36 GROSS MOTOR

fUonth Questionnaire
SOMETIMES NOT YET

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1.

Without holding onto anything for support, does your child

kick a ball by swinging his leg forward?

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YES

Does your child jump with both feet leaving the floor at the same time?

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3.

Does your child walk up stairs, using only one foot on M*... each stair? (The left foot is on one step, and the right foot ll ll *ffi\|; is on the next.) She may hold onto the railing or wall. (You Lifl-fll ll can look for this at a store, on a playground, or at home.)

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4.

Does your child stand on one foot for about 1 second without holding onto anything?

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5.

While standing, does your child throw a ball overhand raising his arm to shoulder height and forward? (Dropping the batl or throwing the batt underhand should be scored as "not

yet.",

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6.

Does your child jump forward at least 6 inches with both

feet leaving the ground at the same time?

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GROSS MOTOR TOTAL

FINE MOTOR
Count as "yes"

SOMETIMES

NOT YET

1.

After your child watches you draw a line from the top of the paper to the bottom with a pencil, crayon, or pen, ask her to make a line like yours. Do not let your child trace your line. Does your child copy you by drawing a single line in a vertical direction?

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Count as "not yet"

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E101360300

Ages & Stages Ouestionnaires@ Third Edition (ASO-3rM), Squires & Bricker @ 2009 Paul H. Brookes Publishing Co. All rights reserved.