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SELF-HELP SKILLS |
Y |
N |
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Washes & dries hands with some supervision |
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Toilet trained well during the day |
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Holds glass with one hand |
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Controls turning of spoon |
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Unbuttons and zips |
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Buttons large buttons |
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Removes clothing |
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Puts on
shoes (not always on proper feet) |
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Dresses self with supervision |
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Buttons small buttons |
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Dresses self completely (except for difficult
fasteners) |
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Holds spoon and fork in fingers |
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Starts a zipper |
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Uses
knife for spreading |
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Ties
shoes |
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GROSS MOTOR SKILLS |
Y |
N |
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Pedals a tricycle |
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Runs
well without falling |
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Jumps with two feet |
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Walks alone down stairs holding rail |
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Walks backwards |
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Bends over to pick up objects |
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Hops on
one foot |
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Runs
smoothly; changes speed |
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Can jump
consecutively |
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Climbs a ladder fairly well |
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Walks down stairs alternating feet |
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Catches thrown ball with arms and body |
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Balances on one foot for a few seconds |
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Skips, alternating feet |
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Catches ball with hands |
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Can
swing well (pumps) |
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FINE MOTOR SKILLS |
Y |
N |
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Strings 1” beads |
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Builds tower, 2-5 blocks |
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Completes inset puzzle |
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Scribbles, staying on paper |
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Holds pencil / crayon with fingers, not fist |
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Copies
O |
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Makes snips with scissors |
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Pounds and squeezes clay |
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Copies
½
and
¾ |
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Folds paper |
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Strings ½” beads |
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Builds tower, 6-9 blocks |
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Copies + and
Ú |
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Cuts
paper in two |
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Describes drawings not recognizable to others |
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Builds tower, 10 or more blocks |
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Completes 3-5 piece puzzle |
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Traces along vertical lines |
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Traces along horizontal lines |
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Draws person with head, legs, eyes, nose and
mouth |
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Copies
ÿ |
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Cuts a
triangle |
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Drawings are recognizable |
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Holds pencil with tripod grasp |
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Colors within the lines |
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Draws a person with head, legs, eyes, nose,
mouth, arms, and trunk |
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Copies
D |
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Traces letters and numbers |
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Prints first name |
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Cuts
circles and curves |
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Prints letters and numbers |
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LANGUAGE SKILLS |
Y |
N |
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Identifies pictures of objects |
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Identifies some body parts |
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Follows single step directions |
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Gives first and last name |
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Asks
simple questions |
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Uses
pronoun to refer to others |
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Adds
“-ing” |
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Uses
past tense |
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Responds with “please” and “thank you” |
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Expresses wants and needs |
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Average length of sentence, 3 words |
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Delivers simple messages |
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Responds to and makes social greetings |
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States age and sex |
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Shows interest in the conversation of others |
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