<p>Interviewer name ...... Atoll...... Island ...... Children's name: ...... Sex: ...... Date ...... Age: ...... Type of disability .:...... AGE 3m 6m 9m 12m 18m 24m 3y 4y 5y 6y</p><p>1-Smiles when 10-Plays next to 13-Competes for smiled at 4-Shy with strangers 7-Gives affection 8-Copies simple other children adult attention 16-Plays cooperatively hug and kisses action with other children 18-Separates easily 19-Likes to play from the mother games and L competitions A I C</p><p>O 14-More comfortable S 2-Recognizes 5-Likes to be played 11-Obeys and gives with the strangers mother with by adults the simple orders</p><p>3-Reacts to mother's voice 6-Responds to gestures 9-Rolls ball to 12-Copies adult behavior 15-Likes praise for 17-Copies adults 20-Uses polite like up, bye-bye adult or child in play (not well) accomplishment work in play expressions</p><p>1-Cries when hungry 4-Recognizes other people 15-Matches big 18-Constructs/arranges 23-Explains what he or uncomfortable in the environment 7-Stops 9-Indicates wants 11-Finds object 13-Follows one and small with several pieces 21-Matches, is seeing and doing activity for "No" by gesture hidden under a cover and two step points to and</p><p>N directions names 5 O</p><p>I colors T I N G 2-"Cools"when 5-Attends briefly to 16-Sorts/matches 19-Points to and names O comfortable objects/sounds objects and shapes 5 or more body parts 24-Matches letter C</p><p>22-Shows interest 3-Attracts people by 8-Looks for 14-Solves simple 17-Understands in things around 25-Counts and vocalizing, smiling, 6-Uncovers partially objects taken 10-Combines 12-Imitates problems using quantitative different 20-Follows 3 step him and asks recognizes looking, or other activity hidden object out of sight two or more simple actions an aid between 1 and 2 simple directions questions numbers 1-10 objects Interviewer name ...... Atoll ...... Island ...... Children's name: ...... Sex: ...... Date ...... Age: ...... Type of disability .:...... AGE 3m 6m 9m 12m 18m 24m 3y 4y 5y 6y</p><p>1- Stops crying when sees and touches 4-Vocalizes to get 6-Vocalizes to 8-Recognizes two 10-Says 3 or more breast or bottle attention get something objects, people, words 12-Combines two 14-Uses 6-20 15-Uses 20-50 words 18-Repeats 20-Asks needs words correctly, words simple stories/songs questions</p><p>E eg: "Big cat" G A U G N</p><p>A 2-Makes simple 16-Speaks 4 words L sounds in a sentence</p><p>7-Repeats consonant 9-Indicates 19-Uses 5-Repeats simple vowel combinations wants by 11-Imitates environmental 13-Names pictures, adjectives, verbs 21-Describes 3-Laughs sounds like aaah, gaaa (ga ga, da da) vocalizing sounds in play objects and people 17-Gives his/her name and adverbs pictures G N I 1-Reacts to sounds R A E H</p><p>4-Enjoys 8- Combines 2 or 3-Reaches rhythmic, 5-Can use 4-5 of 6-Uses signs for 7-Uses simple signs more signs to 2-Reacts to mother's voice for noisy toy musical sounds hand signs 10 words to communicate communicate N O</p><p>I S I R V</p><p>O 1-Looks at light or 2-Looks at bright, 3-Reacts to 4-Explore objects with 5-Finds objects 6-Explores living area using 7-Recognizes</p><p>T bright object moving colorful object different textures fingers and mouth using other senses touch, hearing, and smell places O M</p><p>E N I F Interviewer name ...... Atoll...... Island ...... Children's name: ...... Sex: ...... Date ...... Age: ...... Type of disability .:...... </p><p>3-Touches own 9-Grasps with thumb 11-Drops objects through 13-Plays with 15-Builds a tower 17-Copies 22-Draws 3-6 body 6-Plays in water and forefinger small hole sand/clay using 8 blocks of wood circles 20-Copies square body parts</p><p>1-Turns head from side to 5-Pushes up 8-Sits alone or uses hands for support side on stomach 16-Stands on 12-Pulls 14-Throws one foot, R to stand O overhand kicks ball 19-Hops on one foot T O M 2-Brings hands to mouth 9-Puts weight on hands and knee S or middle of body S O</p><p>R 6-Controls G head straight 17-Jumps alone 21-Coordinates 10-Moves from hands movements very well, 3-Sits with full support and knee to sitting runs, jumps, swings, clamps, crawls</p><p>7-Head and 13-Starts to 20-Catches ball when 4-Rolls from front to side trunk control 11-Crawls walk 15-Walks well 18-Begins to run standing alone Interviewer name ...... Atoll ...... Island ...... Children's name: ...... Sex: ...... Date ...... Age: ...... Type of disability .:...... AGE 3m 6m 9m 12m 18m 24m 3y 4y 5y 6y E R A 4-Chews/eats solid food 11-Puts on the clothes C 1-Suckles 8-Washes hands</p><p>F L</p><p>E 3-Eats semi-solid 6-Holds drink 7-Eats with a spoon 10-Washes 13-Helps with simple,</p><p>S crushed food from a cup whole body household tasks</p><p>2-Munches food 5-Fingers feed 9-Takes off clothes 12-Uses the toilet</p><p>Stimulation Programme – </p><p>Date of Assessment</p><p>Social</p><p>Cognition</p><p>Language</p><p>Hearing</p><p>Vision</p><p>Fine Motor</p><p>Gross Motor</p><p>Self-Care</p>