Asq 42 Month Score Sheet

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Asq 42 Month Score Sheet SCORE AND TRANSFER TOTALS TO CHART BELOW See ASQ 3 User s Guide for details including how to adjust scores if item responses are missing Score each item YES 10 SOMETIMES 5 NOT YET 0 Add item scores and record each area total In the chart below transfer the total scores and fill in the circles corresponding with the total scores

1 SCORE AND TRANSFER TOTALS TO CHART BELOW See AS0 3 User s Guide for details including how to adjust scores if item responses are missing Score each item YES 10 SOMETIMES 5 NOT YET 0 Add item scores and record each area total In the chart below transfer the total scores and fill in the circles corresponding with the total scores Date ASQ 3 completed by parent caregiver Date of review with health professional should be scored as not yet 4 Does your child jump forward at least 6 inches with both feet leaving the ground at the same time 5 Does your child catch a large ball with both hands You should stand about 5 feet away and give your child two or three tries before you mark the answer 6

Asq 42 Month Score Sheet

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We provide up to date evidence based integrative natural complementary alternative and preventive medicine Information in this website is provided for informational purposes only This information is not intended as a substitute for the advice provided by your physician or other healthcare professional Transfer scores and information to the ASQ 3 Information Summary sheet Total the points in each of the ve developmental areas and record the scores on the scoring sheet and compare results to the area cuto s

Ifan item cannot be answered refer to the ratio scoring procedure in The ASQ User sGuide 2 Score each item on the questionnaire by writingthe appropriate number on the line by each item answer YES 10 SOMETIMES 5 NOT YET 0 3 Add up the item scores for each area and record these totals in the space provided for area totals 4 ASQ SCORE INTERPRETATION AND RECOMMENDATION FOR FOLLOW UP You must consider total area scores overall responses and other considerations such as opportunities to practice skills to determine appropriate follow up

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Cover sheets family information sheets in data template format scoring sheets Information Sum mary sheets intervention activities and supplemental materials You may print this PDF in its SCORE AND TRANSFER TOTALS TO CHART BELOW see ASQ 3 User s Guide for details including how to adjust scores if item responses are missing Score each item YES 10 SOMETIMES 5 NOT YET O

The ASQ 3 Starter Kit contains everything you need to start screening children with ASQ 3 21 paper masters of the questionnaires and scoring sheets a CD ROM with printable PDF questionnaires the ASQ 3 User s Guide and a FREE ASQ 3 Quick Start Guide Ages Stages Questionnaires Third Edition ASQ 3 E101420200 42 Month Questionnaire 39 months 0 days through 44 months 30 days 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

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SCORE AND TRANSFER TOTALS TO CHART BELOW See ASQ 3 User s Guide for details including how to adjust scores if item responses are missing Score each item YES 10 SOMETIMES 5 NOT YET 0 Add item scores and record each area total In the chart below transfer the total scores and fill in the circles corresponding with the total scores

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1 SCORE AND TRANSFER TOTALS TO CHART BELOW See AS0 3 User s Guide for details including how to adjust scores if item responses are missing Score each item YES 10 SOMETIMES 5 NOT YET 0 Add item scores and record each area total In the chart below transfer the total scores and fill in the circles corresponding with the total scores


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Asq 42 Month Score Sheet - We provide up to date evidence based integrative natural complementary alternative and preventive medicine Information in this website is provided for informational purposes only This information is not intended as a substitute for the advice provided by your physician or other healthcare professional