Virtual Service Coordination & Family Assessment: Setting the Stage for Functional IFSP Development DAY 2

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Walk-A-Bout 2 Notes Page 3 ASQ3 and ASQ:SE-2 Comparison 4 ASQ:SE-2 Behavioral Area 5 Identifying the ASQ:SE-2 Behavioral Areas 6 Table 3.3 ASQ:SE-2 Users Guide 7-9 ASQ:SE-2 Response Sheet - 12 months 10-11 Vidar Intake Social History Summary Form pages 1-2 12-13 Vidar ASQ:SE-2 14-19 Blank Intake Social History Summary Form 20-22 Factors to Consider Before Beginning the Referral Process 23-24 ASQ:SE-2 Parent Activity Sheets 25-29 ASQ:SE-2 Is… 30

Updated 10/2020

Walk-a-bout

My Notes & Next Steps

ASQ3 & ASQ:SE-2 Comparison

ASQ:SE-2 Behavioral Areas (Taken from the ASQ:SE-2 User’s Guide)

Self-regulation –

Compliance –

Communication –

Adaptive functioning –

Autonomy –

Affect –

Interaction with people –

Identifying The ASQ:SE-2 Behavioral Areas Match the ASQ:SE-2 Item from the 24 month Questionnaire into the corresponding

ASQ-SE:2 behavioral area.

A. Does your child look at you when you talk to him? B. Is your child too worried or fearful? If sometimes, often or always, please

describe. C. When you leave, does your child stay upset and cry for more than an hour? D. Does your child have trouble falling asleep at naptime or at night? E. Does your child follow simple directions? For example, does she sit down when

asked? F. Does your child get constipated or have diarrhea? G. Does your child like to be hugged or cuddled?

Self Regulation

Compliance

Communication

Adaptive Functioning

Autonomy

Affect

Interaction with people

12 Month Item Response Sheet 9months0daysthrough 14months30days (•ASQ=SE-2)

Baby's name: ___________________ _ Date ASQ:SE-2 completed: ____________ _

Baby's ID#: Baby's date of birth: ________________ _

Person who completed ASQ:SE-2: __________ _ Baby's age/adjusted age in months and days: _______ _

Administering program/provider: ___________ _ Baby's gender: QMale QFemale

This optional sheet is intended for program use only and should not be used for questionnaire completion.

To record item responses: 1. Transfer item response points to the Item score column. 2. Enter 5 points in the Concern score column for each item checked as a Concern. 3. Circle YES or no for Overall items. 4. Record any item comments or notes.

Item Item Concern

Item score key: Z=O

V=S

X= 10

Concern score key: No Concern marked = 0

Concern marked = 5

no. Item description score score Comments/notes

1. Laughs or smiles at you and family members?

2. Looks for you when stranger comes near?

3. Likes to play near or be with family and friends?

4. Likes to be picked up and held?

5. Calms within half hour when upset?

6. Stiffens and arches back when picked up?

7. Likes to play games such as Peekaboo?

8. Body relaxed?

9. Cries, screams, or has tantrums for long periods?

10. Can calm self?

11. Interested in things (people, toys, and foods)?

12. Feeding takes longer than 30 minutes?

13. Enjoy mealtimes together?

14. Eating problems?

15. Trouble falling asleep at naptime or night?

16. Makes babbling sounds?

17. Sleeps at least 10 hours in a 24-hour period?

P201120100C Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASO:SE-2™), Squires, Bricker, & Twombly.

© 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved.

(continued}

page 1 of 2

1 2 Month Questionnaire 9months0daysthrough 14months30days (�ASQ:SE-2] Ouestions about behaviors babies may have are listed on the following pages. Please read each question carefully and check the box� that best describes your baby's behavior. Also, check the circle G'.5 if the behavior is a concern.

Important Points to Remember:

0

0

0

1.

2.

3.

4.

5.

6.

7.

Answer questions based on what you know about your baby's behavior. Answer questions based on your baby's usual behavior, not behavior when your baby is sick, very tired, or hungry. Caregivers who know the baby well and spend more than

0

0

0

15-20 hours per week with the baby should complete ASO:SE-2.

Does your baby laugh or smile at you and other family members? r:r:-;

, r

, t

Does your baby look for you when a stranger comes near?

Does your baby like to play near or be with family and friends?

Does your baby like to be picked up and held?

When upset, can your baby calm down within a half hour?

Does your baby stiffen and arch her back when picked up?

