Ages Stages 18 Month Form – Fill Out and Use This PDF

The Ages & Stages Questionnaires® 18 Month form is a developmental screening tool designed to capture a snapshot of a child's growth and development from 17 months 0 days through 18 months 30 days. Parents, guardians, or educators use this questionnaire to document the child's abilities in communication, fine motor skills, problem-solving, personal-social development, and overall parents’ observations. By engaging with this form, caregivers can identify areas where the child excels or may need support, thereby fostering a supportive environment for the child's growth. Click the button below to fill out the form and share valuable insights into your child's development.

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Ages Stages 18 Month Form PDF Details

The Ages & Stages Questionnaires® 18 month form serves as a critical tool for parents and caregivers to gauge the developmental progress of children aged 17 months 0 days to 18 months 30 days. This detailed form is designed to be filled out with ease, favoring black or blue ink to ensure clarity. The questionnaire demands a comprehensive collection of child information, including the child's name, gender, and detailed birth data, alongside specifying if the child was born prematurely. Focusing on a holistic assessment, it covers a spectrum of developmental areas—communication, gross motor, fine motor, problem-solving, and personal-social skills. Each section comprises pointed questions that help to observe and record the child's ability to perform age-specific activities. The process emphasizes interaction, suggesting that trying each activity with the child before responding can make the evaluation both engaging and insightful. Furthermore, it reflects on the child's communication abilities, physical coordination, problem-solving skills, and social interactions, providing a rounded view of their development. Additional considerations towards the end of the form encourage reflection on the child's hearing, speech, physical abilities, and whether there are any familial medical concerns that might affect development, thereby fostering a comprehensive approach to understanding the child's growth and well-being at this tender age.

Question	Answer
Form Name	Ages Stages 18 Month Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	18month asq, ages stages 18 questionnaires, ages stages 18 month pdf, printable asq forms

Form Preview Example

Ages & Stages

Questionnaires®

18 17 months 0 days through 18 months 30 days

Month Questionnaire

Please provide the following information. Use black or blue ink only and print legibly when completing this form.

Date ASQ completed:

Child’s information

	Middle
Child’s first name:	initial:	Child’s last name:
		If child was born 3	Child’s gender:
		or more weeks	Male	Female
		prematurely, # of	Male	Female
		prematurely, # of
Child’s date of birth:		weeks premature:

Person filling out questionnaire

	Middle	Last name:
First name:	initial:	Last name:
		Relationship to child:
		Parent	Guardian	Teacher	Child care
		Parent	Guardian	Teacher	provider
					provider
Street address:		Grandparent	Foster	Other:
		or other	parent	Other:
		or other	parent
		relative

	State/	ZIP/
City:	Province:	Postal code:

	Home	Other
	telephone	telephone
Country:	number:	number:

E-mail address:

Names of people assisting in questionnaire completion:

Program Information

	Child ID #:	Age at administration in months and days:

	Program ID #:	If premature, adjusted age in months and days:

	Program name:


P101180100		Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
P101180100		© 2009 Paul H. Brookes Publishing Co. All rights reserved.

18 Month Questionnaire	17 months 0 days
	through 18 months 30 days

On the following pages are questions about activities babies may do. Your baby may have already done some of the activities described here, and there may be some your baby has not begun doing yet. For each item, please fill in the circle that indi- cates whether your baby is doing the activity regularly, sometimes, or not yet.

Important Points to Remember:

✓

❑ Try each activity with your baby before marking a response.

✓

❑ Make completing this questionnaire a game that is fun for you and your child.

✓

❑ Make sure your child is rested and fed.

✓

❑ Please return this questionnaire by _______________.

Notes:

____________________________________________

At this age, many toddlers may not be cooperative when asked to do things. You may need to try the following activities with your child more than one time. If possible, try the activities when your child is cooperative. If your child can do the activity but refuses, mark “yes” for the item.

