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Self Assessment > Referral for 18 months and below

Referral for 18 months and below

*For every question please indicate yes or no
YesNoDoes the child
Uses at least 20 words consistently even if not clear (e.g. labelling food, toys, people)
Makes at least 4 different consonant sounds (e.g. p, b, m, n, d, g, w, h)
Imitates words and gestures
Responds with words or gestures to simple questions (e.g. "where's teddy?", "what's that?")
Understands the concepts of "in & out", "off & on"
Points to three or more body parts when asked
Points to familiar pictures using one finger
Enjoys being read to and sharing simple books with you
Demonstrates some pretend play with toys (e.g. gives teddy a drink, pretends a bowl is a hat)
Walks alone (feet may have wide gait)
Walks up and down stairs with assistance
Climbs onto a low step, table or stool
Likes to retrieve and carry objects
Takes off own socks and hat
Stacks 3 blocks
Brings spoon to mouth in attempts to self feed
YesNoHas anyone noticed whether the child
Has lost any previously obtained skills
Has inconsistent / no response when name is called
Tries to get your attention to show you what they are interested in
Consistently points to what he / she wants when it is out of reach
Looks for a toy when asked where it is or you point to it
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Is more withdrawn or more difficult to comfort than other children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
When eating has sensitivity to different textures OR difficulty chewing or swallowing
Lacks interest in toys or typically plays with them in an unusual way (e.g. lining up, spinning, opening / closing parts rather than using the toy as a whole)
Shows an intense interest in letters or numbers to the exclusion of a more typical way of interacting with an object (e.g. focusing on the words rather than the pictures in a book, or on the letters written on an toy vs. the toy itself)
Performs activities in a special way / certain order and may have a temper tantrum if this activity is interrupted
Moves his / her fingers, hands or body in an odd or repetitive way
Echoes other people's phrases or sentences (e.g. parent say "Put on your shoes" child responds "Put on your shoes")
Talks in whole phrases or scripts from TV shows or books when these do not seem relevant to the situation
STUTTERS: Parents report child "stutters" using repetitions of words (e.g. "I I I" or syllables (e.g. "dadadaddy"), sound prolongations(e.g. mmmommmy) or blocks (e.g. "b---all"))
Has an unusual voice quality (e.g. nasal, hoarse, breathy)