DEVELOPMENTAL SCREENING TEST

CRF NO0- NAME AGE/SEX- Date:

ITEMS Years Months ITEMS Years Months Days

Days
Birth cry present 13 can name primary color 12
Equal bilateral movement 26 plays games govened by rules 24

Responds to bell 39 writes simple words

Vocalizes sounds gains admission to school
Smiles spontaneously enjoys constructive play 12
Eyes follow moving object 78 adapts to home, school 2

head steady M Tells differences of objects 24

Reaches for objects spells, reads, writes simple words 6

Laughs aloud 30 enjoys group play 8

Recognizes mother 45 knows comparative valuc of coins

Vocalizes for pleasure/babbles 60 combs hair by seif

-
Caried objects to mouth 75 makes small purchases
Rolls over 6M Competition in schoollplay
Imitates speech sounds tells time 8Y
Sits by self 46 tells day, month, ycar 2

Thumb finger grasp 68 reads on own initiative

Shows curiosity 9M Recognizes property rights
Says 3 words, 'dada', 'mama' etc 23 favorites of fairy tales
Stands alone well 46 muscle coordination games(marbles)
Follows simple instructions Bathes self unaided 9Y
Cooperates for dressing Cooperates keenly with companions 12
Many intelligible words has various hobbies, collections L4

Walks, runs well goes about town freely

Indicates wants sex differences in play become marked 18

Scribbles spontaneously 14Y can stay away from home 10Y
Says sentences of 2/3 worlds 15 writes occasional short letters
Points out objects in pictures comprehends social situations
Shows body parts 15 physical feats liked
participates in play able to discuss problem 11Y
Copies 0
enjoys books, newspapers, magazines
|Relates experiences more independent in spending

Knows names, uses ofcommon objects capable of self criticisn 12Y

Begins to ask "why'? shows foresight, planning, judement 12
Takes food by self TO Learms from experience 24
Toilet control present 3Y plays difficult games
Buttons up 2 interested in dressing up 9
Comprehends "hunger, 'cold 24 understands abstract ideas (justice) 13Y
Plays cooperatively with children makes sensible plans torfuture gob)
Repeats 3 digits 8 Follows current events
tells stories Y buys own clothing

Defines words systematizes own works

Makes simple drawings purchases for others 1SY

Dresses with no supervision
Describes action in pictures

Gives sensible answers to questions 10

goes about neighborhood 5Y

 VINELAND SOCIAL MATURITY SCALE
CRF NO: NAME AGE /SEX-

0-1 YEAR
49 perfo for others
"Crows", laughs 50 washes hands unaided
balances head
grasps objects within reach
4-5 YEAR
S1| cares for self at toilet
reaches for samiliar persons
52 washes face
unassisted
rolls over(unassisted)
53 goes about neighbourhood unattended
6 reaches for nearby objects
54 drcsses
self except for tying
occupies self unattended
55| uses pencil or crayon for drawing
Sits unsupported
S6 plays competitive cxcrcise games
pulls self upright
5-6 YEAR
"talks", imitates sound 57 uses hoops,flies kites,or uscs knife
drinks from glass or cup assisted
58 Simple words writes
12 moves about on
floor(crecping, crawling) 59| plays simple games which rcquire taking turn
13 grasps with thumb and finger 60 i s trusted with money
demands personal atention
61 gocs to school unattended
stands alone
6-7 YEAR
16 does not drool 62
mixes rice "properly"unassisstcd
17 follow simple instructions 63 uscs pencil or chalk for writing
1-2 YEAR 64
walk.s about room unattended
bathes selfassissted
65 gocs to bed unassisted
19 mark with pencil or crayon
7-8 YEAR
20 masticates (chews) solid or semi-solid food
66 tell time to quarter hour
21 pulls off clothes 67 helps himself during meal
22 transfers objects 68 understands and keeps family sccrets
23 overcomes simple obstacles 69 participates in pre-adolescents play
fetches or caries familiar objects
70 combs or brushes hairs
25 drinks from cup or glass un-assissted
8-9 YEAR
26
walks without support 71| uses tools or utensils
27
plays with other children 12 does routine household tasks
28 eats with own hands (biscuits,bread etc.) reads on own initiative
29 goes about house or yards 4 bathes self unaided
30 discriminates edible substances from non-edibles 9-10 YEAR
31 uses names of familiar objects 75 cares for self at meals
32 walks upstairs unassisted 76 makes minor purchases
33 unwraps sweets, chocolates 77 goes about home town freely
talks in short sentences
34
10-11YEAR
2-3 YEAR 78 distinguishes between friends and play mates
35 signals to go to toilet 79 makes independent choice of shops
36 initiates own play activities |80 does smallremunerative work;makes articles
removes shirt or frock if un-buttoned |81 follows local current events
eats with spoon/hands (food) 1-12 YEAR
39 gets drink (water) unassisted 82 does simple creative work
40 dnes own hands i s left to care for selfor others

avoids simple hazards enjoys reading books,newspapers and magazines

42 puts on shirt or frock un-assissted( need not button)
12-15 YEAR
43 can do paper folding 85 plays difficult games

44 relates experiences 86 excrcise complete care of dress

3-4 YEAR 87 buys own clothingaccessories

45 walks downstairs,one step at a time 88 engages in adolescent group activities
46 plays cooperatively at kindergarte level 89 performs responsible routine chores

47 buttons shirn or frock

48 helps at little household tasks

Social Quotient: Impression: Examiner