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problem checklist

Sample Problem Checklist

Sensory Processing Disorder Checklist:

Signs And Symptoms Of Dysfunction

The purpose of this sensory processing disorder checklist is to help parents and professionals who interact with children become educated about particular signs of sensory processing dysfunction.

It is not to be used as the absolute diagnostic criteria for labeling children with sensory processing disorder. But rather, as an educational tool and checklist for your own knowledge. Professionals who can diagnose this disorder have their own tools in addition to checklists to observe and test for sensory integration dysfunction.

As you go through this list, you may say, "Wow, my child has so many of these characteristics/behaviors, he must have a sensory processing disorder!!"

That MAY be true, and I want you to take it very seriously if you find a host of these to be characteristic of your child. But, then use this as a guide to speak with your doctor and an Occupational Therapist so you can clearly explain why you think your child may need help.

Or, you may go through the list and say,

"No big deal, so my child has some of these behaviors/characteristics, doesn't every child?"

Well, this may be true too and your child's behavior may fluctuate from day to day.

What we need to be concerned with is which symptoms your child shows, which category they are having difficulty with, how much it interferes with their or other's lives and what kind of impact it is having on their level of functioning. They may have a lot in one category and none in another or some in all categories. This will help target diagnosis and treatment.

Lastly, you may go through the list and say,

"Oh my gosh, that is what I have been dealing with my whole life".

Then I say, I'm so sorry you never got the help you needed! Perhaps we can start to work on it now.

Identifying and understanding this disorder is HUGE!

Please understand the "Five Caveats" that Carol Stock Kranowitz points out in her book, "The Out-Of-Sync Child" (1995), about using a checklist such as this. She writes:

1. "The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone."

2. "Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of every neurological dysfunction. "

3. "The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, instead, have an emotional problem."

4. "The child may be both hypersensitive and hyposensitive. For instance, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation."

5. "Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or by depriving it of, sensory stimulation."

Tactile Sense: input from the skin receptors about touch, pressure, temperature, pain, and movement of the hairs on the skin.

Signs Of Tactile Dysfunction: 

 1. Hypersensitivity To Touch (Tactile Defensiveness)

         ·            becomes fearful, anxious or aggressive with light or unexpected touch

         ·            as an infant, did/does not like to be held or cuddled; may arch back, cry, and pull away

         ·            distressed when diaper is being, or needs to be, changed

         ·            appears fearful of, or avoids standing in close proximity to other people or peers (especially in lines)

         ·             becomes frightened when touched from behind or by someone/something they can not see (such as under a blanket)

         ·             complains about having hair brushed; may be very picky about using a particular brush

         ·             bothered by rough bed sheets (i.e., if old and "bumpy")

         ·            avoids group situations for fear of the unexpected touch

         ·             resists friendly or affectionate touch from anyone besides parents or siblings (and sometimes them too!)

         ·             dislikes kisses, will "wipe off" place where kissed

         ·             prefers hugs

         ·             a raindrop, water from the shower, or wind blowing on the skin may feel like torture and produce adverse and avoidance reactions

         ·             may overreact to minor cuts, scrapes, and or bug bites

         ·             avoids touching certain textures of material (blankets, rugs, stuffed animals)

         ·             refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans, hats, or belts, etc.

         ·             avoids using hands for play

         ·             avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.

         ·             will be distressed by dirty hands and want to wipe or wash them frequently

         ·             excessively ticklish

         ·             distressed by seams in socks and may refuse to wear them

         ·             distressed by clothes rubbing on skin; may want to wear shorts and short sleeves year round, toddlers may prefer to be naked and pull diapers and clothes off constantly

         ·             or, may want to wear long sleeve shirts and long pants year round to avoid having skin exposed

         ·             distressed about having face washed

         ·             distressed about having hair, toenails, or fingernails cut

         ·             resists brushing teeth and is extremely fearful of the dentist

         ·             is a picky eater, only eating certain tastes and textures; mixed textures tend to be avoided as well as hot or cold foods; resists trying new foods

         ·             may refuse to walk barefoot on grass or sand

         ·             may walk on toes only

2. Hyposensitivity To Touch (Under-Responsive):

         ·            may crave touch, needs to touch everything and everyone

         ·             is not aware of being touched/bumped unless done with extreme force or intensity

         ·             is not bothered by injuries, like cuts and bruises, and shows no distress with shots (may even say they love getting shots!)