COMMUNICATION

YES

SOMETIMES

NOT YET

1. When your child wants something, does she tell you by pointing to it?

2. When you ask your child to, does he go into another room to find a fa- miliar toy or object? (You might ask, “Where is your ball?” or say, “Bring me your coat,” or “Go get your blanket.”)

3. Does your child say eight or more words in addition to “Mama” and “Dada”?

4. Does your child imitate a two-word sentence? For example, when you say a two-word phrase, such as “Mama eat,” “Daddy play,” “Go home,” or “What’s this?” does your child say both words back to you?

(Mark “yes” even if her words are difficult to understand.)

5. Without your showing him, does your child point to the correct picture when you say, “Show me the kitty,” or ask, “Where is the dog?” (He needs to identify only one picture correctly.)

6. Does your child say two or three words that represent different ideas together, such as “See dog,” “Mommy come home,” or “Kitty gone”?

(Don’t count word combinations that express one idea, such as “bye- bye,” “all gone,” “all right,” and “What’s that?”) Please give an ex-

ample of your child’s word combinations:

COMMUNICATION TOTAL

page 2 of 6

E101180200	Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
	© 2009 Paul H. Brookes Publishing Co. All rights reserved.

18 Month Questionnaire page 3 of 6

GROSS MOTOR

YES

SOMETIMES

NOT YET

1. Does your child bend over or squat to pick up an object from the floor and then stand up again without any support?

2. Does your child move around by walking, rather than by crawling on her hands and knees?

3. Does your child walk well and seldom fall?

4. Does your child climb on an object such as a chair to reach something he wants (for example, to get a toy on a counter or to “help” you in the kitchen)?

5. Does your child walk down stairs if you hold onto one of her hands? She may also hold onto the railing or wall. (You can look for this at a store, on a playground, or at home.)

6. When you show your child how to kick a large ball, does he try to kick the ball by moving his leg forward or by walking into it? (If your child already kicks a ball, mark “yes” for this item.)

GROSS MOTOR TOTAL

FINE MOTOR

YES

SOMETIMES

NOT YET

1. Does your child throw a small ball with a forward arm motion? (If he simply drops the ball, mark “not yet” for this item.)

2. Does your child stack a small block or toy on top of another one? (You could also use spools of thread, small boxes, or toys that are about 1 inch in size.)

3. Does your child make a mark on the paper with the tip

of a crayon (or pencil or pen) when trying to draw?

4. Does your child stack three small blocks or toys on top of each other by himself?

5. Does your child turn the pages of a book by himself? (He may turn more than one page at a time.)

6. Does your child get a spoon into her mouth right side up so that the food usually doesn’t spill?

FINE MOTOR TOTAL

E101180300	Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
	© 2009 Paul H. Brookes Publishing Co. All rights reserved.

18 Month Questionnaire page 4 of 6

PROBLEM SOLVING

YES

SOMETIMES

NOT YET

1. Does your child drop several small toys, one after another, into a con- tainer like a bowl or box? (You may show him how to do it.)

2. After you have shown your child how, does she try to get a small toy that is slightly out of reach by using a spoon, stick, or similar tool?

3. After a crumb or Cheerio is dropped into a small, clear bottle, does your child turn the bottle over to dump it out? (You may show him how.) (You can use a soda-pop bottle or a baby bottle.)

4. Without your showing her how, does your child scribble back and forth when you give her a crayon (or pencil or pen)?

Count as “yes”

5. After watching you draw a line from the top of the paper to the bottom with a crayon (or pencil or pen), does your child copy you by drawing a single line on

the paper in any direction? (Mark “not yet” if your Count as “not yet” child scribbles back and forth.)

6. After a crumb or Cheerio is dropped into a small, clear bottle, does		*
your child turn the bottle upside down to dump out the crumb or
Cheerio? (Do not show him how.)

PERSONAL-SOCIAL

1.While looking at herself in the mirror, does your child offer a toy to her own image?

2.Does your child play with a doll or stuffed animal by hugging it?