Does your baby like to play games such •'ft Cl� as Peekaboo? /2�--� (jj1 ;7"1j\ l \

o�� -�CJ

Please return this questionnaire by: _______ _ If you have any questions or concerns about your baby or about this questionnaire, contact: ______ _ Thank you and please look forward to filling out another ASO:SE-2 in ____ months .

: CHECK IF

OFTEN OR ' SOME- RARELY OR THIS IS A

ALWAYS TIMES NEVER CONCERN

Dz Dv Ox Qv ·-·--

Dz Ov Ox Qv ··--

Dz Dv Ox Qv --

Dz Ov Ox Qv --

Dz ' Dv Ox Qv

---

'

Ox Ov Dz Qv ---·

: Dz '

Ov Ox Qv ' --' ' ' ' ' ' ' : : ' '

'

' '

' ' :

'

TOTAL POINTS ON PAGE

P201120100 Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASO:SE-2™), Squires, Bricker, & Twombly.

© 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved. page 1 of 4

1 2 Month Information Summary 9months0daysthrough 14months30days (�ASQ=SE-2] Baby's name: ___________________ _ Date ASO:SE-2 completed: ____________ _

Baby's ID#: Baby's date of birth: _______________ _

Person who completed ASO:SE-2: ___________ _ Baby's age/adjusted age in months and days: ______ _

Administering program/provider: ___________ _ Baby's gender: QMale QFemale

1. ASQ:SE-2 SCORING CHART:TOTAL POINTS ON PAGE 1

• Score items (Z = 0, V = 5, X = 10, Concern= 5). Cutoff Total score

• Transfer the page totals and add them for the total score. TOTAL POINTS ON PAGE 2

• Record the baby's total score next to the cutoff. i i

TOTAL POINTS ON PAGE 3 50

I Total score

2. ASO:SE-2 SCORE INTERPRETATION: Review the approximate location of the baby's total score on the scoring graphic. Then, check off the area for the score results below.

no or low risk 40

monitor refer ------> lS+ 5o (90%ile)

__ The baby's total score is in the CJ area. It is below the cutoff. Social-emotional development appears to be on schedule. __ The baby's total score is in the CJ area. It is close to the cutoff. Review behaviors of concern and monitor. __ The baby's total score is in the - area. It is above the cutoff. Further assessment with a professional may be needed.

3. OVERALL RESPONSES AND CONCERNS: Record responses and transfer parent/caregiver comments. YES responses require follow-up.

1-27. Any Concerns marked on scored items?

28. Eating/sleeping concerns?

29. Other worries?

YES

YES

YES

no Comments:

no Comments:

no Comments:

4. FOLLOW-UP REFERRAL CONSIDERATIONS: Mark all as Yes, No, or Unsure (Y, N, U). See pages 98---103 in the ASQ:SE-2 User's Guide.__ Setting/time factors (e.g., Is the baby's behavior the same at home as at school?)

__ Developmental factors (e.g., Is the baby's behavior related to a developmental stage or delay?)

__ Health factors (e.g., Is the baby's behavior related to health or biological factors?)

__ Family/cultural factors (e.g., Is the baby's behavior acceptable given the baby's cultural or family context? Have there been any stressful events in the baby's life recently?)

__ Parent concerns (e.g., Did the parent/caregiver express any concerns about the baby's behavior?)

5. FOLLOW-UP ACTION: Check all that apply. Provide activities and rescreen in months.

__ Share results with primary health care provider.

__ Provide parent education materials.

__ Provide information about available parenting classes or support groups.

__ Have another caregiver complete ASO:SE-2. List caregiver here (e.g., grandparent, teacher): ___________ _

__ Administer developmental screening (e.g., ASO-3).

__ Refer to early intervention/early childhood special education.

__ Refer for social-emotional, behavioral, or mental health evaluation.

Other:

P201120500 Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASO:SE-2™), Squires, Bricker, & Twombly.

© 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved.

