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Occupational &
Physical Therapy

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Therapy

Developmental Survey

Complete the appropriate survey for your child to help guide you to your next step.
1 Year Old Developmental Survey

Development Survey (1 Year Old)

Does Your Child Have…
1. Enjoy imitating people in play?(Required)
2. Repeat sounds or gestures for attention?(Required)
3. Finger-feed himself?(Required)
4. Move into the sitting position unassisted?(Required)
5. Walk while holding onto furniture?(Required)
6. Creep/crawl on hands and knees?(Required)
7. Respond to simple verbal requests?(Required)
8. Try to imitate words?(Required)
9. Say"mama" and "dada"?(Required)
10. Respond when told "no"?(Required)
11. Use simple gestures? (shaking head no, waving, etc.)(Required)
12. Find an object you have covered with a blanket?(Required)
13. Paint at objects and/or pictures?(Required)
14. Use objects correctly in play? (drink from cup, talk on phone, etc.)(Required)
15. Pull themself to standing?(Required)
2 Year Old Developmental Survey

Development Survey (2 Year Old)

Does Your Child Have…
1. Exhibit a mature heel to toe walking technique?(Required)
2. Use two to four word sentences?(Required)
3. Know the function of common household items?(Required)
4. Imitate actions and words?(Required)
5. Follow simple instructions?(Required)
6. Pushed a wheel toy?(Required)
7. Walk up and down stairs holding support bar?(Required)
8. Run?(Required)
9. Kick a ball?(Required)
10. Pull toys while walking?(Required)
11. Scribble spontaneously?(Required)
12. Demonstrate imaginative/pretend play?(Required)
13. Sort by shapes and colors?(Required)
14. Pour things from one container to another?(Required)
15. Get enthusiastic over the company of other children?(Required)
3 Year Old Developmental Survey

Development Survey (3 Year Old)

Does Your Child Have…
1. Go up and down the stairs without support?(Required)
2. Throw a ball overhand?(Required)
3. Jump in place?(Required)
4. Pedal a tricycle?(Required)
5. String 2-3 beads?(Required)
6. Cut paper with scissors?(Required)
7. Part from parents with ease?(Required)
8. Show interest in interactive games?(Required)
9. Engage in play with peers?(Required)
10. Respond to people outside your family?(Required)
11. Engage in fantasy/imaginative play?(Required)
12. Copy a circle?(Required)
13. Exhibit self control when mad or upset?(Required)
14. Use sentences of more than 3 words?(Required)
15. Use me and you properly?(Required)
4 Year Old Developmental Survey

Development Survey (4 Year Old)

Does Your Child Have…
1. Wash and dry her hands?(Required)
2. Brush own teeth efficiently?(Required)
3. Dress and undress herself?(Required)
4. Build a tower of 9-10 blocks?(Required)
5. Recall daily activities and experiences?(Required)
6. Differentiate with fantasy and reality?(Required)
7. Eat, sleep, and use the toilet well?(Required)
8. Interact with other children and adults?(Required)
9. Engage in a wide range of activities?(Required)
10. Hop forward on one foot, at least 5 steps?(Required)
11. Stay focused on one activity for more than 5 minutes?(Required)
12. Run and stop without falling?(Required)
13. Have a willingness to experience new things & people?(Required)
14. Play with others without being overly aggressive?(Required)
15. Understand two-part commands with prepositions?(Required)

Sensory Processing Survey

Complete the appropriate survey for your child to help guide you to your next step.
Sensory Survey for Infants

Sensory Survey for Infants

Infants
1. Dislikes touch or cuddling, arches back when held?(Required)
2. Doesn't develop a regular sleep pattern?(Required)
3. Doesn't develop a regular feeding schedule?(Required)
4. Dislikes tummy time, has trouble lifting head?(Required)
5. Delayed milestone development?(Required)
6. Gets fussy in a car seat and/or baby swing?(Required)
7. Takes an unusually long time to feed?(Required)
8. Excessive need to suck? (increased feeds, relies on pacifier)(Required)
9. Acts overly sensitive to loud sounds or bright lights?(Required)
Sensory Survey for Toddlers/Preschoolers