         ·             may not be aware that hands or face are dirty or feel his/her nose running

         ·             may be self-abusive; pinching, biting, or banging his own head

         ·             mouths objects excessively

         ·             frequently hurts other children or pets while playing

         ·             repeatedly touches surfaces or objects that are soothing (i.e., blanket)

         ·             seeks out surfaces and textures that provide strong tactile feedback

         ·             thoroughly enjoys and seeks out messy play

         ·             craves vibrating or strong sensory input

         ·             has a preference and craving for excessively spicy, sweet, sour, or salty foods

 

3. Poor Tactile Perception And Discrimination:

         ·            has difficulty with fine motor tasks such as buttoning, zipping, and fastening clothes

         ·             may not be able to identify which part of their body was touched if they were not looking

         ·             may be afraid of the dark

         ·             may be a messy dresser; looks disheveled, does not notice pants are twisted, shirt is half un tucked, shoes are untied, one pant leg is up and one is down, etc.

         ·             has difficulty using scissors, crayons, or silverware

         ·             continues to mouth objects to explore them even after age two

         ·             has difficulty figuring out physical characteristics of objects; shape, size, texture, temperature, weight, etc.

         ·             may not be able to identify objects by feel, uses vision to help; such as, reaching into backpack or desk to retrieve an item

Signs Of Vestibular Dysfunction:

1. Hypersensitivity To Movement (Over-Responsive):

          ·            avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-rounds

          ·             prefers sedentary tasks, moves slowly and cautiously, avoids taking risks, and may appear "wimpy"

          ·             avoids/dislikes elevators and escalators; may prefer sitting while they are on them or, actually get motion sickness from them

          ·             may physically cling to an adult they trust

          ·             may appear terrified of falling even when there is no real risk of it

          ·             afraid of heights, even the height of a curb or step

          ·             fearful of feet leaving the ground

          ·             fearful of going up or down stairs or walking on uneven surfaces

          ·             afraid of being tipped upside down, sideways or backwards; will strongly resist getting hair washed over the sink

          ·             startles if someone else moves them; i.e., pushing his/her chair closer to the table

          ·             as an infant, may never have liked baby swings or jumpers

          ·             may be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing on one foot (especially if eyes are closed)

          ·             may have disliked being placed on stomach as an infant

          ·             loses balance easily and may appear clumsy

          ·             fearful of activities which require good balance

          ·             avoids rapid or rotating movements

2. Hyposensitivity To Movement (Under-Responsive):

          ·            in constant motion, can't seem to sit still

          ·             craves fast, spinning, and/or intense movement experiences

          ·             loves being tossed in the air

          ·             could spin for hours and never appear to be dizzy

          ·             loves the fast, intense, and/or scary rides at amusement parks

          ·             always jumping on furniture, trampolines, spinning in a swivel chair, or getting into upside down positions

          ·             loves to swing as high as possible and for long periods of time

          ·             is a "thrill-seeker"; dangerous at times

          ·             always running, jumping, hopping etc. instead of walking

          ·             rocks body, shakes leg, or head while sitting

          ·             likes sudden or quick movements, such as, going over a big bump in the car or on a bike

3. Poor Muscle Tone And/Or Coordination:

         ·            has a limp, "floppy" body

         ·            frequently slumps, lies down, and/or leans head on hand or arm while working at his/her desk

         ·             difficulty simultaneously lifting head, arms, and legs off the floor while lying on stomach ("superman" position)

         ·             often sits in a "W sit" position on the floor to stabilize body

         ·             fatigues easily!