3.Does your child get your attention or try to show you something by pulling on your hand or clothes?

4.Does your child come to you when he needs help, such as with winding up a toy or unscrewing a lid from a jar?

5.Does your child drink from a cup or glass, putting it down again with little spilling?

6.Does your child copy the activities you do, such as wipe up a spill, sweep, shave, or comb hair?

PROBLEM SOLVING TOTAL

*If Problem Solving Item 6 is marked “yes” or “sometimes,” mark Problem Solving Item 3 “yes.”

YES

SOMETIMES

NOT YET

PERSONAL-SOCIAL TOTAL

E101180400	Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
	© 2009 Paul H. Brookes Publishing Co. All rights reserved.

18 Month Questionnaire page 5 of 6

OVERALL

Parents and providers may use the space below for additional comments.

1. Do you think your child hears well? If no, explain:

YES

2. Do you think your child talks like other toddlers his age? If no, explain:

YES

3. Can you understand most of what your child says? If no, explain:

YES

4. Do you think your child walks, runs, and climbs like other toddlers her age?	YES	NO
If no, explain:

5. Does either parent have a family history of childhood deafness or hearing	YES	NO
impairment? If yes, explain:

6. Do you have concerns about your child’s vision? If yes, explain:

YES

E101180500	Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
	© 2009 Paul H. Brookes Publishing Co. All rights reserved.

18 Month Questionnaire page 6 of 6

OVERALL (continued)
7. Has your child had any medical problems in the last several months? If yes, explain:	YES	NO

8. Do you have any concerns about your child’s behavior? If yes, explain:

YES

9. Does anything about your child worry you? If yes, explain:

YES

E101180600	Ages & Stages Questionnaires®, Third Edition (ASQ-3™), Squires & Bricker
	© 2009 Paul H. Brookes Publishing Co. All rights reserved.

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1. You will need to fill out the 18 month asq questionnaire accurately, therefore be mindful when filling in the parts comprising all of these fields:

How you can fill out 18 month questionnaire asq stage 1

2. The third step would be to submit the following blank fields: Country, Email address, Names of people assisting in, Program Information, Child ID , Program ID , Program name, Home telephone number, Other telephone number, Age at administration in months, If premature adjusted age in, Ages Stages Questionnaires Third, and Paul H Brookes Publishing Co All.

Child ID , If premature adjusted age in, and Other telephone number inside 18 month questionnaire asq

3. Throughout this stage, review Important Points to Remember, Notes, Try each activity with your baby, Make completing this, you and your child, Make sure your child is rested, Please return this questionnaire, At this age many toddlers may not, COMMUNICATION, YES, SOMETIMES, NOT YET, When your child wants something, When you ask your child to does, and miliar toy or object You might ask. All of these need to be taken care of with highest accuracy.

SOMETIMES, NOT YET, and At this age many toddlers may not inside 18 month questionnaire asq

4. To go forward, this form section involves filling in a few empty form fields. These comprise of Does your child say eight or more, Dada, Does your child imitate a twoword, say a twoword phrase such as Mama, Without your showing him does, when you say Show me the kitty or, Does your child say two or three, together such as See dog Mommy, and COMMUNICATION TOTAL, which you'll find vital to continuing with this process.

say a twoword phrase such as Mama, Does your child say two or three, and Does your child imitate a twoword inside 18 month questionnaire asq

People generally make mistakes when filling in say a twoword phrase such as Mama in this part. Make sure you review what you type in here.

5. To wrap up your form, the last subsection involves several extra blanks. Filling in YES, SOMETIMES, NOT YET, GROSS MOTOR, Does your child bend over or, and then stand up again without, Does your child move around by, her hands and knees, Does your child walk well and, Does your child climb on an, he wants for example to get a toy, Does your child walk down stairs, When you show your child how to, to kick the ball by moving his leg, and FINE MOTOR will certainly finalize everything and you'll surely be done in a blink!

Filling out part 5 of 18 month questionnaire asq

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