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Signs of Developmental Delay

This questionaire has been used at Tinsley House Clinics for children of four and upwards. It is only a rough guide and is not a replacement for a proper diagnosis.

1 Is there a family history of any learning or behavioural problems?
Yes = 10 points, No = 0 points

2 Were you and the baby fit and well during the pregnancy?
Yes = 0 points, No = 1 Point

3 Did the pregnancy go to full term?
Yes = 0 points, No = 2 points

4 Was the delivery natural or assisted (ventouse, Caesarean or forceps)?
Natural = 0 points, Assisted = 5 points

5 Was there any concern over foetal distress?
Yes = 5 points, No = 0 points

6 When did your child sit unaided?
Six months or earlier = 0, Later than six months = 2 points

7 Did your child crawl?
Yes = 0 points, No = 2 points

8 When did your child walk?
One year or earlier = 0 points, Later than one year = 1 point

9 In the first year did your child have a collection of single words?
Yes = 0 points, No = 1 point

10 In the second year did your child put two words together?
Yes = 0 points, No = 1 point

11 By the third year was your child making mini-sentences?
Yes = 0 points, No = 1 point

12 When was your child potty-trained by day?
Two and a half years or earlier = 0 points, Later than two and a half years = 1 point

13 When was your child no longer wetting the bed at night?
Three years or earlier = 0 points, Later than three years = 2 points

14 Have there been any bed-wetting incidents since?
Yes = 1 point, No = 0 points

15 Has your child ever soiled?
Yes = 2 points, No = 0 points

16 Does your child have problems with reading/writing?
Yes = 2 points, No = 0 points

17 Does your child have problems in concentrating?
Yes = 1 point, No = 0 points

18 Is your child ever hyperactive?
Yes = 2 points, No = 0 points

19 How is your child’s short-term memory?
Good = 0 points, Poor = 1 point

20 Has your child ever had any rituals or obsessions?
Yes = 3 points, No = 0 points

21 Has your child ever had any involuntary movements, tics, excessive blinking, grimacing, or made repeated sounds?
Yes = 5 points, No = 0 points

22 Is your child, or was your child ever, clumsy or accident-prone?
Yes = 2 points, No = 0 points

Results
15 points or less means that you have very little to worry about
16-29 points means there is a high probability of developmental delay
30 points or more means that a developmental delay is virtually certain

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