R11/01/2015 Page 1 of 3

CHILD & FAMILY CONNECTIONS

INTAKE/SOCIAL HISTORY SUMMARY SHEET

Child’s Last Name, First Name & Middle Initial:

Child’s Date of Birth (Month/Date/Year): Date of Intake:

Chronological Age (CA): Months Days Adjusted Age (AA): Months Days

CFC #: Name of Service Coordinator:

Name of Person Completing Intake:

I. REFERRAL INFORMATION REVIEW

Review the reasons(s) for referral with the family member(s): Does the family agree or disagree? Summarize discussion below:

II. OTHER PERSONS RESIDING IN HOUSEHOLD WITH CHILD

Please list all members of child’s immediate family and other persons living in the same household and provide the information requested below (also enter this in PA16 in Cornerstone):

Family Member Name Relationship Date of Birth Occupation- Place of Employment/ Grade in School

Other Comments

Mother

Father

Is there a history of medical or developmental problems in either the mother or father’s side of the family that may be important for us to know with respect to your child?

Yes No

If yes, please explain.

R11/01/2015

Page 2 of 3

III. PRIMARY MEDICAL CARE

Primary Care Physician:

Physician’s Name Phone #

Specialty Physician Phone #

Reason to see specialist and results of visit:

Specialty Physician Phone #

Reason to see specialist and results of visit:

Specialty Physician Phone #

Reason to see specialist and results of visit:

Specialty Physician Phone #

IV. HEALTH HISTORY SINCE BIRTHHow has your child’s health been since birth? (include discussion of illnesses, hospitalizations, long-term medications, etc.):

Prescribed Medications: Reason Taken:

Adaptive Equipment: Reason Needed:

V. SCREENING & ASSESSMENT HISTORY

Please list dates of previous screening, assessments or other tests (including birth and developmental screening, vision and hearing, etc): Date Test Administered By Whom? Results/Comments

New Born Hearing Screening Passed: Yes No

Date Test Administered By Whom? Results/Comments Additional Hearing Tests

Vision

R11/01/2015

Page 3 of 3

VI. BIRTH AND PREGNANCY INFORMATION

Please complete the EI20 and PA11 in Cornerstone

VII. RESULTS OF ROUTINE BASED INTERVIEW AND ASQ:SESTRENGTHS: Objective Observations, Parent Statements About Support Systems, Use of Other Resources, Parent/Child Interaction, Knowledge/Understanding of Child’s Needs, etc.

SUPPORTS AND RESOURCES: (List all supports and resources available to the family including childcare (Home, Center or Relative), Extended Family, Church, Community Playgroups, WIC, All Kids/Medicaid, Respite Care, Health Department, etc.)

FAMILY ROUTINES: List Important Family Routines Including Satisfaction and Struggles with those Routines: (NOTE: This should be a Summary of Routines that are most important and have the highest priorities For Each Family. Same routines such as bed or bath time will differ in importance and priority across families).

DEVELOPMENTAL CONCERNS, ISSUES and PRIORITIES: Parental Concerns/Issues identified through conversation/ ASQ:SE/RBI, Objective Statements of SC Observations, Family Priorities as Related to Their Child’s Development, etc.

ASQ-SE Concerns: Yes No

Evaluations Needed: DT ST PT OT SW Psych

Other:

Factors to Consider Before Beginning the Referral Process Factors to consider

before referral Sample questions Examples of follow-up action options

Setting/time Does the child act the same way at home and in child care or preschool? (i.e., Is the behavior consistent across settings?) How long has the problem behavior been occurring?

Is the setting new or unfamiliar to the child or family?

Is the setting a good match for the child’s temperament (e.g., large versus small child care settings)?

Where, when, and under what environmental conditions does the behavior occur?

Is the child being reinforced for this behavior or gaining access to reinforcers, such as preferred foods or activities, special time with a parent or teacher, or time alone?

Have another caregiver complete ASQ:SE-2 to determine the consistency of behavior across settings. If the child’s behavior is not consistent, consider developing a behavior support plan in the setting where the behavior is problematic.

Analyze caregiving environments to determine in what ways the environment is supporting or compromising the child’s positive behaviors. (See Appendix F for examples of environmental assessments.)

Provide parenting support and education to the parent in the home environment.

Conduct a functional behavioral analysis (Dunlap et al., 2014) to determine the function of the behavior for the child. Use the results to create a positive behavior support plan for the child. (See Appendix F for examples.)

Refer the child for an early childhood behavioral or mental health evaluation if concerns persist.

Development Is the behavior related to a developmental stage? Are individual factors (e.g., temperament) related to the child’s behavior?

Can the behavior be attributed to a developmental delay or a sensory processing disorder?

Are the child’s skills at age level in the following domains?

• Fine and gross motor• Cognitive/problem solving• Personal-social• Expressive and receptive communication

Provide developmental information (e.g., ASQ:SE-2 Social-Emotional Development Guides and Activities in Appendix E), positive behavior management suggestions, and so forth.

