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Self Assessment > Referral for 24 months and below

Referral for 24 months and below

*For every question please indicate yes or no
YesNoDoes the child
Uses 100 words or more
Uses at least two pronouns (e.g. "you", "me", "mine")
Consistently combines 2 to 4 words in short phrases (e.g. "Daddy hat", "Truck go down")
Words are understood by others half the time
Forms words and sounds easily and effortlessly
Follows two-step directions (e.g. "Go find your teddy and show it to grandma")
Enjoys being around and playing with other children (e.g. sharing or to offering toys to peers)
Begins to imitate peers; actions and words
Holds the book the right way up and turns pages one at a time
Pretends by acting out daily and special routines with toys (e.g. cooking a meal or a birthday party)
Can run or walk fast
Walks downstairs holding only onto parent's finger
Kicks ball forward
Tries to undress self (e.g. takes off / opens coat, pulls down pants)
Can throw a small ball overhand
Scribbles with crayons / marks paper
Feeds him / herself with a spoon, spilling little
YesNoHas anyone noticed whether the child
Has lost any previously obtained skills, language or social skills
Does not respond consistently or at all 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Is more withdrawn or more difficult to comfort than other children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
When eating, has sensitivity / aversions to different textures OR difficulty chewing or swallowing
Lacks interest in toys or typically play with them in an unusual or repetitive way (e.g. lining up, spinning, opening / closing parts rather than using the toy in the expected way)
Is preoccupied with unusual interests or topics (e.g light switches, doors, fans, trains)
Is preoccupied with unusual interests or topics (e.g. light switches, doors, fans, trains)
Shows an intense interest in letters or numbers and / or some ability to recognize untaught printed words
Moves his / her fingers, hands or body in an odd or repetitive way
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)