PRE-PRIMARY PSYCHOLOGICAL SCREENER

DEVELOPMENTAL SCREENING

Age: 12–24.9 Months
Grade: Play Group

Instructions: Read each statement carefully and select the answer that best describes your child’s behavior during the last 30 days.

Cognitive: Does your child try to solve problems, like figuring out how to get a toy from a box?

Cognitive: Does your child imitate household tasks (e.g., sweeping, talking on phone)?

Motor: Can your child walk without help?

Motor: Can your child stack two or more blocks?

Language: Does your child point to objects when named?

Language: Can your child say at least 5–10 words?

Social-Emotional: Does your child show affection to familiar people?

Social-Emotional: Does your child get upset when separated from you?

Adaptive: Can your child feed themselves with fingers or a spoon?

Adaptive: Does your child try to brush teeth or wash hands with help?

Cognitive Result:

Cognitive Total Score:

Motor Result:

Motor Total Score:

Language Result:

Language Total Score:

Social-Emotional Result:

Social-Emotional Total Score:

Adaptive Result:

Adaptive Total Score:

Age: 25–36.9 Months
Grade: Nursery

Instructions: Read each statement carefully and select the answer that best describes your child’s behavior during the last 30 days.

Cognitive: Can your child complete a simple puzzle (e.g., 3–4 pieces)?

Cognitive: Does your child match similar objects (e.g., shoes, animals)?

Motor: Can your child jump with both feet?

Motor: Can your child draw a line or circle?

Language: Can your child form 2- to 3-word phrases (e.g., “want juice”)?

Language: Does your child ask simple questions like “What’s that?”

Social-Emotional: Does your child play pretend (e.g., feeding a doll)?

Social-Emotional: Does your child show awareness of other people’s feelings?

Adaptive: Can your child take off some clothes without help?

Adaptive: Is your child starting to show interest in potty training?

Cognitive Result (Nursery):

Cognitive Total Score (Nursery):

Motor Result (Nursery):

Motor Total Score (Nursery):

Language Result (Nursery):

Language Total Score (Nursery):

Social-Emotional Result (Nursery):

Social-Emotional Total Score (Nursery):

Adaptive Result (Nursery):

Adaptive Total Score (Nursery):

Age: 37 – 60 Months
Grade: Kindergarten 1 & 2

Instructions: Read each statement carefully and select the answer that best describes your child’s behavior during the last 30 days.

Cognitive: Can your child count to 5 or recognize some colors?

Cognitive: Can your child follow two-step directions (e.g., “Get your shoes and put them by the door”)?

Motor: Can your child hop on one foot or catch a large ball?

Motor: Can your child use scissors to cut paper?

Language: Can your child tell a short story or describe an object?

Language: Are you able to understand what your child is saying most of the time?

Social-Emotional: Does your child play cooperatively with other children?

Social-Emotional: Does your child express emotions appropriately (e.g., anger, frustration)?

Adaptive: Can your child dress and undress without help?

Adaptive: Can your child use the toilet independently?

Cognitive Result (Kindergarten):

Cognitive Total Score (Kindergarten):

Motor Result (Kindergarten):

Motor Total Score (Kindergarten):

Language Result (Kindergarten):

Language Total Score (Kindergarten):

Social-Emotional Result (Kindergarten):

Social-Emotional Total Score (Kindergarten):

Adaptive Result (Kindergarten):

Adaptive Total Score (Kindergarten):

SOCIAL EMOTIONAL BEHAVIORAL SCREENING

Age: 24 – 60 Months
Grade: Play Group – KG 2

Instructions: Read each statement carefully and select the answer that best describes your child’s behavior during the last 30 days.

Complains of aches or pains (e.g., stomach, head) without clear cause

Seems sad, unhappy, or cries easily

Seems irritable or angry more than usual

Has trouble sitting still or staying in one place

Is easily distracted or has trouble focusing on tasks or play

Doesn’t listen when spoken to directly

Fidgets with hands or feet or squirms in seat

Acts as if “driven by a motor” or always “on the go”

Argues or talks back when told to do something

Has difficulty waiting for their turn

Blames others for their mistakes

Hits, kicks, or bites others when upset

Seems anxious or worries a lot

Is afraid to try new things or explore surroundings

Refuses to separate from parents or caregivers (e.g., at school/daycare)

Has nightmares or trouble sleeping

Loses temper easily or has frequent tantrums

Internalizing Score

Attention Score

Externalizing Total Score:

Externalizing Score

Attention Total Score:

Internalizing Total Score:

AUTISM SPECTRUM DISORDER SCREENING

Age: 24 – 60 Months
Grade: Play Group – KG 2

Please answer the following questions about your child’s typical behavior over the past 3 months.

Does your child make eye contact when talking or playing?

Does your child show feelings like happiness, sadness, or anger in ways you understand?

Does your child use gestures like pointing, waving, or nodding to communicate?

Does your child gets upset to changes in routine or new situations?

Does your child respond when someone calls their name or speaks to them?

Does your child use words or sentences to express needs or feelings?

Does your child use facial expressions (smiling, frowning) to communicate?

Does your child seem more restless or less active than other children?

Can your child follow simple directions (e.g., “Bring me the toy”)?

Does your child play with other children or engage in group activities?

Autism Spectrum Score

Autism Spectrum Total Score:

AUTISM SPECTRUM

PRIMARY/SECONDARY PSYCHOLOGICAL SCREENER

Age: 6-16 years
Grade: 1-10

Instructions: Ask the child: "In the past few weeks, how often have these things been true for you?"
Ask each question in a child-friendly, age-appropriate way. Mark the response as reported by the child.

You feel sad, unhappy, or like crying.

You are easily distracted or have trouble concentrating.

You feel nervous, worried, or afraid a lot.

You have trouble sleeping or feel tired most of the time.

You feel lonely or like being alone more than usual.

You often argue or talk back when told to do something.

You take things that do not belong to you or refuse to share.

You fight with other children or get angry quickly.

You don’t enjoy things you used to enjoy.

You are clingy or need to be with adults all the time.

You have trouble sitting still or feel “on the go” a lot.

You don’t listen to rules or directions.

Internalizating Result

Internalizating Total Score:

Externalizating Result

Externalizating Total Score:

Attention Result

Attention Total Score:

Psychological Assessment Comments:

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