         ·            compensates for "looseness" by grasping objects tightly

         ·             difficulty turning doorknobs, handles, opening and closing items

         ·             difficulty catching him/her self if falling

         ·             difficulty getting dressed and doing fasteners, zippers, and buttons

         ·             may have never crawled as an baby

         ·             has poor body awareness; bumps into things, knocks things over, trips, and/or appears clumsy

         ·             poor gross motor skills; jumping, catching a ball, jumping jacks, climbing a ladder etc.

         ·             poor fine motor skills; difficulty using "tools", such as pencils, silverware, combs, scissors etc.

         ·             may appear ambidextrous, frequently switching hands for coloring, cutting, writing etc.; does not have an established hand preference/dominance by 4 or 5 years old

         ·             has difficulty licking an ice cream cone

         ·            seems to be unsure about how to move body during movement, for example, stepping over something

         ·             difficulty learning exercise or dance steps

Proprioceptive Sense: input from the muscles and joints about body position, weight, pressure, stretch, movement, and changes in position in space.

Signs Of Proprioceptive Dysfunction:

1. Sensory Seeking Behaviors:

·         seeks out jumping, bumping, and crashing activities

·          stomps feet when walking

·         kicks his/her feet on floor or chair while sitting at desk/table

·         bites or sucks on fingers and/or frequently cracks his/her knuckles

·          loves to be tightly wrapped in many or weighted blankets, especially at bedtime

·          prefers clothes (and belts, hoods, shoelaces) to be as tight as possible

·         loves/seeks out "squishing" activities

·         enjoys bear hugs

·          excessive banging on/with toys and objects

·         loves "roughhousing" and tackling/wrestling games

·          frequently falls on floor intentionally

·         would jump on a trampoline for hours on end

·          grinds his/her teeth throughout the day

·          loves pushing/pulling/dragging objects

·         loves jumping off furniture or from high places

·         frequently hits, bumps or pushes other children

·         chews on pens, straws, shirt sleeves etc.

2. Difficulty With "Grading Of Movement":

·         misjudges how much to flex and extend muscles during tasks/activities (i.e., putting arms into sleeves or climbing)

·          difficulty regulating pressure when writing/drawing; may be too light to see or so hard the tip of writing utensil breaks

·          written work is messy and he/she often rips the paper when erasing

·          always seems to be breaking objects and toys

·          misjudges the weight of an object, such as a glass of juice, picking it up with too much force sending it flying or spilling, or with too little force and complaining about objects being too heavy

·          may not understand the idea of "heavy" or "light"; would not be able to hold two objects and tell you which weighs more

·          seems to do everything with too much force; i.e., walking, slamming doors, pressing things too hard, slamming objects down

·          plays with animals with too much force, often hurting them

Signs Of Auditory Dysfunction: (no diagnosed hearing problem)

1. Hypersensitivity To Sounds (Auditory Defensiveness):

·         distracted by sounds not normally noticed by others; i.e., humming of lights or refrigerators, fans, heaters, or clocks ticking

·         fearful of the sound of a flushing toilet (especially in public bathrooms), vacuum, hairdryer, squeaky shoes, or a dog barking

·         started with or distracted by loud or unexpected sounds

·         bothered/distracted by background environmental sounds; i.e., lawn mowing or outside construction

·         frequently asks people to be quiet; i.e., stop making noise, talking, or singing

·         runs away, cries, and/or covers ears with loud or unexpected sounds

·          may refuse to go to movie theaters, parades, skating rinks, musical concerts etc.

·          may decide whether they like certain people by the sound of their voice

2. Hyposensitivity To Sounds (Under-Registers):

·         often does not respond to verbal cues or to name being called

·          appears to "make noise for noise's sake"

·          loves excessively loud music or TV

·         seems to have difficulty understanding or remembering what was said

·         appears oblivious to certain sounds

·         appears confused about where a sound is coming from

·         talks self through a task, often out loud

·         had little or no vocalizing or babbling as an infant

·         needs directions repeated often, or will say, "What?" frequently

Signs Of Oral Input Dysfunction:

1. Hypersensitivity To Oral Input (Oral Defensiveness):

·         picky eater, often with extreme food preferences; i.e., limited repertoire of foods, picky about brands, resistive to trying new foods or restaurants, and may not eat at other people's houses)

·         may only eat "soft" or pureed foods past 24 months of age

·         may gag with textured foods

·         has difficulty with sucking, chewing, and swallowing; may choke or have a fear of choking

·         resists/refuses/extremely fearful of going to the dentist or having dental work done

·         may only eat hot or cold foods

·         refuses to lick envelopes, stamps, or stickers because of their taste

·         dislikes or complains about toothpaste and mouthwash

·         avoids seasoned, spicy, sweet, sour or salty foods; prefers bland foods

2. Hyposensitivity To Oral Input (Under-Registers)

·         may lick, taste, or chew on inedible objects

·         prefers foods with intense flavor; i.e., excessively spicy, sweet, sour, or salty

·         excessive drooling past the teething stage

·         frequently chews on hair, shirt, or fingers

·         constantly putting objects in mouth past the toddler years

·         acts as if all foods taste the same

·         can never get enough condiments or seasonings on his/her food

·         loves vibrating toothbrushes and even trips to the dentist

Signs Of Olfactory Dysfunction (Smells):

1. Hypersensitivity To Smells (Over-Responsive):

·         reacts negatively to, or dislikes smells which do not usually bother, or get noticed, by other people

·          tells other people (or talks about) how bad or funny they smell

·          refuses to eat certain foods because of their smell

·          offended and/or nauseated by bathroom odors or personal hygiene smells

·         bothered/irritated by smell of perfume or cologne

2. Hyposensitivity To Smells (Under-Responsive):

·         has difficulty discriminating unpleasant odors

·         may drink or eat things that are poisonous because they do not notice the noxious smell

·         unable to identify smells from scratch 'n sniff stickers

·         does not notice odors that others usually complain about

Signs Of Visual Input Dysfunction (No Diagnosed Visual Deficit):

1. Hypersensitivity To Visual Input (Over-Responsiveness)

·         sensitive to bright lights; will squint, cover eyes, cry and/or get headaches from the light

·          has difficulty keeping eyes focused on task/activity he/she is working on for an appropriate amount of time

·         easily distracted by other visual stimuli in the room; i.e., movement, decorations, toys, windows, doorways etc.

·         has difficulty in bright colorful rooms or a dimly lit room

·         rubs his/her eyes, has watery eyes or gets headaches after reading or watching TV

·         avoids eye contact

·         enjoys playing in the dark

2. Hyposensitivity To Visual Input (Under-Responsive Or Difficulty With Tracking, Discrimination, Or Perception):

·         has difficulty telling the difference between similar printed letters or figures; i.e., p & q, b & d, + and x, or square and rectangle

·          has a hard time seeing the "big picture"; i.e., focuses on the details or patterns within the picture

·         has difficulty locating items among other items; i.e., papers on a desk, clothes in a drawer, items on a grocery shelf, or toys in a bin/toy box

·         often loses place when copying from a book or the chalkboard

·         difficulty controlling eye movement to track and follow moving objects

·         has difficulty telling the difference between different colors, shapes, and sizes

·         often loses his/her place while reading or doing math problems

·         makes reversals in words or letters when copying, or reads words backwards; i.e., "was" for "saw" and "no" for "on" after first grade

·         complains about "seeing double"

·         difficulty finding differences in pictures, words, symbols, or objects

Auditory-Language Processing Dysfunction:

·         unable to locate the source of a sound

·         difficulty identifying people's voices

·         difficulty discriminating between sounds/words; i.e., "dare" and "dear"

·         difficulty filtering out other sounds while trying to pay attention to one person talking

·         bothered by loud, sudden, metallic, or high-pitched sounds

·         difficulty attending to, understanding, and remembering what is said or read; often asks for directions to be repeated and may only be able to understand or follow two sequential directions at a time

Social, Emotional, Play, And Self-Regulation Dysfunction:

Social:

