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Self Assessment > Referral for 12 months and below

Referral for 12 months and below

*For every question please indicate yes or no
YesNoDoes the child
Follows simple 1-step directions e.g. "sit down"
Looks accross the room to a toy when adult points to it
Uses specific gestures to communicate (e.g. waves hi/bye, shakes head "no")
Uses three or more "words" (same sounds to indicate same object or person)
Brings / extends toys to you
Gets your attention using sounds, gestures and pointing while looking at your eyes
Consistently points to request
"Performs" for social attention and praise
Plays social games with you (e.g. "Peek-A-Boo", "patty cake")
Combines a lot of sounds together as though talking (e.g. "abada badu abee")
Shows interest in simple picture books
Turns pages of books a few at a time
Removes objects from containers (e.g. food, block, toys)
Helps a little while being dressed (e.g. extends arm to put in sleeve)
Lifts cup to mouth with two hands to drink
Picks up and eats finger foods
Stands alone for 2 seconds or more
Walks sideways holding on to furniture
Lowers self from standing with control, not falling on bottom
YesNoHas anyone noticed whether the child
Has lost any previously obtained skills
Has inconsistent / no response when name is called
Rarely engages socially (e.g. smiling, eye contact)
Is more withdrawn or more difficult to comfort than other children
Is more interested in looking at objects than people's faces
Has any difficulty with feeding, chewing or swallowing