DAYC-2 Training Resources

June 2021
Page 1
DAYC- 2 Additional Training Resources

Although this archived webinar located on the HHSC ECI internet under the
Training and Technical Assistance webpage references the BDI-2, it also
contains helpful information and resources you will want to consider for
interpreting test results and moving to QDD. Part III: Evaluation and
Assessment for Children in Bilingual Environments: Interpreting the BDI

DAYC-2 Videos- Below are two links to short YouTube videos which provide
a general overview of the DAYC-2 including norms, scoring, methods of
administration and tips.

https://www.youtube.com/watch?v=_SC8Md9YTEk

https://www.youtube.com/watch?v=mB5IyHAZ62w

Scoring the DAYC2: Below are two links to short YouTube videos which
review scoring of the DAYC-2 including how to manually calculate
chronological age, entry points, scoring, and how to complete the domain
scoring forms including the Examiner Summary sheet.

https://youtu.be/bnZGKGeSewA

https://youtu.be/hKgyhXDDZ98

Interpreting the DAYC2: Below is a link to a short YouTube video which

reviews how to convert raw scores to standard scores, age equivalents and
percentile rank as well as descriptive terms using the DAYC-2 Examiner’s
Manual.

https://youtu.be/z4eNfEiA9po

DAYC-2 Power Point Presentation created by Holli Ford M. Ed., BCBA:

This power point presentation provides an overview of the DAYC-2 and
includes information about scoring, basal and ceilings, and recommendations
for administration.
DAYC-2 Training Resources
Page 2

http://ucpalabama.org/wp-content/uploads/2015/05/dayc-2.pdf

Online Calculators:
http://www-users.med.cornell.edu/~spon/picu/calc/agecalc.htm

https://everydaycalculation.com/age.php

https://images.pearsonclinical.com/images/ageCalculator/ageCalculator.htm
 DAYC-2 Training
June 2021
DAYC-2 Recommended Materials

Birth to 11 months:
Infant Toys
Cloth
Mirror
Cheerio or puff

12 months to 23 months:
Ball
Child’s book
Crayon and pencil
Raisin
Empty bottle
Paper
Toy car or truck
Open cup
Straw
Push or toy

24-35 months:
Children’s blocks
Shape sorter or cut outs of circle, square, and triangle

36 months and up
Children’s scissors
Nesting cups or ring post
 DAYC-2 Difficult Items
Responses from Co-author and Publisher
Receptive Language
Test Items Question Answer
Item 11: follows simple spoken Is there a target There’s not a target
commands number of percentage, per se, but
Item 12: responds to “where” directions they use your best judgement
questions should on these. Try to get at
Items 17: carries out two-step follow/”where” least 2-3
directions that are related questions they attempts/requests in
Item 22: carries out two-step respond to? there to get a
unrelated commands representative sample of
abilities.
Item 14: follows directions Is this within That’s up to you and what
about placing one item “in” and routine directions you have available in the
“on” another (in the trash, on the environment. Get a
table, etc.) or with representative sample
the same two items that demonstrates the
(put the block on child does or does not
the box, put the understand “in” and “on.”
block in the box)?
Item 17: carries out two-step Should this be Don’t use gesture support
directions that are related verbal only two- if you can help it. That
Item 22: carries out two-step step commands, or provides a visual cue, as
unrelated commands with gesture well, which can
support? overshadow the receptive
language.
Expressive Language
Test Items Question Answer
Item 17: knows names of two Can siblings count If siblings are the only
or more playmates as “knowing names playmates in the child’s
of playmates” if a environment, then yes,
child is not in that will count.
daycare?
Item 19: produces three or Is this within a day? At least 2-3 samples
more two-word phrases should be obtained to
make sure the ability is
consistent.
Item 22: uses sentences of How many three- At least 2-3 samples
three or more words word sentences in a should be obtained to
day? make sure the ability is
consistent.
Social-Emotional
Test Items Question Answer
Item 30: sings familiar songs If the child has a The target behavior is
with adult language delay but social-emotional, looking
vocalizes during at appropriate interaction
songs, can they with an adult and
receive credit? awareness of social
DAYC-2
Page 1
June 2021
 activity. Without any
accommodation, the child
would be expected to sing
most or all of the words
to a familiar song. If the
child has a language
delay, they may use
alternative
communication options or
in some way show
appropriate interaction
with the adult and
recognize the song is a
familiar one.

Item 32: asks for assistance If the child has a Yes, as long as the child
when having difficulty language delay but is making a meaningful
they use nonverbal attempt to ask for help,
communication including vocalizations,
(pulling, pointing, grunting, or pulling your
reaching paired hand over. They are
with vocalization), demonstrating that’s
as opposed to what they need to do in
crying, does the order to get help rather
child receive credit? than just sitting and
crying.
Gross Motor
Test Items Question Answer
Item 37: walks up and down If they hold a The child must be able to
stairs with support from rail or parent’s hand for demonstrate these
wall; may place both feet on support instead of abilities solo, without
each step the wall does the assistance (not holding a
Item 40: walks up stairs, child receive credit? parent’s hand if rail/wall
alternating feet, in adult not available).
fashion while holding on to rail
or wall
Fine Motor
Test Items Question Answer
Item 19: imitates circular, If the child does not The child must be able to
vertical, and horizontal strokes use vertical, demonstrate all three
Item 20: uses vertical, horizontal, AND motions. If an item states
horizontal, and circular motions circular motions, do “and” the child must
when drawing they get credit? demonstrate all
behaviors; if an item
states “or” the child need
not demonstrate all
behaviors listed.

DAYC-2
Page 2
June 2021
 DAYC-2 Difficult Items
Responses from DAYC-2 Co-Author and Publisher
June 2021
Cognitive
Test Items Question Answer
Item 24: attempts to start toy Is this a toy only, It needs to be a toy with
if he or she has seen someone or do other things a wind-up feature, pull-
else make it work count (light switch, string, or some other
buttons to turn on start-up function.
devices, etc.)?
Item 29: looks at picture book If the child looks Give credit if they are
with adult, may name or point and attends but able to sit attentively with
to simple objects does not label or an adult to read a book,
identify, do they then note if they are able
still receive credit? to respond to “Where is
the XXX?” or “What is
that?”
Item 30: manages three to four What is this item The response requires
toys by setting one aside when looking for? problem solving on the
given a new toy child’s part; how to
accept a new toy/item
when both hands are full.

Item 34: matches five or more Would this be This requires a child to
objects to a corresponding seeing a picture of match a 2-dimensional
picture a duck and finding item to a 3-dimensional
their own duck? one.

Adaptive Behavior
Test Items Question Answer
Item 18: sleeps through the If the child takes Yes, if they take more
night; may take one nap during more than one nap than one nap they would
the day can they receive get credit. The main focus
credit? here is whether they
sleep through the night.

DAYC-2
Page 3
June 2021
518380
research-article2013
JPAXXX10.1177/0734282913518380Journal of Psychoeducational AssessmentTest Review

Journal of Psychoeducational Assessment

2014, Vol. 32(6) 577­–580
Test Review © 2014 SAGE Publications
Reprints and permissions:
sagepub.com/journalsPermissions.nav
jpa.sagepub.com

Judith, K. V., & Maddox, T. (2013). Developmental Assessment of Young Children–Second Edition (DAYC-2).
Austin, TX: PRO-ED.