Sensory Survey for Toddlers/Preschoolers

Infants
1. Several temper tantrums a day, behavior extremes?(Required)
2. Difficulty getting to sleep or staying asleep?(Required)
3. Does not explore playground?(Required)
4. Speech delays or difficult to understand?(Required)
5. Very picky eater?(Required)
6. Gross and fine motor delays?(Required)
7. Difficulty separating from parent?(Required)
8. Disconnected from environment?(Required)
9. Unusually high or low activity level?(Required)
Sensory School

Sensory School Age Survey

Does Your Child…
1. Hate having her hair washed, brushed, or cut?(Required)
2. Have "selecting hearing" or difficulty listening?(Required)
3. Resist certain foods/textures, "picky eaters"?(Required)
4. Complain about tags or "itchy clothes"?(Required)
5. Touch others too hard/"not know his own strength"?(Required)
6. HATE or LOVE being tickled or cuddled?(Required)
7. Tend to be clumsy or fall a lot?(Required)
8. Always run or walk on tiptoes?(Required)
9. Have trouble focusing/concentrating?(Required)
10. Act overly sensitive to loud sounds or bright lights?(Required)
11. Chew on everything? (shirts, erasers, nails, etc.)(Required)
12. Have a poor fine motor skills? (writing, cutting, etc.)(Required)
13. Have difficulty dressing himself?(Required)
14. Have trouble transitioning?(Required)
15. Refuse to or insist on going barefoot?(Required)
Sensory Survey for Infants

Sensory Survey for Infants

Infants
1. Dislikes touch or cuddling, arches back when held?(Required)
2. Doesn't develop a regular sleep pattern?(Required)
3. Doesn't develop a regular feeding schedule?(Required)
4. Dislikes tummy time, has trouble lifting head?(Required)
5. Delayed milestone development?(Required)
6. Gets fussy in a car seat and/or baby swing?(Required)
7. Takes an unusually long time to feed?(Required)
8. Excessive need to suck? (increased feeds, relies on pacifier)(Required)
9. Acts overly sensitive to loud sounds or bright lights?(Required)
Sensory Survey for Toddlers/ Preschoolers

Sensory Survey for Toddlers/Preschoolers

Infants
1. Several temper tantrums a day, behavior extremes?(Required)
2. Difficulty getting to sleep or staying asleep?(Required)
3. Does not explore playground?(Required)
4. Speech delays or difficult to understand?(Required)
5. Very picky eater?(Required)
6. Gross and fine motor delays?(Required)
7. Difficulty separating from parent?(Required)
8. Disconnected from environment?(Required)
9. Unusually high or low activity level?(Required)
Sensory School

Sensory School Age Survey

Does Your Child…
1. Hate having her hair washed, brushed, or cut?(Required)
2. Have "selecting hearing" or difficulty listening?(Required)
3. Resist certain foods/textures, "picky eaters"?(Required)
4. Complain about tags or "itchy clothes"?(Required)
5. Touch others too hard/"not know his own strength"?(Required)
6. HATE or LOVE being tickled or cuddled?(Required)
7. Tend to be clumsy or fall a lot?(Required)
8. Always run or walk on tiptoes?(Required)
9. Have trouble focusing/concentrating?(Required)
10. Act overly sensitive to loud sounds or bright lights?(Required)
11. Chew on everything? (shirts, erasers, nails, etc.)(Required)
12. Have a poor fine motor skills? (writing, cutting, etc.)(Required)
13. Have difficulty dressing himself?(Required)
14. Have trouble transitioning?(Required)
15. Refuse to or insist on going barefoot?(Required)

Speech Therapy Survey

Complete the appropriate survey for your child to help guide you to your next step.
Speech Survey for 12-18 Month Olds

