(By age two)
Child Name_________________________________ Age_________________
Observer______________________________ Date_________________
Does the child… Yes No Comments
Walk alone? _____ _____
Bend over and pick up toy without falling over? _____ _____
Seat self in child-size chair? _____ _____
Walk up and down
stairs with assistance? _____ _____
Place several rings on a stick? _____ _____
Place five pegs in a pegboard? _____ _____
Turn pages two or three at a time? _____ _____
Scribble? _____ _____
Follow one step directions involving something
familiar (e.g.: give me ____) _____ _____
Match familiar objects? _____ _____
Use spoon with some spilling? _____ _____
Drink from a cup holding it with one hand? _____ _____
Chew food? _____ _____
Take off coat, shoe, and socks? _____ _____
Zip and unzip large zipper? _____ _____
Recognize self in mirror? _____ _____
Refer to self by name? _____ _____
Imitate adults in play? _____ _____
Help put things away? _____ _____
Ask for desired items by name? _____ _____
Answer to question “What’s that?” _____ _____
Make some two word statements? _____ _____
Reference: Allen, K.E. & Marotz, L.R. (2003). Developmental profiles: Pre-birth through twelve, 4th ed. Clifton Park, NY: Delmar Learning.