Reviewed by: Melissa D. Swartzmiller, Central Michigan University, Mount Pleasant, MI, USA
DOI: 10.1177/0734282913518380

Test Description
The Developmental Assessment of Young Children–Second Edition (DAYC-2) was developed
for children from birth through 5 years of age to assess development across five domains:
Cognitive, Communication, Social-Emotional, Physical Development, and Adaptive Behavior
(Voress & Maddox, 2013). The purposes of the assessment are to identify children who may be
experiencing developmental delays in any of the five domains, to monitor children’s progress
in early childhood programs, and for research. Examiners may administer all domains to derive
the General Development Index (GDI) or only those pertaining to an area(s) of concern.
Domain and subdomain results are described as quotients (M = 100, SD = 15), age equivalents,
or percentiles.
Administration time for the inventory varies based on how many domains are administered.
Each domain takes approximately 10 to 20 min to complete; therefore, it may take 50 to 100 min
to administer all five domains.
Materials include the examiner’s manual, a scoring form for each domain, an Examiner
Summary Sheet, and a supplemental Early Childhood Development Chart. Instructions for
administration and scoring appear on the scoring forms. The Examiner Summary Sheet is used
to record raw scores (RSs) and derived results for the subdomains, domains, and the overall
GDI.

Description of Domains
All DAYC-2 items can be scored through observation, by interviewing a caregiver, through
directly assessing the child, or use of any combination of these methods. The manual neither indi-
cates which method is best to use nor specifies when to use a specific administration method. Each
item is scored 1 (passed) or 0 (not passed). Three consecutive passed items (i.e., scores of 1)
establish the basal. The ceiling is reached after three consecutive scores of 0.
The GDI is the composite resulting from all five domains. The Cognitive domain contains
88 items that assess skills related to memory, planning, discrimination, and making decisions.
The 78-item Communication domain consists of two subdomains: Receptive Language
(37 items) and Expressive Language (41 items). The Social-Emotional domain assesses skills
that aid in the development of social interaction and has 63 items. The Physical Development
domain has 87 items and includes two subdomains: Gross Motor (54 items) and Fine
Motor (33 items). The 64-item Adaptive Behavior domain assesses self-help skills and
independence.
578 Journal of Psychoeducational Assessment 32(6)

Technical Adequacy
Standardization
Data for DAYC-2 norms were collected from 2009 to 2011. The sample included 1,832 children,
with at least 100 children in each 4-month interval from birth to 35 months and each 6-month
interval from 36 to 71 months. Demographic characteristics of the sample were similar to the
2010 U.S. Census data in terms of gender, ethnicity, parents’ education level, household income,
geographic region, and disability status. No data were reported for urban/rural residence.

Reliability
In this review, a minimum correlation of .90 was considered satisfactory, as reliability of .90 has
been recommended for tests used to make important decisions (Salvia, Ysseldyke, & Bolt, 2010;
Sattler, 2008). Data for internal consistency are given for 6-month age intervals. Correlation
coefficients for the domains range from .89 to .98; 1 of the 60 coefficients was less than .90.
Correlation coefficients for the subdomains range from .82 to .97; 10 of the 48 coefficients were
less than .90. Correlation coefficients for the GDI range from .98 to .99. Correlation coefficients
are also reported for selected subgroups (e.g., gender, race), all of which are satisfactory.
Test–retest reliability data are provided for 90 children who were less than 1 to 5 months of
age. The retest interval ranged from 1 to 2 weeks. Domain reliability coefficients for the group
range from .70 to .91; subdomain coefficients range from .82 to .90. Because this is a measure of
development, these coefficients may be somewhat lower due to rapid changes in development at
certain stages, leading to less stability over time. DAYC-2 results most likely to be used to make
important decisions about students, for example, decisions regarding the need for services, would
be domain results. Physical Development is the only domain with satisfactory reliability, although
the Cognitive and Communication domains were both close, each with a correlation of .89.
Correlations for the remaining domains were Social-Emotional (.70) and Adaptive Behavior
(.79). The Expressive Language and Fine Motor subdomains have correlations equal to .90. The
subdomains with correlations less than .90 are Receptive Language (.86) and Gross Motor (.82).
The test–retest reliability coefficient for the GDI is .89. Unfortunately, stability of DAYC-2
results for children from 6 to 71 months of age is unknown.

Validity
The format of the DAYC-2 is similar to the DAYC. The original items on the DAYC were devel-
oped based on an examination of both research and existing measures of child development.
Based on reviews of the DAYC (Ogletree, 2001; Watson, 2001), some items were eliminated or
revised, and other items were added to the upper and lower ends of the second edition. Average
item discrimination and item difficulty results are presented for the norm sample. These data
appear acceptable. Items determined to be biased were removed.
Although items can be scored through observation, interview, or direct assessment, there are
no data demonstrating that the different scoring methods provide similar results. Thus, it is
unknown whether the method of administration impacts the reliability and validity of results
provided by the assessment.
DAYC-2 results were compared with the Battelle Developmental Inventory–Second Edition
(BDI-2; Newborg, 2005) and the Developmental Observation Checklist System–Second Edition
(DOCS-2; Hresko & Sherbenou, in press) to evaluate criterion-prediction validity. Moderate to
large correlations were found between DAYC-2 domains measuring similar constructs to those
on the BDI-2 and the DOCS-2.
Test Review 579

Positive prediction data were presented for children with previous diagnoses of autism, physi-
cal disabilities, and language delay. It was noted that these children were part of a clinical group
and most were not included in the normative sample. In order for sensitivity and specificity to be
considered adequate, the indexes must be at least .70 (American Academy of Pediatrics, 2001).
For children with autism, the sensitivity, specificity, and classification accuracy across all
domains were above .70. For children with physical disabilities, the sensitivity, specificity, and
classification accuracy for the Physical Development domain were above .70. For children with
language delay, the sensitivity, specificity, and classification accuracy for the Communication
domain were above .70. Therefore, membership in each of these groups was predicted as
expected.
Construct validity was demonstrated by examining performance related to age, performance
differences among groups, and relationships among domains. Across domains and subdomains,
RSs were shown to increase with age. Performance of different groups (i.e., gender, race, dis-
ability status) on the DAYC-2 was examined and results were as expected (e.g., groups based on
gender and race performed in the average range and children with disabilities performed below
average). In addition, correlations among the domains demonstrated measurement of similar, yet
unique abilities.

Floors. Floors are considered adequate when a RS of 1 corresponds with a standard score (SS)
two or more standard deviations below the mean (Bracken, 1987, 2000). When floors are inade-
quate, performance on a particular measure may be overestimated because there are too few easy
items to discriminate between children of below average and average abilities. Thus, the test may
not properly discriminate between children with and without deficits.
Adequate floors begin at birth for the Adaptive Behavior domain. However, for the
Communication and Social-Emotional domains, adequate floors begin at 1 month rather than at
birth. Adequate floors begin at 2 months for the Cognitive domain and 6 months for the Physical
Development domain. For the Expressive subdomain, adequate floors begin before 1 month of
age; adequate floors begin at 6 months for the Receptive subdomain. The Gross Motor subdo-
main begins at 5 months and the Fine Motor subdomain at 9 months.

Item gradients. Item gradient problems exist when a 1-point RS change results in a large SS
change. A steep item gradient occurs when the change in SS points is greater than 1 / 3 of a stan-
dard deviation (e.g., greater than 5 for a SS; Bracken, 1987, 2000). Steep item gradients may
result in an under or over estimate of performance and may not appropriately discriminate
between children with and without deficits.
The DAYC-2 has many item gradient violations, especially for the Receptive and Expressive
Language domains at the lower end of the age distribution. For example, for 3-month-olds on the
Expressive Language domain, a RS of 6 = a SS of 102, but a RS of 7 = a SS of 111 (a 9-point SS
difference based on a 1-point change in RS). For the Receptive Language domain for children 4
months of age, a RS of 1 = 64, but a RS of 2 = 74 (a 10-point SS difference). These problems with
item gradients occur throughout the domains, primarily from birth to 12 months of age, with a
few occurring at the upper age level for the Language Domain.

