• Ages & Stages

    Ages & Stages

  • Questionnaires

  • 17 months 0 days through 18 months 30 days 18Month Questionnaire

  • Please provide the following information. Use black or blue ink only and print legibly when completing this form.

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  • 17 months 0 days 18Month Questionnaire through 18 months 30 days

    On the following pages are questions about activities babies may do. Your baby may have already done some of the activities

    described here, and there may be some your baby has not begun doing yet. For each item, please fill in the circle that indi-

    cates whether your baby is doing the activity regularly, sometimes, or not yet.

  • 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

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  • FINE MOTOR

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  • PROBLEM SOLVING

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  • PERSONAL-SOCIAL

  • OVERALL

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  • Ages & Stages Questionnaires®, Third Edition (ASQ-3™),Squires & Bricker © 2009 Paul H. Brookes Publishing Co. All rights reserved.

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