·         difficulty getting along with peers

·          prefers playing by self with objects or toys rather than with people

·          does not interact reciprocally with peers or adults; hard to have a "meaningful" two-way conversation

·          self-abusive or abusive to others

·         others have a hard time interpreting child's cues, needs, or emotions

·         does not seek out connections with familiar people

Emotional:

·         difficulty accepting changes in routine (to the point of tantrums)

·         gets easily frustrated

·         often impulsive

·         functions best in small group or individually

·         variable and quickly changing moods; prone to outbursts and tantrums

·         prefers to play on the outside, away from groups, or just be an observer

·         avoids eye contact

·         difficulty appropriately making needs known

Play:

·         difficulty with imitative play (over 10 months)

·         wanders aimlessly without purposeful play or exploration (over 15 months)

·         needs adult guidance to play, difficulty playing independently (over 18 months)

·         participates in repetitive play for hours; i.e., lining up toys cars, blocks, watching one movie over and over etc.

Self-Regulation:

·         excessive irritability, fussiness or colic as an infant

·          can't calm or soothe self through pacifier, comfort object, or caregiver

·         can't go from sleeping to awake without distress

·         requires excessive help from caregiver to fall asleep; i.e., rubbing back or head, rocking, long walks, or car rides

Internal  Regulation (The Interoceptive Sense):

·         becoming too hot or too cold sooner than others in the same environments; may not appear to ever get cold/hot, may not be able to maintain body temperature effectively

·         difficulty in extreme temperatures or going from one extreme to another (i.e., winter, summer, going from air conditioning to outside heat, a heated house to the cold outside)

·         respiration that is too fast, too slow, or cannot switch from one to the other easily as the body demands an appropriate respiratory response

·         heart rate that speeds up or slows down too fast or too slow based on the demands imposed on it

·         respiration and heart rate that takes longer than what is expected to slow down during or after exertion or fear

·         severe/several mood swings throughout the day (angry to happy in short periods of time, perhaps without visible cause)

·         unpredictable state of arousal or inability to control arousal level (hyper to lethargic, quickly, vacillating between the two; over stimulated to under stimulated, within hours or days, depending on activity and setting, etc.)

·         frequent constipation or diarrhea, or mixed during the same day or over a few days

·         difficulty with potty training; does not seem to know when he/she has to go (i.e., cannot feel the necessary sensation that bowel or bladder are full

·         unable to regulate thirst; always thirsty, never thirsty, or oscillates back and forth

·         unable to regulate hunger; eats all the time, won't eat at all, unable to feel full/hungry

 

A Child Developmental Checklist:
Find Out When Early InterventionOr Developmental Therapy
May Be Needed

Below you will find a child developmental checklist for children ages 0-3. It is written in the form of a child NOT meeting infant/toddler developmental milestones. In other words, these are the "Red Flags" that may indicate some sort of developmental delay.

This list is broken up into different categories (i.e. fine motor, gross motor, social/emotional etc.) and can be used to help you determine if an early intervention/developmental therapy and referral is needed.
As I described in my sensory stimulation for infants and toddlers article , early intervention is a FREE program designed for children ages 0-3 as part of the educational system, and is available to all parents and children in every community. It is a program that addresses any current or possible developmental delays in children. All children are entitled to these services if any medical or developmental issue is present, or if their social, economic, or environmental conditions put them "at risk" for a possible delay.
Every child develops at a different rate, and variability in obtaining skills is seen across the board. If a child is expected to have twenty-five skills in a specific area of development at 18 months of age, missing one or two does not necessarily mean that a problem exists. However, as a caregiver for children, it is important to be able to recognize when a child may need further intervention.
The following lists are to give a generalized idea of different skill areas to look at, and when an early intervention referral and developmental therapy may be appropriate.

---

*Red Flags*
That May Warrant An Early Intervention Referral

---

Gross Motor

If a child is...