Summary
The normative sample for the DAYC-2 appears to be representative based on the reported demo-
graphic data. However, no urban/rural residence data are presented. Because test–retest data are
only presented for children less than 6 months of age, it is not possible to determine whether
results are stable over time for older children, further several domains do not have adequate reli-
ability for making important educational decisions. In addition, although it is convenient that the
580 Journal of Psychoeducational Assessment 32(6)

items can be scored using any of three methods, it is unclear whether these different methods
yield similar results. This may be a significant limitation because examiners need guidance with
regard to which administration methods provide the most valid measure of these constructs.
Adequate supportive evidence is provided regarding the validity of the test. When selecting a test
or interpreting results for infants under 9 months of age, examiners should keep in mind that
DAYC-2 floors on some domains are inadequate for children under 9 months of age or younger
and that the test has steep item gradients for many domains, particularly for children 12 months
of age or younger. Many measures of child development have limitations, especially for the
youngest children, including the DAYC-2. The DAYC-2 problems with floors and item gradients
appear to be more frequent than with other measures of development; however, other measures
may have serious limitations in other areas of technical adequacy (e.g., problems with cut-scores
on the BDI-2). Overall, the DAYC-2 appears to be a useful measure of young children’s
development.

Author’s Note
This test review has neither been published elsewhere nor is currently being considered for publication by
any other journal or source.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publi-
cation of this article.

Funding
The author received no financial support for the research, authorship, and/or publication of this article.

References
American Academy of Pediatrics. (2001). Developmental surveillance and screening of infants and young
children (Committee on Children With Disabilities). Pediatrics, 108, 192-196.
Bracken, B. A. (1987). Limitations of preschool instruments and standards for minimal levels of technical
adequacy. Journal of Psychoeducational Assessment, 4, 313-326.
Bracken, B. A. (2000). Maximizing construct relevant assessment: The optimal preschool testing situation.
In B. A. Bracken (Ed.), The psychoeducational assessment of preschool children (3rd ed., pp. 33-44).
Needham Heights, MA: Allyn & Bacon.
Hresko, W. P., & Sherbenou, R. J. (in press). Developmental observation checklist system (2nd ed.). Austin,
TX: PRO-ED.
Newborg, J. (2005). Battelle developmental inventory (2nd ed.). Itasca, IL: Riverside Publishing.
Ogletree, B. T. (2001). Review of the developmental assessment of young children. In The fourteenth mental
measurements yearbook. Retrieved from EBSCO Mental Measurements Yearbook database.
Salvia, J., Ysseldyke, J., & Bolt, S. (2010). Assessment in special and inclusive education (11th ed.). New
York, NY: Houghton-Mifflin.
Sattler, J. M. (2008). Assessment of children: Cognitive foundations (5th ed.). La Mesa, CA: Jerome M.
Sattler Publisher.
Voress, J. K., & Maddox, T. (2013). Developmental assessment of young children (2nd ed.). Austin, TX:
PRO-ED.
Watson, T. S. (2001). Review of the developmental assessment of young children. In The fourteenth mental
measurements yearbook. Retrieved from EBSCO Mental Measurements Yearbook database.
Section 1. Identifying Information

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Examiner's Name

Female D Male D Examiner's ntle ______________

Year Month Day Parent/Guardian _ _ _ _ _ _ _ _ _ _ _ _ __

Date Tested School/Day Care _ _ _ _ _ _ _ _ _ _ _ __

Date of Birth Respondent's Name _ _ _ _ _ _ _ _ _ _ _ __

Age Relationship to Child _ _ _ _ _ _ _ _ _ _ __

E
Age in Months Length ofTime Respondent Has Known Child _ _ _ _ __

Section 2. Record of Scores

PL
Raw Age %lie Standard
Domain Score Equivalent Rank Score SEM Descriptive Term
--- . ·-----~•--··-------- --·~~·--- --------- -------·----·-- ----·-------------- -·· ----··----
M
Cognitive 3
Communication 3
Social-Emotional 3
SA

Physical Development 3
Adaptive Behavior 3

%He Sum of Standard

Rank Standard Scores Score SEM Descriptive Term

General Development Index

---) 2

Section 3. Descriptive Terms

Descriptive Term "" _Very Poor"" "__ "_" __Po_or "· __"""Below Average ___ ""Average __ " _Above Average Superior __ Very Superior
Standard Score < 70 70-79 80-89 90-110 111-120 121-130---- "" " " " " "
> 130---- - - --- -
"""

Section 4. Observations and Recommendations

Additional clll)ies of this form (#13751) may be purchased from

© 2013 by PRO-ED, Inc PRIHD, 8700 Shoal Cree< Blvd, Austin, TX 78757-6897
l 3 4 S 6 7 8 9 10 21 20 19 18 17 16 15 14 13 800/897-3202, Fax 8001397-7633, www.pmedinc.com
 Developmental Assessment of Young Children-Second Edition

Cognitive Domain Scoring Form

YC-2
Judith K. Voress TaddyMaddox

Section 1. Identifying Information

Name Examiner's Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Female □ Male D Examiner's Title _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Year Month Day Parent/Guardian _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date Tested School/Daycare _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date ofBi rth Respondent's Name _ _ _ _ _ _ _ _ _ _ _ _ _ __

Age Relationship to Child _ _ _ _ _ _ _ _ _ _ _ _ _ __

E
Age in Months Length of Time Respondent Has Known Child _ _ _ _ _ _ _ __

Section 2. Record of Scores

PL
Raw Age %ile Standard
Score Equivalent Rank Score SEM Descriptive Term
--~------- --------------------
3
M

Section 3. Descriptive Terms

SA

Descriptive Term Very Poor Poor Below Average Average Above Average Superior Very Superior
Standard Score <70 70-79
---
80-89 90-110 111-120 121-130
.•..........................•................................................................. >130

Section 4. Observations and Recommendations

Additional copies ofthis form (#13748) may be purchased from

© 2013 by PRO-ED, Inc. PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6897
2 3 4 5 6 7 8 9 10 21 20 19 18 17 16 15 14 13 800/897-3202, Fax 800/397-7633, www.proedinc.com
Section 5. Record of Performance

Cognitive Domain
Instructions: Starting points are determined by the child'; age. Score 1 Wthe~hild does exhibit the behavior described most of
the time, or did when he or she was younger but has outgrown the behavior. Score Oif the child does not exhibit
the behavior described ·or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items ·receive a score of O (i.e., to establish a
Ceiling: ceiling). If the child receives a score of Oon any of the first three items, test backward until the child scores a 1 on
three items In a row (i.e., to establish a basal). If the child does not receive a score of Oon three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Blrth-11 months: Item 1 24-35 months: Item 29 48-59 months: Item 53
12-23 months: Item 19 36-47 months: Item 40 60 months and older: Item 65
Item Score
# (1 or 0) Item

*1. turns head or moves eyes to visually explore surroundings

2. moves hand to mouth

E
3. looks at object for at least 3 seconds

4.
PL
watches an object moved slowly through his or her line of sight

5. looks back and forth between two objects

6. inspects own hands

M
7. holds toy placed in hand for 10 to 15 seconds

mouths toys
SA

8. ,•

9. alternatively glances from hand to an object or from one hand to another

repeats arm or leg movements to cause an action to occur again (e.g., shakes arm with rattle attached to wrist, kicks
10. leqs to move mobile attached to crib) .

11. gaze lingers where object moved slowly through line of sight disappears from view

12. explores objects in a variety of ways (e.g., visually, turning it around, feeling all surfaces, banging and shaking)

13. follows path of fast-moving object

14. pulls cloth rrorn face

15. intentionally drops an object and watches it fall (e.g., drops spoon from high-chair tray and watches it fall)
.

