Ages & Stages Questionnaires®, Third Edition (ASQ-3), Squires & Bricker Month Questionnaire 34 months 16 days to 38 months 30 days (inclusive) On the following pages are questions about activities children may do. Your child may have already done some of the ASQ-3 - Ages and StagesAges & Stages Questionnaires ®, Third Edition (ASQ ® -3) is a developmental screening tool designed for use by early educators and health care professionals. It relies on parents as experts, is easy-to-use, family-friendly and creates the snapshot needed to catch delays and celebrate milestones. ASQ-3 questionnaires.
Ages & Stages Questionnaires (ASQ) If your child was premature please call the office to find out the right ASQ to fill out since the age will need to be adjusted for premature infants. Please fill out age appropriate ASQ form for your childs Well Child Check. 2 Month Questionnaire. Intervention Activities 1 Ages & Stages Questionnaires 24 Month QuestionnaireAges & Stages Questionnaires® Month Questionnaire 24 Month Questionnaire page 3 of 7 E101240300 YES SOMETIMES NOT YET COMMUNICATION TOTAL YES SOMETIMES NOT YET GROSS MOTOR TOTAL *If Gross Motor Item 6 is marked 35.16 29.78 31.54 4. FOLLOW-UP ACTION TAKEN:Check all that apply. Ages & Stages Questionnaires 30 Month QuestionnaireAges & Stages Questionnaires® Month Questionnaire 28 months 16 days through 31 months 15 days Please provide the following information. Use black or blue ink only and print legibly when completing this form. 30 30 Month Questionnaire 28 months 16 days through 31 months 15 days
About This CD-ROM This CD-ROM contains 1) your End User License Agreement, 2) printable ASQ-3 Spanish PDFs, 3) information about ASQ, 4) information about the authors, 5) Ages & Stages QuestionnairesAge at administration, in months and days:Ages & Stages Questionnaires® Month Questionnaire 1 month 0 days through 2 months 30 days Please provide the following information. Use black or blue ink only and print legibly when completing this form. 2 Babys first name:Babys last name:Babys date of birth:First name:Last name:Middle Measure:Ages and Stages QuestionnairesThe specificity* of ASQ-3, or the ability of ASQ-3 to correctly identify typically developing children, ranged from 70% for the 14-month questionnaire to 100% for the 2-month, 16-month, and 54-month questionnaires, with 85% overall agreement. More information is available from