·  Not rolling by 7 months of age

·  Not pushing up on straight arms, lifting his head and shoulders, by 8 months of age

·  Not sitting independently by 10 months of age

·  Not crawling ("commando" crawling--moving across the floor on his belly) by 10 months of age

·  Not creeping (on all fours, what is typically called "crawling") by 12 months of age

·  Not sitting upright in a child-sized chair by 12 months of age

·  Not pulling to stand by 12 months of age

·  Not standing alone by 14 months of age

·  Not walking by 18 months of age

·  Not jumping by 30 months of age

·  Not independent on stairs (up and down) by 30 months of age


Here are some other gross motor "red flags":

·  "walking" their hands up their bodies to achieve a standing position

·  only walking on their toes, not the soles of their feet

·  frequently falling/tripping, for no apparent reason

·  still "toeing in" at two years of age

·  unusual creeping patterns

·  any known medical diagnosis can be considered a "red flag": Down's syndrome, cerebral palsy, congenital heart condition etc.

Fine Motor

If a child is...

·  Frequently in a fisted position with both hands after 6 months of age

·  Not bringing both hands to midline (center of body) by 10 months of age

·  Not banging objects together by 10 months of age

·  Not clapping their hands by 12 months of age

·  Not deliberately and immediately releasing objects by 12 months of age

·  Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age

·  Still using a fisted grasp to hold a crayon at 18 months of age

·  Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age

·  Not imitating a drawing of a vertical line by 24 months of age

·  Not able to snip with scissors by 30 months


Here are some other fine motor "red flags":

·  Using only one hand to complete tasks

·  Not being able to move/open one hand/arm

·  Drooling during small tasks that require intense concentration

·  Displaying uncoordinated or jerky movements when doing activities

·  Crayon strokes are either too heavy or too light to see

·  Any know medical diagnosis can be considered a "red flag": Down's Syndrome, cerebral palsy etc.

Cognition/Problem Solving

If a child is...

·  Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)

·  Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)

·  Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth)

·  Not able to match two sets of objects by color by 31 months of age

·  Having difficulty problem solving during activities in comparison to his/her peers

·  Unaware of changes in his/her environment and routine

 

Sensory

If a child is...

·  Very busy, always on the go, and has a very short attention to task

·  Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)

·  A picky eater

·  Not aware of when they get hurt (no crying, startle, or reaction to injury)

·  Afraid of swinging/movement activities; does not like to be picked up or be upside down

·  Showing difficulty learning new activities (motor planning)

·  Having a hard time calming themselves down appropriately

·  Appearing to be constantly moving around, even while sitting

·  Showing poor or no eye contact

·  Frequently jumping and/or purposely falling to the floor/crashing into things

·  Seeking opportunities to fall without regard to his/her safety or that of others

·  Constantly touching everything they see, including other children

·  Hypotonic (floppy body, like a wet noodle)

·  Having a difficult time with transitions between activity or location

·  Overly upset with change in routine

·  Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.

·  Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.

NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Possible visual problems may exist if the child...

·  Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes

·  Does not reach for an object close by


Possible hearing problems may exist if the child...

·  Does not respond to sounds or to the voices of familiar people

·  Does not attend to bells or other sound-producing objects

·  Does not respond appropriately to different levels of sound

·  Does not babble

Self-Care

If a child is...

·  Having difficulty biting or chewing food during mealtime

·  Needing a prolonged period of time to chew and/or swallow

·  Coughing/choking during or after eating on a regular basis

·  Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)

·  Having significant difficulty transitioning between different food stages

·  Not feeding him/herself finger foods by 14 months of age

·  Not attempting to use a spoon by 15 months of age

·  Not picking up and drinking from a regular open cup by 15 months of age

·  Not able to pull off hat, socks or mittens on request by 15 months of age

·  Not attempting to wash own hands or face by 19 months

·  Not assisting with dressing tasks (excluding clothes fasteners) by 22 months

·  Not able to deliberately undo large buttons, snaps and shoelaces by 34 months

Social/Emotional/Play Skills

If a child is...

·  Not smiling by 4 months

·  Not making eye contact during activities and interacting with peers and/or adults

·  Not performing for social attention by 12 months

·  Not imitating actions and movements by the age of 24 months

·  Not engaging in pretend play by the age of 24 months

·  Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)