16. imitates familiar action after observing caregiver doing that action (e.g., claps hands)

17. finds an object that is partially hidden

18. ' transfers an object from one hand to the other to pick up second object

*19. retrieves an object seen hidden under or behind a single barrier

20. touches adult to have that person start or continue interesting game or action

!_2_J
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 29 48-59 months: Item 53
12-23 months: Item 19 36-47 months: Item 40 60 months and older: Item 65
Item Score
# (1 or 0) Item

21. looks at pictures in a book (may pat or point to the pictures)

22. rolls wheeled toys

23. hands an object to an adult to have that person repeat or start a desired action (e.g., start windup toy)

24. attempts to start toy if he or she has seen someone else make it work (e.g., a windup toy)

25. places a small object into small container (e.g., a raisin into a small bottle)

26. imitates scribbling

27. demonstrates appropriate use of everyday items (e.g., pretends to drink from a cup, sweeps with a broom)

28. combines two related objects during play (e.g., bowl and spoon, brush to doll's hair)

*29, looks at picture book with adult, may name or point to simple objects

E
30. manages three to four toys by setting one aside when given a new toy

31. spontaneously names five or more objects

PL
32. stacks six to seven blocks

33. imitates activities using substitute object to represent real one (e.g., stick for spoon, washcloth for doll blanket)
M
34. matches five or more objects to a corresponding picture
,____ ----------- --· -·--------,--- -- --- -------- ""•·------ --------- - - · - - - - - - -
sequences related action in play involving two to three steps (e.g., feeds doll with bottle, then pats it on the back, then
35.
SA

.. putsdolltobed2. ____ ___ .. _______ .._.._.. _____.._.. _________________________ -----·-

36. repeats finger plays with words and actions

37. tells own age (may state or hold up appropriate number of fingers)
-. ----------- -, - -·- - -------- - -·-· ---- ----·---- ------------- ·-- ··-· ------- ------- -------
38. understands concepts of"one" (e.g., "Give me one block."), "one more" (e.g., "Give me one more."), and "all" (e.g., "Give
me all the blocks.")
...---------+--"'-----·~=--'---- - -------·- -- - - - - - -·--··"·-··--- .. ,___ ,.......... -....--------..-- --- ...-------- - ··-- ..... ····--· - -- ...... ,_
39. matches circle, square, and triangle

puts graduated sizes in order (e.g., nests four boxes or stacks rings on peg in order of size)

41. states accurately whether boy or girl

42. counts by rote to five

43. counts up to five objects

- - - -- ---------------------
44. builds bridge using three blocks (adult models)
00
45. matches objects by color, shape, and size

46. tells if objects are "heavy" or "light"

--- -- --- -------·- - - -
47. understands concepts of"same" and "different" (e.g., "Are these two colors the same?")
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 29 48-59 months: Item 53
12-23 months: Item 19 36-47 months: Item 40 60 months and older: Item 65
Item Score
# (1 orO) Item

48. matches three pairs of objects that have the same function (e.g., comb and brush, bowl and plate)

49. understands "more" and "less" (e.g., 'Which pile has more?")

50. understands concept of "three" (e.g., "Give me three blocks.")

- --- ---------- ---------- --\,..--~
----. ., _____ "_______ - -~---------·------ -·-------·----~-
sorts objects by physical characteristics (Give child three or more pictures or objects across at least two variables, e.g.,
51.
. ........ shape or color,and state,."Put th.ese into groups that are alike.")
sorts objects into categories (Give child three or more pictures or objects for at least two categories, e.g., toys or ani-
... 5...2...·. ··-i-·· ............... mals, and state, "Punhese into groups that are alike."); may not be able to label the categories
identifies objects that do not belong in a group (e.g., recognizes that dog does not belong with food items) for three or
*53_
----+- mo_re_obj_e_ct_~ets --------·-·-----~----------------- ___________ ....._________

54. imitates drawing of a face with at least three features

55. retells story from picture book with reasonable accuracy

56. builds pyramid of six blocks (adult models) & _____ - - - - -

E
----------------------- ----------~---------- ...

57. draws people, may be stick figures

58.
PL
copies own name; may use large, irregular letters

59. predicts what may happen next (e.g., ask child what may happen next in a story)

60. identifies "first," "last," and "middle" (e.g., "Point to the child who is first in line.")
M
61. knows sequence of reading a book from left to right, top to bottom
- -- --- --------------~-------------------- -~--------- ------ ----------
distinguishes between real and make-believe and living and nonliving (e.g., "Is the truck alive?""Show me which of
62,
SA

............ these thingsare make-believe.") ... - ........... _ -···-·--..- - - - - - - - - - - - - - - - - .. •·-·.. -· .. - ....·

63. understands concept of"zero" (e.g., "Which cup has zero cubes 7")

64. identifies "half" and "whole" objects

*65. names 20 or more letters

66. draws person with six recognizable parts

67. prints first name legibly without a model

-------------~------~------ ________ ,____
., - -------
identifies the larger of two numbers for three or more number sets (e.g., "Which is more, 2 or 3?" 'Which is more, 8 or
68.
67")_ - - -··---·- ....
69, matches the number of items in a set to the correct numeral for three or more sets; does not need to state numeral
·····--- ..! .. _ .............................................. _,_ ........ ·--···.. ·--... - - - - - · - .................., ___ -·-······- .... , .._
sorts groups of objects in more than one way (Give child pictures or objects across at least two categories, e.g., color,
70.
....... ----- size, or shape,_and.state, "Put these into groups that are alike. Now sort them in another way~_")~--

71. puts three pictures in a sequence to tell a story

72 . counts up to 20 objects
... 'I.
73. draws five or more identifiable objects without a model

74. arranges numbered tiles or cards (1-10) in sequenced order at leasttwo times
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 29 48-59 months: Item 53
12-23 months: Item 19 36-47 months· Item 40 .
60 months and older· Item 65
Item Score
# (1 orO) Item

75. consistently tells month and day of birth

~

76. names the days of the week in order

77. writes first and last name from memory

78. consistently tells own street name and town

for numbers 1 through 30, can state the preceding and following numbers for three numbers (e.g., "What number
79.
comes before 19?" "What number comes after 19?')
80, can state use of at least three body parts (e.g., 'What do you do with your ... eyes, nose, ears?")

81. reads 10 or more printed words

82. names the months of the year

83. writes numerals 1 to 19 without model

E
84. counts by rote from 1to 100

85. calculates five or more single-digit addition problems

PL
86. calculates five or more single-digit subtraction problems

87. writes name, address,.and phone number

M
88. measures length to the inch and half inch using ruler

0 TOTAL DOMAIN RAW SCORE

SA
 Developmental Assessment ofYoung Children-Second Edition

Communication Domain Scoring Form

DAYC-2
Judith K. Voress Taddy Madd_ox

Section 1. identifying Information

Name __________________ Examiner's Name _______________

Female D Male D Examiner's Title _______________

Year Month Day Parent/Guardian _______________

Date Tested School/Day Care _ _ _ _ _ _ _ _ _ _ _ _ __

Date of Birth Respondent's Name ______________

Age Relationship to Child _ _ _ _ _ _ _ _ _ _ _ __

E
Age in Months Length of Time Respondent Has Known Child _ _ _ _ __

Section 2. Record of Scores

PL
Raw Age %ile Standard Descriptive Standard Score
Subdomain Score Equivalent Rank Score SEM Term Difference

>r
M
Receptive Language 5
Expressive Language 4
O Not important
SA

O Statistical
12 or above
0 Clinical
22 or above
Sum of
Sum of Age %ile Standard Standard
Domain Raw Scores Equivalent Rank Scores Score SEM Descriptive Term

Communication 3

Section 3. Desqiptive Terms

Descriptive Ter.rn_. .. Very Poor Poor Below Average_- Average Above Average Superior Very Superior
Standard Score <70 70-79 80-89 90-110 111-120- -.. ·-·-·~--·-·· --121-130
- -------------
>130

Section 4. Observations and Recommendations

Additional copies of this form (#13752) may be purchased from

© 2013 by PRO·ED, Inc PRO·ED, 8700 lhoal Creek Blvd., Austin, TX 7875/.6897
2 3 4 5 6 7 8 9 10 21 20 19 18 17 16 15 14 13 800/897-3202, Fax 800/397·7633, www.proedinccom
 Section 5. Record of Performance

