to fine tune the score accuracy.

Rate, in the order of preference, how your child wants to spend his/her free time.*

rank the priorities on 1 to 5, 5 being most preferred

Outdoors
1
2
3
4
5
Gadgets
1
2
3
4
5
Coloring
1
2
3
4
5
Music
1
2
3
4
5
By Him/Herself
1
2
3
4
5
Is your child toilet trained yet?
Yes
No
In which social setting is your child most comfortable?
With friends
Alone
Preschool/Daycare
With family
Select all the numbers that your toddler can CORRECTLY recognize?
Seven
Three
Zero
Nine
None
Select all the Geometrical shapes that your toddler can CORRECTLY identify?
Circle
Rectangle
Triangle
Cube
None
When your child is in a terrible mood, what works best to comfort him/her?
Hug
Gadgets
Sugar
Pets
Play
Which of these emoticons best describe your child’s usual mood?
Happy
Mischiveous
Neutral
Confused
Grumpy
Non Verbal