Screen the child using a developmental screening tool such as ASQ-3.

Refer the child to local Part C (early intervention) or Part B (early childhood special education) agency if concerned and/or if developmental screening tool indicates a need for further evaluation.

Refer the child for an early childhood behavioral or mental health evaluation if concerns persist.

Health Is the child’s behavior related to health or biological factors?

Has the child had a recent medical checkup?

Have the following been considered as behavioral influences?

• Lack of sleep or hunger• Medications or allergies• Exposure to drugs in utero

Refer the child to his or her primary health care provider. Address behavior of concern to determine if there is a biological/medical cause, and make referrals or provide follow-up as indicated within the health system.

Keep in close contact with the family regarding all aspects of the child’s health.

Refer the child for an early childhood behavioral or mental health evaluation if concerns persist.

Family/culture What is the child’s home (native) language? Is the “problem” behavior within the cultural norm for this child’s family? Is the parent–child relationship influencing the child’s ASQ:SE-2 results? Has the child been affected by stressful or traumatic events (ongoing, past, or present)?

• Has the child witnessed violence in the home or in the community?

• Has the child been involved in abusive or neglectful situations?

• Has the child recently been moved from his or her home?

• Are there family issues that are stressful (e.g., parent mental health issues, drug and alcohol issues)?

Determine if language or translation issues may be influencing parent responses to items (e.g., misunderstanding the intent of items). Talk to family members about the behavior and whether they consider it to be problematic. Work with the family to determine appropriate follow- up action. Seek advice from community health workers or “cultural brokers” (i.e., professionals who are familiar with or a member of the culture of the family) to determine if the behavior is within the cultural “norm.” Use a professionally administered parent–child interaction measure (see Appendix F). Support the parent’s understanding of responses to the social-emotional needs of the young child. If necessary, refer the child to early childhood mental health specialists to assess needs and provide therapeutic services to the parent–child dyad. If the child recently has moved to a new caregiving environment that is safe and nurturing, it may be appropriate to wait a short time before referring. If the child is in an unsafe or neglectful environment, refer to child protective or other services. Refer the child for an early childhood behavioral or mental health evaluation if concerns persist.

Parent concerns Did the parent or caregiver express any concerns about the child’s behavior? What is the intensity and frequency of the behavior of concern? Is the behavior of concern typical or atypical given the child’s developmental stage? Are individual factors of parent or child (e.g., temperament) related to the parent’s concern about the child’s behavior?

Obtain more information from the parent or caregiver about any concerns noted on ASQ:SE-2; ask, “Can you tell me more about?” Provide developmental information (e.g., ASQ:SE-2 Social-Emotional Development Guides and Activities in Appendix E, ASQ:SE-2™ Learning Activities), parenting education or support, and so forth. Listen carefully to all parent concerns. Support the parent in identifying and accessing resources and supports within the community to address any priority concerns (e.g., support agencies to access basic needs such as housing/food, quality child care, respite care, drug/alcohol counseling, adult mental health counseling). Refer the child for an early childhood behavioral or mental health evaluation if concerns persist and are atypical for the child’s age.

Excerpted from the Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™) User’s Guide, Squires, Bricker, & Twombly.

© 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Activities1HELP YOUR CHILD LEARN AND GROW!

Try these fun and easy activities with your 1-year-old—a great way to have fun together and encourage your child’s healthy development.

AGE

Babies love games at this age(Pat-a-Cake, This Little Piggy).

Try different ways of playing thegames and see if your baby will tryit with you. Hide behind furniture

or doors for Peekaboo; clap blocksor pan lids for Pat-a-cake.

Make puppets out of a sock or paper bag—one for you and one for your baby.Have your puppet talk to yourbaby or your baby’s puppet.

Encourage your babyto “talk” back.

This is the time your babylearns that adults can be useful!

When your baby “asks” for somethingby vocalizing or pointing, respond to

his signal. Name the object your babywants and encourage him tocommunicate again—taking

turns with each otherin a “conversation.”

Cut up safe finger foods(do not use foods that pose a dangerof your baby’s choking) in small piecesand allow your baby to feed himself.It is good practice to pick up smallthings and feel different textures (bananas, soft crackers, berries).

Tape a large piece of drawing paper to a table.

Show your baby how to scribble with large nontoxic crayons.Take turns making marks on

the paper. It’s also fun topaint with water.