Communication Domain
Receptive Language Subdomain

Instructions: Starting points are determined by the child's age. Score 1 if the child does exhibit the behavior described most of
the time, or did when he or she was younger but has outgrown the behavior. Score Oif the child does not exhibit
the behavior described or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items receive a score of O(i.e., to establish a
Ceiling: ceiling). If the child receives a score of Oon any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of Oon three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Birth-11 months: Item 1 24-35 months: Item 16 48-59 months: Item 27
12-23 months: Item 8 36-47 months: Item 23 60 months and older: Item 31
Score
(1 or 0)
I, Item

E
!
*1. 1
··-·-·-·+··· ............ : normal breathing .rate ___ ············· ••············· ··········•· .................................................
2. I 1·reacts to loud noise by blinking, moving arms or legs, or stopping movement
PL
••-••~•--••••••--1••e,~•••-----.•-•-,-•••-----~--•••••••••---"••••••"•--••••S ••••-••••••••--•--•M"• ,,,..,.,_,_,.,.-,, .. , ..,__,•••••••--•-••'•• ,•'"'• '• ' • •---••••,.~-••+••

3. i , quieted by music

4. I . j' tu~ns head toward voi~~_:he~ some~ne speaks.to.him or her

M
5.. i smiles at person who is talking or gesturing
....•..... ·. ,--- ...... - .....
:
...... . . .... - ...
J
6. I turns and looks toward noise
SA

!
;
7. ; briefly stops activity when name is called
t·--· -·---·· ,_,.____ T-' --···---····----.. ·•-·---·· ..--·-··•···-•- ... ... ·-·--.-··•· .. ··· . ··--·-~-----
*8. ! responds with appropriate gestures to "up;' "bye·bye;• or other routines
9. / moves body to music

10. i briefly stops activity when told "no"

.__.,___._._., ___________ .. l ········--·---..'"'------ ____ ., _____ · - - - - - - - -----.----·-···--··---
11. ifollows simple spoken ·commands (e.g., "Give Mommy the cup.")
,-·-------------.---..t---·---
12. 1 responds to "where" questions (e.g., "Where is the ball?" May point, state the location, or go get the ball.)

13. when asked, will point to five or more familiar persons, animals, or toys

14. follows directions about placing one item "in" and"on" another
___ _,_ -· ---·· !- .... -- .. -...... '• ... ,. ----·----·-- ---- ....,,-~---··--··------·---
15. ! indicates "yes" or"no" (or appropriate head movement) in response to questions

*16.
. . . . §................
i points to three body parts when asked
' . . . . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
17. carries out two-step directions that are related (e. g., "Go to the table and bring me the toy.")
• •• , . . _,,, .,, -•• ,"·••••••·•~ , _ , . , , . , , , . , , , . , . , , , , , , ••·•••••---•"••"••"w-•• ••• •••• --••• -•••·•~• ~••••••·"·•-•••• '""·•~~••••--•-•••••••• •••·""""""' • • "•·•~•• ·•••·•• ••• • •·• ••• ••••~ • •-••"·• ,,,.,,., . ..,.,,,,,,,,.,_,

18.
......... , points to six body parts v;hen as~e~ _ .. .......... ___ . . •• .... . . •. . • . . ..

2 !
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 16 48-59 months: Item 27
12-23 months: Item 8 36-47 months: Item 23 60 months and older: Item 31

Item Score
# (1 or 0) I item
19. i points to 15 or more pictures of common objects when they are named
20. , understands at least three possessives (e.g., mine, yours, and boy's; "Is this your ball?" "Show me the dog's food'.')

21. : points to five or more common objects described by their use (e.g.,"Show me what you eat with'.')

22. carries out two-step unrelated commands (e.g., "Put the ball on the shelf and then clap your hands'.')

*23. understands negative (e.g., "Which is not ... red, the dog?")

24. knows "big"and "little"(e.g., "Throw the big ball to me'.')

25. ; responds to "who" and "whose" questions (e.g., "Who has on a red shirt today?")

26. follows directions about placing one item "beside" and "under" another

E
*27. understands "in front of"and "behind"(e.g., "What is behind the screen?")

28. answers comprehension questions when told a short story

PL
29. demonstrates understanding of passive sentences (e.g., "Show me the train was pushed by the car:')

30. i carries out three-step commands that are not related (e.g., "Put the ball on the table, shut the door, and turn around'.')

tells whether two words rhyme or have the same ending sound for at least three word pairs (e.g., "Do cat and pat have
M
*31. _; the same ending sound?'')

32. ; responds to questions involving time concepts (e.g., "When do we eat lunch?")
SA

33. understands all four seasons of the year and what you do in each (e.g., "What do we do in the summer?")

can identify at least three opposites using pictures or objects ("Show me the opposite of ... big/little, hot/cold,
34.
tall/short:')

35. i identifies "left"and "right" on own body (e.g., "Raise your right hand'.')

36. i can identify at least three units of currency (e.g., "Pointto the ... penny, dollar, quarter")
' can identify at least three complete sentences ("Tell me if this is a complete sente~ce'.' e.g., brov,;~·dog;.The boy ra~
37.
, away.)_

RECEPTIVE LANGUAGE SU8DOMAIN RAW SCORE

Continues with
Expressive Language--+

3
 Expressive Language Subdomain

Instructions: Starting points are determined by the child's age. Score 1 if the child does exhibit the behavior described most of
the time, or did when he or she was younger but has outgrown the behavior. Score O if the child does not exhibit
the behavior described or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items receive a score of O (i.e., to establish a
Ceiling: ceiling). If the child receives a score ofO on any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of O on three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Birth-11 months: Item 1 24-35 months: Item 16 48-59 months: Item 30
12-23 months: Item 8 36-47 months: Item 24 60 months and older: Item 34
Item Score
# (1 or 0) Item

has a strong cry

2. makes sucking noises

E
3. cries when hungry or uncomfortable

4.
PL
makes noises other than crying (e.g., cooing, gurgling)

5. has different cries for pain, hunger1 or discomfort

6. produces three or more single vowel sounds (e.g., ah, eh, uh)
M
7. laughs out loud

*3_ produces three or more consonants, such as /b/, /ml, or /d/

SA

9. produces string of consonant-vowel sounds (e.g., ba-ba, da-da)

10. uses word for parent or caregiver discriminately (e.g., mama, dada, nana)

11. uses inflection patterns when vocalizing (e.g., raises pitch as if asking a question)

12. spontaneously says familiar greetings and farewells

13. has a word, sound, or sign for"drink"

14. uses at least five words

says one word that conveys entire thought; meaning depends on context (e.g., "cookie" may mean "wants more" or
15.
"the cookie fell")

*16. can name familiar characters or items seen on TV or in movies (e.g., Big Bird)

17. knows names of two or more playmates

18. uses 10 to 15 words spontaneously

19. produces three or more two-word phrases (e.g., more juice)

*Entry Points: Birth-11 months: Item 1 24-35 months: Item 16 48-59 months: Item 30
12-23 months: Item 8 36-47 months: Item 24 60 months and older: Item 34
Item
#
I. Score ·\
(1 or OJ Item
I i
20. : : names eight or more pictures of familiar objects
•-•• ,-----••-•f-•••----- -••-~•--- • •1••-••• •••• -•--••-••••-•M -•,. •••'"•~---•-•q "'
I
21. j whispers

22.
-·-····-L·---
r .. .. \ us~~-~e-nt-e-nc_e_s-of three or ~;;~·:;~ds

23. i ' uses at least 50 different words in spontaneous speech

describes what he or she is doing (e.g., responds to "What are you doing?")
--r---~
25. , asks "what" or "where" questions (e.g., "Where is my ball?")
-- ··-----·--,,i,,_ ----"···
26, I uses five or more regular plurals (e.g., boys, toys)
-··-ri ---·-····
27. ' I changes speech depending on listener (e.g., talks differently to babies than to adults)

E
28. J. . Igives full name on request (e.g., "What is your name?")
I
29.
..... J
PL
J. answers questi°.n'.~W.ha~ ~appens if-~:" (e.g.," ... you drop an egg:? - - - - · ·..···-·· ... •···"·•·······
*30, ] uses five or more contractions (e.g., I'll, can't)

31 •
. .- ,. .............. I ,
uses.fucial expressions and body languageto.demonstrate at least five emotions (e.g.,"Show me.how you would look if
you were ... angry, proud, frightened, scared'.')
··y-·--..----·---•-,•··--·~---~------· - --------- -·-------···-~--------- - - -
M
32. [ makes statements about cause and effect (e.g., "It won't roll because the wheel is off.")

