Emotion and Eye Gaze

1. Do you know when your child is happy and when your child is upset?
   • Not Yet
   • Sometimes
   • Often
2. When your child plays with toys, does he/she look at you to see if you are watching?
   • Not Yet
   • Sometimes
   • Often
3. Does your child smile or laugh while looking at you?
   • Not Yet
   • Sometimes
   • Often
4. When you look at and point to a toy across the room, does your child look at it?
   • Not Yet
   • Sometimes
   • Often

Communication

1. Does your child let you know that he/she needs help or wants an object out of reach?
   • Not Yet
   • Sometimes
   • Often
2. When you are not paying attention to your child, does he/she try to get your attention?
   • Not Yet
   • Sometimes
   • Often
3. Does your child do things just to get you to laugh?
   • Not Yet
   • Sometimes
   • Often
4. Does your child try to get you to notice interesting objects—just to get you to look at the objects, not to get you to do anything with them?
   • Not Yet
   • Sometimes
   • Often

Gestures

1. Does your child pick up objects and give them to you?
   • Not Yet
   • Sometimes
   • Often
2. Does your child show objects to you without giving you the object?
   • Not Yet
   • Sometimes
   • Often
3. Does your child wave to greet people?
   • Not Yet
   • Sometimes
   • Often
4. Does your child point to objects?
   • Not Yet
   • Sometimes
   • Often
5. Does your child nod his/her head to indicate yes?
   • Not Yet
   • Sometimes
   • Often

Sounds

1. Does your child use sounds or words to get attention or help?
   • Not Yet
   • Sometimes
   • Often
2. Does your child string sounds together, such as uh oh, mama, gaga, bye bye, dada?
   • Not Yet
   • Sometimes
   • Often
3. About how many of the following consonant sounds does your child use: ma, na, ba, da, ga, wa, la, ya, sa, sha?
   • None
   • 1–2
   • 3–4
   • 5–8
   • over 8

Words

1. About how many different words does your child use meaningfully that you recognize (such as baba for bottle; gaggie for doggie)?
   • None
   • 1–3
   • 4–10
   • 11–30
   • over 30
2. Does your child put two words together (for example, more cookie, bye bye Daddy)?
   • Not Yet
   • Sometimes
   • Often

Understanding

1. When you call your child’s name, does he/she respond by looking or turning toward you?
   • Not Yet
   • Sometimes
   • Often
2. About how many different words or phrases does your child understand without gestures? For example, if you say “where’s your tummy” “where’s Daddy,” “give me the ball,” or “come here,” without showing or pointing, your child will respond appropriately.
   • None
   • 1–3
   • 4–10
   • 11–30
   • over 30

Object Use

1. Does your child show interest in playing with a variety of objects?
   • Not Yet
   • Sometimes
   • Often
2. About how many of the following objects does your child use appropriately: cup, bottle, bowl, spoon, comb or brush, toothbrush, washcloth, ball, toy vehicle, toy telephone?
   • None
   • 1–2
   • 3–4
   • 5–8
   • over 8
3. About how many blocks (or rings) does your child stack?
   • None
   • 2 blocks
   • 3–4 blocks
   • 5 or more
4. Does your child pretend to play with toys (for example, feed a stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?
   • Not Yet
   • Sometimes
   • Often