Babies enjoy push and pull toys. Make your own pull

toy by threading yogurt cartons,spools, or small boxes on a piece of

yarn or soft string (about 2 feet long).Tie a bead or plastic stacking ring

on one end for a handle.

Let your baby “help”during daily routines. Encourage

your baby to “get” the cup and spoonfor mealtime, to “find” shoes and coatfor dressing, and to “bring” the pants

or diaper for changing.Following directions is an important

skill for your baby to learn.

Excerpted from ASQ-3™ User’s Guide by Jane Squires, Ph.D., Elizabeth Twombly, M.S., Diane Bricker, Ph.D., & LaWanda Potter, M.S. ©2009 Brookes Publishing. All rights reserved. www.agesandstages.com

HELP YOUR CHILD LEARN AND GROW! Try these fun and easy activities with your 2-year-old—a great way to have fun together and encourage your child’s healthy development.

Children can findendless uses for boxes.

A box big enough for your child to fitin can become a car. An appliance box

with holes cut for windows and adoor can become your child’s

playhouse. Decorating the boxes with crayons, markers, or paints can be

a fun activity to do together.

Play “Follow theLeader.” Walk on tiptoes,

walk backward, andwalk slow or fast with big steps and

little steps.

Action is an importantpart of a child’s life. Play a game

with a ball where you give directions and your child does

the actions, such as “Roll the ball.”Kick, throw, push, bounce, and catch

are other good actions.Take turns giving

the directions.

Enhance listening skills by playing both slowand fast music. Songs withspeed changes are great.Show your child how to

move fast or slowwith the music.

Take time to draw withyour child when she wants

to get out paper and crayons.Draw large shapes and let your

child color them in.Take turns.

Children at this age loveto pretend and really enjoy it

when you can pretend with them.Pretend you are different animals, like a

dog or cat. Make animal sounds and actions. Let your child

be the pet owner who pets and

feeds you.

Add actions to yourchild’s favorite nursery rhymes.

Easy action rhymes include “Here We Go ‘Roundthe Mulberry Bush,”“Jack Be Nimble,”

“This Is the Way We Wash Our Clothes,”“Ring Around the Rosy,”

and “London Bridge.”

Activities2AGE

Excerpted from ASQ-3™ User’s Guide by Jane Squires, Ph.D., Elizabeth Twombly, M.S., Diane Bricker, Ph.D., & LaWanda Potter, M.S. ©2009 Brookes Publishing. All rights reserved. www.agesandstages.com

HELP YOUR CHILD LEARN AND GROW! Try these fun and easy activities with your 3-year-old—a great way to have fun together and encourage your child’s healthy development.

Before bedtime, lookat a magazine or children’s book

together. Ask your child to point topictures as you name them, such as

“Where is the truck?” Be silly and ask himto point with an elbow or foot.

Ask him to show you something thatis round or something that goes fast.

While cooking or eatingdinner, play the “more or less”game with your child. Ask who hasmore potatoes and who has less.Try this using same-size glasses

or cups, filled withjuice or milk.

Make a necklaceyou can eat by stringing Cheeriosor Froot Loops on a piece of yarn

or string. Wrap a short pieceof tape around the endof the string to make afirm tip for stringing.

Make an adventure pathoutside. Use a garden hose, rope, orpiece of chalk and make a “path” that

goes under the bench, around the tree,and along the wall. Walk your child

through the path first, usingthese words. After she can do it,

make a new path or haveyour child make a path.

Practice following directions.Play a silly game where you ask your

child to do two or three fun orunusual things in a row. For example,

ask him to “Touch your elbow andthen run in a circle” or “Find a book and put it

on your head.”

Find large pieces of paper orcardboard for your child to draw on.

Using crayons, pencils, or markers, playa drawing game where you follow his

lead by copying exactly what he draws.Next, encourage your child to copy your

drawings, such as circlesor straight lines.

Listen and dance to musicwith your child. You can stop

the music for a moment and play the“freeze” game, where everyone

“freezes,” or stands perfectly still, untilyou start the music again.Try to “freeze” in unusual

positions for fun.

Activities3AGE

Excerpted from ASQ-3™ User’s Guide by Jane Squires, Ph.D., Elizabeth Twombly, M.S., Diane Bricker, Ph.D., & LaWanda Potter, M.S. ©2009 Brookes Publishing. All rights reserved. www.agesandstages.com

HELP YOUR CHILD LEARN AND GROW! Try these fun and easy activities with your 4-year-old—a great way to have fun together and encourage your child’s healthy development.