33.
____ ,_
......................... .. .
SA

*34, [ completes at least three simple verbal analogies (e.g., "Daddy is a man; Mommy is a _ _ _.")
--·-·1 .. ,.-...~--•-----.---------------·--··---- --------
35. 1 states similarities between objects for at least three object pairs (e.g., "How are shoes and boots alike?")
-- - II - .

36. ! responds to "Tell me the opposite of ____"for at least three words

•--•--•···•·-----··-·-"'··-· ---.!·-·--••---··•··-······-·--··~······-··--------· '"~•.--~·----·-------·- -------
37. [ uses irregular plurals correctly (e.g., foot/feet, goose/geese)
I
··--·4·-·~·-·······~· - - ' - - - - - - · - - · - - - - - · · - · - - · ~ · · · ~ · - - - - - - - - - - - - - - - - - - - - - · - - - - - - - - - -
i
38. ! tells simplejokes
'
39. states differences between objects for at least three object pairs (e.g., "How are milk and water different?")

40. uses "yesterday" and "tomorrow" meaningfully

I

41. I uses irregular comparatiVes correctly (e.g., good, better, best)

·□ EXPRESSIVE LANGUAGE SUBDOMAIN RAW SCORE

 Developmental Assessment of Young Children-Second Edition

Social-Emotional Domain Scoring Form

DAYC-2
Judith K. Voress Taddy Maddox

Section 1. Identifying Information

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Examiner's Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Female D Male D Examiner's Title _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Year Month Day Parent/Guardian _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date Tested School/Daycare _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date of Birth Respondent's Name _ _ _ _ _ _ _ _ _ _ _ _ _ __
Age Relationship to Child _ _ _ _ _ _ _ _ _ _ _ _ __

E
Age in Months Length ofTime Respondent Has Known Child _ _ _ _ _ _ __

Section 2. Record of Scores

PL
Raw Age %ile Standard
Score Equivalent Rank Score SEM Descriptive Term
M
3

Section 3. Descriptive Terms

SA

Descriptive Term . Ver}'P_oor Poo_r__ Below Average . Average Above Ave!il!J_e_ Su-"p-"er.c.cio.c. .r_ _V_e~ry_Superior
Standard Score- - -<- 70 - - - -
70-79 80-89 90-110 111-120 121-130 > 130

Section 4. Observations and Recommendations

Additional copies of this form (#13749) may be purchased from

© 2013 by PRO-ED, Inc. PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6897
2 3 4 5 6 7 8 9 10 21 20 19 18 17 16 15 14 13 800/897-3202, FaxB00/397-7633, www.proedinc.com
Sectidn 5. Recordt>f Performance

Sodal-Emotfonal I>omam·
St;irtirig points are determined by the child's ~ge. Score 1 if the child does exhibitthe behavior described most of
the;tinie, or did when he or she was youn~er but has outgrown the behavior. Score O if the child does not exhibit
.th~ behavior describect·or exhibitsthe benaviorinconsistently.

·hsaland Begin.at the starting point. Administer items until three consecutive items receive a score of O O.e., to establish a
Ceiling: ceiling). If the child receives a score of Oon any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of Oon three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Birth-11 rnonths: Item 1 24-35 months: Item 28 48-59 months: Item 46
12-23 months: Item 16 36-47 months: Item 38 60 months and older: Item 51
Item Score
# (1 or OJ Item
*1. relaxes body when held . .

E
2. stops crying when- talked to, picked up, or comforted
-··

3. establishes eye contact for at least afew ·seconds

-------
4.
PL
looks at adult face for several seconds

5. I smiles reflexively
M
6. j interacts by smiling and cooing
i

7. recognizes familiar faces and objects (e.g., parent, bottle); reaas by waving arms and legs or squealing with excitement
SA

8. . expresses feelings such as anger, tiredness, excitement, and hunger

-----·-- -.-•-- .

_laughs, squeals, or s_hows enjoyment when caregiver involves child in play (e.g., moves hands to act out pat-a-cake,
9. bounces on knee) ·• ·
. .

10. comforts self (i.e., quits fussing by himself or herself) .

11.

12.

13.
------.•·----- -
I
-· -~
i laughs when_ head is covered with cloth

smiles at or pats own image In the mirror

.
.

knows the difference between caregivers and strangers (e.g., smiles at loved ones; stares, quiets; or refuses to smile with

14. when someone

. calls the child's name, he or she looks at the person and vocalizes
- ..-- ,• .

-
15. extends arms to familiar persons
. ----·

*16. shows preference for certain toys, activities, or places (e.g:, interacts positively vs: negative response)
I

17.
___,._
______ ,,
expresses affection (e.g., hugging, patting, special looks, resting head)
·- ·- ----·-·--·-----·-
18. plays simple games (e.g., peek-a-boo, pat-a-cake)
--------- I
.

19. i . imitates facial express_ions, actions, and sounds

--- I
I
20. 1·repeats activity that elicit: laughter or positive response from other?
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 28 48-59 months: Item 46
12-23 months: Item 16 36-47 months: Item 38 60 months and older: Item 51
Item Score
# (1 orO) Item

21. brings toys to share with caregiver

22. plays well for brief time in groups of two or three children; at least some interaction among children

23. spontaneously greets familiar person by hugging or other appropriate gesture

24. separates from parent in familiar surroundings without crying

25. attempts to comfort others in distress (e.g., comforts a child who is hurt or distressed)

26. insists on trying to do many things without help (e.g., eating with spoon, putting on a coat)

27. enjoys simple make-believe play (e.g., pretends he or she is the parent, is an animal, doll is a baby)

*28. shows pride in accomplishments

29. quietly listens to story, music, movie, or TV

E
30. sings familiar songs with adult

31.
PL
"please" and "thank you" appropriately; may need to be reminded

32. for assistance when having difficulty

33. at person when speaking with him or her

M
34. usually takes turns

35, recognizes when another person is happy or sad

SA

36, avoids common dangers (e.g., sharp knives, fire, hot stove)

37, plays dress-up

*38, shows off by repeating rhymes, songs, or dances for others

39. changes from one activity to another when required by teacher or parent

40, interacts appropriately with others during group games or activities

41. knows and follows classroom rules

42. gains attention from peers in appropriate ways

43, plays group board or card games

44. volunteers for tasks

45. quiets down after active play

likes competitive games

47. returns objects to their appropriate place

L 3
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 28 48..'.59 months: Item 46
12-23 months: Item 16 36--47 months: Item 38 60 months and older: Item 51
Item
#
Score
(1 or OJ
I Item
:
48. ! accepts mild, friendly teasing
;-----~------·-··-··------------·-··~--~----·-----·----------------·~----------
1
49. !explains rules of a game to others
---··•--·---··· ------;-'-----·-----------·
50. / expresses anger with. nonaggressive words rather than with physical action

*51. ioffers item or_actlvityto another in exchange for an item or activity

~-----+-·---
52. : accepts valid criticism without crying, pouting, or refusing to continue
I
53. i asks before using another's belongings
I
:
54. \ provides or offers assistance to others when appropriate

55. i i helps with group projects

E
58. remains calm when small requests are denied (e.g.1 cannot have a snack)
PL
59. works alone at chore for 20 to 30 minutes

60. i completes pencil/paper games (e.g., dot-to-dot, hidden pictures, mazes)

iinitiates group activities
M
61. I

62. congratulates others when appropriate

SA

63. i answers the phone, remembers a simple message, and delivers it to the correct person

