Section
A Questions for the parent
A1 Does your child enjoy being
swung,bounced on your knee, etc. ?
YES/NO
A2
Does your child take an interest in other children
? YES/NO
A3
Does your child like climbing on things, such as
stairs ? YES/NO
A4
Does your child enjoy playing peek-a-boo / hide and
seek ? YES/NO
A5
Does your child ever PRETEND , for example to make
a cup of tea using a toy cup and teapot, or pretend
other things ? YES/NO
A6
Does your child ever use his/her index finger to
point, to ASK for something.? YES/NO
A7
Does your child ever use his/her index finger to
point, to indicate INTEREST in something ?
YES/NO
A8
Can your child play properly with small toys (e.g.
cars or bricks) without just mouthing, fiddling or
dropping them ? YES/NO
A9
Does your child ever bring things to you (parent)
to SHOW you something. ? YES/NO
Section
B Health visitor or GP observation
Bi During the appointment has the
child made eye contact with you ? YES/NO
Bii
Get the childs attention, then point
across the room at an interesting object and say "
Oh look! There`s a (name of toy) " Watch the childs
face.
Does the child look across at what you are pointing
at ? YES/NO*
Biii
Get the childs attention, then give the child a
miniature tea pot and tea cup and say "Can you make
a cup of tea?"
Does the child pretend to pour out tea, drink it,
etc. ? YES/NO**
Biv
Say to the child "Where`s the light?", or "Show me
the light".
Does the child POINT with his/her index finger at
the light ? YES/NO***
Bv
Can the child build a tower of bricks ? If so how
many. (No of bricks.........) YES/NO
*
To record YES on this item ensure the child has not
simply looked at your hand but has actually looked
at the object you are pointing at.
**
If you can elicit an example of pretending in some
other game score a YES for this item.
***
Repeat this with "where`s the teddy?" or some other
unreachable object if the child does not understand
"light". To record YES on this item the child must
have looked up at your face around the time of
pointing.
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