Survey for 12-18 Month Olds

Does Your Child…
1. Discriminate between many different sounds?(Required)
2. Use 10-20 words, including names?(Required)
3. Recognize and name pictures of familiar people?(Required)
4. Combine 2 words; "all gone", etc.?(Required)
5. Use words to make wants known; "up", "more"?(Required)
6. Use exclamations; "uh-oh", "oh-no!"?(Required)
7. Imitate words and sounds more precisely?(Required)
8. Point/gesture to call attention to something?(Required)
9. Point to body parts; eyes, nose, toes, etc.?(Required)
10. Bring an object from another room when asked?(Required)
11. Imitate housework; sweeping, setting table, etc.?(Required)
12. Follow simple commands?(Required)
13. Know and say the name of at least 5 things?(Required)
14. Attempt to hum/sing simple tunes?(Required)
15. Respond to and imitate your emotions?(Required)
Speech Survey for 18-24 Month Olds

Survey for 18-24 Month Olds

Does Your Child…
1. Understand simple questions and commands?(Required)
2. Identify body parts?(Required)
3. Carry on conversation with self/dolls?(Required)
4. Ask "what's this/that?", "where's my _______?"?(Required)
5. Use 2 – 3 words phrase and questions?(Required)
6. Refer to him/her self by name?(Required)
7. Mimic the sounds of familiar things?(Required)
8. Name at least 3 pictures?(Required)
9. Have about 50 words in their vocabulary?(Required)
10. Ask for common food and drink by name?(Required)
11. Use pronouns, "mine", "she"?(Required)
12. Attend to activities for more than 5 minutes?(Required)
13. Increase their vocabulary every month?(Required)
14. Use nouns and verbs?(Required)
15. Follow simple directions without the help of gestures?(Required)
Speech Survey for 2-3 Year Olds

Survey for 2 or 3 Year Olds

Does Your Child…
1. Match primary colors, name at least 1?(Required)
2. Identify and name major body parts?(Required)
3. Combine nouns and verbs?(Required)
4. Form short sentences?(Required)
5. Understand big and little?(Required)
6. Use 3-4 sentences?(Required)
7. Have a vocabulary of at least 200 words?(Required)
8. Like to hear the same story repeated?(Required)
9. Form some plurals?(Required)
10. Answer simple questions?(Required)
11. Produce consistently "p, m, h, n, w, b" sounds?(Required)
12. Draw a circle and a vertical line?(Required)
13. Express fatigue verbally?(Required)
14. Understands spatial concepts; in, out?(Required)
15. Strangers can understand 80% of his/her speech?(Required)
Speech Survey for 3-4 Year Olds

Survey for 3 or 4 Year Olds

Does Your Child…
1. Express ideas and feelings?(Required)
2. Use "-ing" verbs?(Required)
3. Use 4 or more word sentences?(Required)
4. Recognize absurdities; "Is that a bird in your ear?"?(Required)
5. Say words without eliminating sounds ("mi-"vs."mine"?)(Required)
6. Understand a series of 2-3 directions?(Required)
7. Use imagination to create stories?(Required)
8. Describe the use of an object; fork, broom, etc.?(Required)
9. Understand sequence (1st, 2nd, 3rd)?(Required)
10. Group objects together; people, clothes, etc.?(Required)
11. Identify and name most colors?(Required)
12. Enjoy rhymes and tunes?(Required)
13. Use most sounds correctly? (excluding l, r, s, sh, ch, y, v, z, th)(Required)
14. Answer simple questions?(Required)
15. Speak clearly enough for strangers to understand?(Required)
Speech Survey for 4-5 Year Olds

Survey for 4 or 5 Year Olds

Does Your Child…
1. Express spatial concepts; in, behind?(Required)
2. Understand complex questions?(Required)
3. Use some irregular past tenses; ran, fell?(Required)
4. Define words?(Required)
5. Use sentences with 8 or more words?(Required)
6. Answer "why" questions?(Required)
7. Recognize rhyming?(Required)
8. Describe "how to"; make a sandwich, grow flowers?(Required)
9. Count up to 10 objects?(Required)
10. Name shapes?(Required)
11. Better understand the concept of time?(Required)
12. Know his/her last name and age?(Required)
13. Understand tomorrow, yesterday, today?(Required)
14. Read (recognize) familiar words; like STOP on a sign?(Required)
15. Use the same grammar as the rest of the family?(Required)

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