0
I -----------

TOTAL DOMAIN RAW SCORE

 Developmental Assessment of Young Children-Second Edition

Physical Development Domain Scoring Form

DAYC-2
Judith K. Voress Taddy Maddox

Section 1. identifying Information

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Examiner's Name _ _ _ _ _ _ _ _ _ _ _ _ __

Female D Male D Examiner'sTitle _ _ _ _ _ _ _ _ _ _ _ _ _ __
Year Month Day Parent/Guardian
Date Tested School/Day Care _ _ _ _ _ _ _ _ _ _ _ _ __
Date of Birth Respondent's Name _ _ _ _ _ _ _ _ _ _ _ __
Age Relationship to Child _ _ _ _ _ _ _ _ _ _ _ __

E
Age in Months ( Length ofTime Respondent Has Known Child _ _ _ _ _ __

Section 2. Record of Scores

PL
Raw Age %ile Standard Descriptive Standard Score
Subdomain Score Equivalent Rank Score SEM Term Difference

Gross Motor 3
M
Fine Motor 4
O Not important
SA

O Statistical
10 or above
0 Clinical
23 or above
Sum of
Sum of Age %ile Standard Standard
Domain Raw Scores Equivalent Rank Scores Score SEM Descriptive Term

Physical
Development ___ ___ ___ ___ ~-- 3

Section 3. Descriptive Terms

Descriptive Term __ Very Poor . - _Joor ___ Below_Average ____ .. Average ____ .. Above Average .. - Superior ___ V~uperior
Standard Score < 70 70-79 80-89 90-110 111-120 121-130 >130

Section 4. Observations and Recommendations

Additional copies of this form (#13750) may be purchased from

© 2013 by PRO-ED, Inc. PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6897
2 3 4 S 6 7 8 9 10 21 20 19 18 17 16 15 14 13 800/897-3202, Fax 800/397-7633, www.proedinc.com
Section 5. Record of Performance

Physical Development Domain

Gross Motor Subdomain

Instructions: Starting points are determined by the child's age. Score 1 if the child does exhibit the behavior described most of
the time, or did when he or she was younger but has outgrown the behavior. Score O if the child does not exhibit
the behavior de.scribed or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items receive a score of O (i.e., to establish a
Ceiling: ceiling). If the child receives a score of O on any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of O on three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Birth-11 months: Item 1 24-35 months: Item 37 48-59 months: Item 43
12-23 months: Item 27 36-47 months: Item 40 60 months and older: Item 47
Item Score
# (1 or 0) I Item
!

E
i normal heart rate (for newborns, above 100 beats per minute)
I
2, i ~hen ly;n~ on b~ck, c~n turn h~ad to ea~h side
PL
3. j when lying on stomach with head turned to one side, lifts and turns head so opposite cheek touches the surface

4. ' when lying on stomach, raises head briefiy; weight is on chest, forearms, and hands

i when lying on back, kicks reciprocally when excited (e.g., one leg, then the other)
M
5.

6. i when held upright, will bear some weight on legs

SA

7, i when lying on stomach, lifts head with face at angle of at least 45° from the surface
8. i rolls from side to back
!

9. i when pulled to sitting, holds head in line with body (i.e., no head lag)
10. ! rolls from back to side

11. ! sits for at least 5 seconds with hips supported

12. i when lying on stomach, lifts arms and legs off surface

13. rolls from back to stomach

i
14. ; when lying on back, brings feet to mouth
i

15,

16. . ! ::~:::::: :::t~~:n::::;ass:;::::~I:~~:::

i
17. i when lying on stomach, reaches with one hand while bearing weight on side and otherforearrn
18. ; sits alone for at least 60 seconds while playing with toy
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 37 48-59 months: Item 43
12-23 months: Item 27 36-47 months: Item 40 60 months and older: Item 47
Item Score
# (1 or OJ Item

19. uses arms to move forward on belly

- ·-~-·-··
20. stands alone, holding on to something, for at least 10 seconds
---·-···-··-••-.•-

21. moves from stand'1ng to sitting in controlled fashion

. --------• ------·-·-···•·
22. from sitting position, pivots 180°to.retrieve an object

23. pulls self to standing position

--·--
24. moves from back to sitting without assistance
.•.•. --·----·-------·--·
25. when falling forward, extends arms to catch self

26. walks sideways while holding on to furniture

~----·- -·

E
*27. walks three or more steps with assistance
----
28. walks at least 8 ft with one hand held
PL
29. · pushes or pulls toys while walking
--~----
30. walks without holding on for at least five steps
M
31. demonstrates controlled startS and stops in walking
~---
32. '· squats during play
I
SA

--···-···-

33. when standing, stoops then stands again without losing balance
-~----- ----
34. creeps backward down steps

35. I climbs low play equipment

-----
36. runs (may be a hurried walk) at least 10 ft without falling
---------
*37. 1walks up and down stairs with support from rail or wall; rnay place both feet on each step

38. throws a ball overhand with relative accuracy

i
I
..
39.
-------- :'
' walks backward at least 1Oft
----
walks up stairs, alternating feet, in adult fashion while holding on to rail or wall
*40.
I ····-·-··--··
41. ' walks swinging arms and legs freely in cross pattern similar to ad_uit walk pattern
----·--· I
42. ' catches ball from straight arrn position, trap in ball a ainst chest
-~---·· I . .p g ' g
~~--·-···_l:alks forward heel to toe without losing balance for four or more steps
. . '
44. !' i' hops forward on one foot without losing balance for four or more hops

1 4 I
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 37 48-59 months: Item 43
12-23 months: Item 27 36-47 months: Item 40 60 months and older: Item 47
Item
#
Score
(1 or OJ
IItem ·

45, : gallops, leading with one foot and transferring weight smoothly and evenly
--- !!
46. j i jumps over objects up to 6 in high; lands with both feet together
--- ---!

.... Jbalanceson one foot with hands onhips forat_leastl Oseconds

! swings on swing maintaining own momentum; uses legs to propel

49. i bounces and catches tennis ball (or any ball of similar size)
i
. '
so. ___ ,,\___ _
I skips, alternating feet, maintaining balance for 1Oft
i
s1. I ! drops a ball and kicks it forward before it hits the floor
! !-----------
I
--------------------- - --- -- -- --- --------
52. : catches a small ball (about 4 in) in hands only (doesn't trap against chest)
! ,, i__ _

i can dribble an 8-to 10-in ball at least four times; uses only one hand and doesn't move feet

E
--- 1---
! jumps rope by self
'
D GROSS MOTOR SUBDOMAIN RAW SCORE
PL
M
SA

Continues with
Fine Motor ➔
 Fine Motor Subdomain

Instructions: Starting points are determined by the child's age. Score 1 If the child does exhibit the behavior·described most of
the time, or did when he or she was younger but has outgrown the behavior. Score o if the child does not exhibit
the behavior described or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items receive a score of O (i.e., to establish a
Ceiling: ceiling). If the child receives a score of Oon any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of Oon three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Blrth-11 months: Item 1 24-35 months: Item 17 48-59 months: Item 22
12-23 months: item 13 36-47 months: Item 19 60 months and older: Item 26
Item Score
# (1 or OJ Item

*1. closes fingers when examiner's finger is placed on palm

2. hands usually open or loosely fisted

E
3. when ·lying on back, brings hands together at midline; may not clasp hands

4. grasps cloth in hand when hand is placed on cloth draped across examiner's arm
PL
5. In supported sitting position, reaches for and grasps an object, holding it for several seconds
' -
6. holds a small object in each hand at one time
M
7. holds objects between fingers and palm of hand
'
8. transfers an object from one hand to the other
------··
SA

9. uses raking or scooping motion to pick up a small object

10. bangs two objects together

-------··-
11. holds an object between fingers and opposed thumb and palm of hand
····----- .. ··-·-..···-·-·~
12. picks up a small object using thumb and forefinger
·----
*13. pokes with index finger
.. ·········- ----- ------- .. . .
14. turns pages in book; may be thick pages
.
---·------ ~---· ------·-----------·
15. scribbles spontaneously
- ------- ,, ___
I holds crayon, pencil, etc., in adaptive fashion (e.g., in fist with thumb up, forearm turned so thumb is directed down·
16. !
!
-~----··"'·-··- ···--
ward) _.....
~
_._ _____

*17. uses one hand consistently in most activities

-·· --····· -··' ----
18. uses hand to hold paper in place when drawing
--·---·-···----- -- -..- ..