Play the “guess whatwill happen” game to encourage

your child’s problem-solving and thinkingskills. For example, during bath time, ask

your child, “What do you think willhappen if I turn on the hot and

cold water at the same time?” or“What would happen if I stacked

the blocks to the top of the ceiling?”

Make a bean bag to catchand throw. Fill the toe of an old sockor pantyhose with 3/4 cup dry beans.Sew the remaining side or tie off witha rubber band. Play “hot potato” orsimply play catch. Encourage yourchild to throw the ball overhand

and underhand.

Go on a walk and pick upthings you find. Bring the items

home and help your childsort them into groups. For example,

groups can include rocks, paper orleaves. Encourage your child to start a

collection of special things. Find abox or special place where

he can displaythe collection.

Play “bucket hoops.”Have your child stand about 6 feet

away and throw a medium-sizeball at a large bucket or

trash can. For fun outdoorson a summer day, fill the

bucket with water.

Invite your child to playa counting game. Using a large pieceof paper, make a simple game board

with a straight path. Use dice todetermine the count. Count with your

child, and encourage her to hop the game piece to each square,counting each time the piece

touches down.

Play “circus.” Find old, colorfulclothes and help your child put on acircus show. Provide a rope on the

ground for the high wire act, a sturdybox to stand on to announce the acts,

fun objects for a magic act, andstuffed animals for the show. Encourage

your child’s imagination and creativityin planning the show.Don’t forget to clap.

“Write” and mail a letterto a friend or relative. Provide your child with

paper, crayons or pencil, and an envelope.Let your child draw, scribble, or write; or he cantell you what to write down. When your child is

finished, let him fold the letter to fit in theenvelope, lick, and seal. You can write the

address on the front. Be sure to let him decorate the envelope as

well. After he has put the stamp on, help mail

the letter.

Activities4AGE

Excerpted from ASQ-3™ User’s Guide by Jane Squires, Ph.D., Elizabeth Twombly, M.S., Diane Bricker, Ph.D., & LaWanda Potter, M.S. ©2009 Brookes Publishing. All rights reserved. www.agesandstages.com

HELP YOUR CHILD LEARN AND GROW! Try these fun and easy activities with your 5-year-old—a great way to have fun together and encourage your child’s healthy development.

Encourage dramaticplay. Help your child act outhis favorite nursery rhyme,

cartoon, or story.Use large, old clothes

for costumes.

Make an obstacle courseeither inside or outside your home.

You can use cardboard boxes for jumpingover or climbing through, broomsticks for laying between chairs for “limbo” (goingunder), and pillows for walking around.Let your child help lay out the course.After a couple of practice tries, havehim complete the obstacle course.

Then try hopping or jumping through the course.

You can play “licenseplate count up” in the car or onthe bus. Look for a license plate

that contains the number 1.Then try to find other plates with

2, 3, 4, and so forth, up to 10. Whenyour child can play “count-up,” play

“count-down,” starting with thenumber 9, then 8, 7, 6, and

so forth, down to 1.

Play “mystery sound.”Select household items that make

distinct sounds such as a clock, cerealbox, metal lid (placed on a pan), andpotato chip bag. Put a blindfold onyour child and have him try to guess

which object made the sound.Take turns with your child.

Play the “memory”game. Put five or six familiarobjects on a table. Have yourchild close her eyes. Remove

one object, and rearrangethe rest. Ask your child which object is missing.

Take turns findingthe missing object.

Let your child help youwith simple cooking tasks such as

mashing potatoes, making cheese sandwiches,and fixing a bowl of cereal. Afterward, see

if he can tell you the order that youfollowed to cook and mash the

potatoes or to get the bread out of thecupboard and put the cheese on it.

Supervise carefully when yourchild is near a hot stove.

Practice writing firstnames of friends, toys, and

relatives. Your child may need totrace the letters of thesenames at first. Be sure

to write in largeprint letters.

Activities5AGE

Excerpted from ASQ-3™ User’s Guide by Jane Squires, Ph.D., Elizabeth Twombly, M.S., Diane Bricker, Ph.D., & LaWanda Potter, M.S. ©2009 Brookes Publishing. All rights reserved. www.agesandstages.com

One Minute Write Up – The ASQ:SE-2 is… Use this space to describe the ASQ:SE-2 and how it is used as you would

to a family to ensure understanding prior to giving consent.