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Self Assessment > Referral for 30 months and below

Referral for 30 months and below

*For every question please indicate yes or no
YesNoDoes the child
Uses 350 words or more
Speaks in sentences of at least 3 words
Uses some adult word-endings (e.g. "two cookies," "bird flying," "I jumped")
Uses action words (e.g. "run," "spill," "fall")
Listens to and understands simple stories and retells familiar stories
Understands concept of size (big vs little), quantity (a little vs a lot)
Uses consonant sounds at the beginning of the words (e.g. big, potty, donut)
Produces words with two or more syllables or beats (e.g. "ba-na-na", "a-pple", "com-pu-ter")
Begins taking short turns with peers, using both words and toys
Shows concern when another child is hurt or sad
Pretend play involves several actions (e.g. feeds doll and then puts her sleep)
Tries to join with you when you sing songs or make rhymes
Recognizes self in mirror or photo
Opens the door by turning the knob
Copies vertical / horizontal line
Can walk up and down the stairs without holding onto wall or railing
Dresses self with a little help
Feeds self with little mess using spoon or fork
Jumps with both feet on the floor
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Is more withdrawn or more difficult to comfort than other children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 the objects than people's faces
Has difficulty with feeding, chewing or swallowing
Lack interest toys or typically plays them in an unsusual or repetitive way (e.g. lining up, spinning, opening / closing parts rather than using toy in expected way)
Performs activities in a specific way / certain order and may have temper tantrum if this activity is interrupted
Moves his / her finger, hands or body in odd or repetitive way
Echoes other people's phrases or sentences (e.g. parents says "Put on your shoes," child responds with "Put on your shoes")
Talks to whole phrases or scripts from TV shoes 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)