*19. imitates circular, vertical, and horizontal strokes

--------· ·-
20. uses vertical, horizontal, and circular motions when drawing
-·
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 17 48-59 months: Item 22
12-23 months: Item 13 36-4 7 months: Item 19 60 months and older: Item 26
Item Score
# (1 or O) I item
21. I i holds pencil between first two fingers and thumb (i.e., adult grasp)
I

I
*22. i i cuts with scissors, making several snips on paper
.1
I
---i
23. j ! copies a cross
24. j pastes or glues neatly
- ----·---·---1--- • 1· • -~-

copies a square

*26. [ cuts a 6-in straight line with scissors within¼ in of the line
---i
27. places at least five paper clips on paper

28. rapidly touches each finger to thumb

29. colors within lines

E
30. T cuts out simple geometric shapes (e.g., circle, square, triangle) with scissors within¼ in of the line
----;
31. i
__i -------~----
PL
folds paper in half with edges parallel

32. copies a diamond with straight, connected lines

33. cuts intricate shapes within¼ in of the line

M

0 FINE MOTOR SUBDOMAIN RAW SCORE

SA

7
Section 1. Identifying Information

Name ________________ Examiner's Name ________________

Female D Male D Examiner's TIiie ________________

Year Month Day Parent/Guardian ________________

Date Tested School/Daycare _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date of Birth Respondent's Name _______________

Age Relationship to Child _ _ _ _ _ _ _ _ _ _ _ _ __

Age in Months ( ) Length of Time Respondent Has Known Child _ _ _ _ _ _ __

E
Section 2. Record of Scores
Raw %ile Standard Age
PL
Score Rank Equivalent
Score SEM Descriptive Term
--------"--------------------
3
M
Section 3. Descriptive Terms
---~---------·---------~---------.,---------·-·---------·---------·----------·----·--·-------·-·----- -·~--------·--
Descriptive Term _ Ve~ry_P_oo_r____P_oo_r Below Average ____ Averag_e_ _A_bove Averag~ _S~up_er_io_r_ _V_ery Superior
SA

Standard Score < 70 70-79 80-89 90-110 111-120 121-130 > 130

Section 4. Observations and Recommendations

Additional copies of this form (#13747) maybe purchased from

© 2013 by PRO-ED, Inc PRO-ED, 8700 Shoal Creek Blvd., Austin, TX 78757-6897
2 3 4 5 6 7 8 9 10 21 20 19 18 17 16 15 -14 13 800/897-3202, Fax 800/397-7633, www.proedinuorn
Section 5. Record of Performance

Adaptive Behavior Domain

Instructions: Starting points are determined by the child's age. Score 1 if the child does exhibit the behavior described most of
the time, or did when he or she was younger but has outgrown the behavior. Score O if the child does not exhibit
the behavior described or exhibits the behavior inconsistently.

Basal and Begin at the starting point. Administer items until three consecutive items receive a score of O (i.e., to establish a
Ceiling: ceiling). If the child receives a score of O on any of the first three items, test backward until the child scores a 1 on
three items in a row (i.e., to establish a basal). If the child does not receive a score of O on three consecutive items
while establishing a basal, return to highest item number scored and continue testing until a ceiling is established.

*Entry Points: Birth-11 months: Item 1 24-35 months: Item 23 48-59 months: Item 44
12-23 months: Item 14 36-47 months: Item 34 60 months and older: Item 50

~
Item Score
# (1 or OJ I Item
*1 • !! maintains body temperature without external assistance

2. forms a tight seal around nipple when sucking

E
3. swallows liquids with no difficulty
PL
4. coordinates sucking, swallowing, and breathing

5. opens mouth in anticipation of feeding (sight of breast or bottle)

6. enjoys bath; keeps eyes open and indicates pleasure when placed in warm water
M
7. sleeps for 4- to I 0-hour intervals

8. closes lips when swallowing

SA

9. swallows pureed foods

10. uses tongue to move food around in mouth

·~ -- - -- ---- ----- -- -- - ---------
shows definite likes and dislikes of various foods (e.g., may spit out or refuse to open lips for undesired foods, eagerly
11.
opensmollth_for desired foods)

12. sleeps through the night; may take two to three naps during the day

13. holds or supports a bottle to feed self

*14. purposely pulls off own socks

15. feeds self finger foods

16. chews textured foods

17. cooperates in dressing and undressing (e.g., helps put arrns in holes)

18. sleeps through the night; may take one nap during the day

19. drinks from open cup or glass held by adult (not a sippy cup)

2
 A cLo.p+JV-L l&i-a.vi6v
*Entry Points: Birth-11 months: Item 1 24-35 months: Item 23 48-59 months: Item 44
12-23 months: Item 14 36-4 7 months: Item 34 60 months and older: Item 50
Item Score
# (1 or OJ Item

20. sips liquid from glass or cup using a straw

21. helps with simple household tasks (e.g., helps put things away)

22. fusses when diaper needs to be changed

tries to wash own hands and face

24. removes loose clothing such as a jacket, shorts, or a shirt without assistance

25. opens door by using handle or knob

26. puts on simple clothing independently (e.g., hat, pants)

27. independently eats entire meal with spoon

28. wipes own nose; may need to be reminded

E
29. sits on toilet for at least 1 minute supervised

30.
PL
squats, holds self, or verbalizes bowel and bladder needs most of the time

31. washes and dries hands and face without assistance

32. cleans up spills, getting own cloth

M
33. shows care when handling an ·,nfant or small animal

*34, pours milk or juice with some assistance

SA

35. tells adult of toilet needs in time to get to toilet

36. takes responsibility for toileting; may require assistance in wiping

37. gets drink of water from tap unassisted (may need help getting cup from cupboard)

38. brushes teeth independently

39. recognizes own home

40. manipulates large buttons or snaps

41. covers mouth and nose when coughing and sneezing (hand, elbow, tissue, or handkerchief may be used)

42. sleeps through the night without wetting

43. hangs up clothes (hanger, hook, or other designated device)

. -------- -
dresses self completely, except for tying shoelaces (includes underwear; clothes must be on correctly, including
all fasteners)

45. serves self at the table (adult may need to hold serving dish)

46. often wants privacy in bathroom

[lJ
*Entry Points: Birth-11 moAths: Item 1 24-35 months: Item 23 48-59 months: Item 44
12-23 months:ltem 14 36-47 months: Item 34 60 months and older: Item 50
Item Score
# (1 or0) IItem
47. \ answers what-to-do-if questions (e.g., 'What would you do if you cut your finger?")

48. i fastens seat belt in automobile independently

_ . . J . __ _ _ _ 1------------------------------------------
49. 'i crosses street safely (e.g., looks both ways, uses crosswalks)
I -----------------------------"~--
I
*so.
1
I i puts dirty dishes in sink or dishwasher
I

51. ' requests food to be passed at the table

52. selects clothing appropriate for temperature and occasion

i
53. i makes own bed; may need to be reminded
·-·-·
i
54. sets and clears table without assistance

55. uses table knife for spreading soft butter, jelly, or peanut butter

E
56. plans ahead to meet toileting needs before beginning an activity
-----··-·•--"
57.,,
______ __ -- takes shower or bath independently
PL
58. cleans counter or work surface with sponge or paper towels

59. j dusts furniture

I
M
60. / makes simple breakfast and lunch

61. washes own hair

.
·--··
SA

62. i takes care of minor cuts (cleans and applies bandage)

I
63.
l rides a bicycle safely without training wheels
I
64. i cuts food (including meat) into bite-sized pieces

0
····------

TOTAL DOMAIN RAW SCORE