ASQ-3-48-month-英文

Ages&StagesQuestionnaires®,ThirdEdition(ASQ-3™),Squires&Bricker©2009PaulH.BrookesPublishingCo.Allrightsreserved.P101480100PersonfillingoutquestionnaireChild’sinformationDateASQcompleted:Relationshiptochild:ParentStreetaddress:Namesofpeopleassistinginquestionnairecompletion:GrandparentorotherrelativeGuardianFosterparentTeacherChildcareproviderOther:Ages&StagesQuestionnaires®MonthQuestionnaire45months0daysthrough50months30daysPleaseprovidethefollowinginformation.Useblackorblueinkonlyandprintlegiblywhencompletingthisform.48Child’sfirstname:Child’slastname:Child’sdateofbirth:Firstname:Lastname:Middleinitial:City:Hometelephonenumber:State/Province:ZIP/Postalcode:Othertelephonenumber:E-mailaddress:Child’sgender:MaleFemaleMiddleinitial:Country:ProgramInformationChildID#:ProgramID#:Programname:9876543212345678911/18/2008JohnX.Smith11/12/2004JaneQ.Smith123CenterStreet,Apt.9AnytownMD21230USA410-555-0155410-555-018900123456789000000SAMPLEAnytownPreschoolAges&StagesQuestionnaires®,ThirdEdition(ASQ-3™),Squires&Bricker©2009PaulH.BrookesPublishingCo.Allrightsreserved.page2of7E101480200MonthQuestionnaire4845months0daysthrough50months30daysImportantPointstoRemember:Tryeachactivitywithyourbabybeforemarkingaresponse.Makecompletingthisquestionnaireagamethatisfunforyouandyourchild.Makesureyourchildisrestedandfed.Pleasereturnthisquestionnaireby_______________.Notes:________________________________________________________________________________________________________________________________________________________________________________Onthefollowingpagesarequestionsaboutactivitiesbabiesmaydo.Yourbabymayhavealreadydonesomeoftheactivitiesdescribedhere,andtheremaybesomeyourbabyhasnotbegundoingyet.Foreachitem,pleasefillinthecirclethatindi-cateswhetheryourbabyisdoingtheactivityregularly,sometimes,ornotyet.COMMUNICATION1.Doesyourchildnameatleastthreeitemsfromacommoncategory?Forexample,ifyousaytoyourchild,“Tellmesomethingsthatyoucaneat,”doesyourchildanswerwithsomethinglike“cookies,eggs,andcereal”?Orifyousay,“Tellmethenamesofsomeanimals,”doesyourchildanswerwithsomethinglike“cow,dog,andelephant”?2.Doesyourchildanswerthefollowingquestions?(Mark“sometimes”ifyourchildanswersonlyonequestion.)“Whatdoyoudowhenyouarehungry?”(Acceptableanswersinclude“getfood,”“eat,”“askforsomethingtoeat,”and“haveasnack.”)Pleasewriteyourchild’sresponse:“Whatdoyoudowhenyouaretired?”(Acceptableanswersinclude“takeanap,”“rest,”“gotosleep,”“gotobed,”“liedown,”and“sitdown.”)Pleasewriteyourchild’sresponse:3.Doesyourchildtellyouatleasttwothingsaboutcommonobjects?Forexample,ifyousaytoyourchild,“Tellmeaboutyourball,”doesshesaysomethinglike,“It’sround.Ithrowit.It’sbig”?4.Doesyourchilduseendingsofwords,suchas“-s,”“-ed,”and“-ing”?Forexample,doesyourchildsaythingslike,“Iseetwocats,”“Iamplaying,”or“Ikickedtheball”?YESSOMETIMESNOTYETSAMPLEGonight-night51050EatCOMMUNICATION(continued)5.Withoutyourgivinghelpbypointingorrepeating,doesyourchildfol-lowthreedirectionsthatareunrelatedtooneanother?Giveallthreedirectionsbeforeyourchildstarts.Forexample,youmayaskyourchild,“Clapyourhands,walktothedoor,andsitdown,”or“Givemethepen,openthebook,andstandup.”6.Doesyourchilduseallofthewordsinasentence(forexample,“a,”“the,”“am,”“is,”and“are”)tomakecompletesentences,suchas“Iamgoingtothepark,”or“Isthereatoytoplaywith?”or“Areyoucoming,too?”GROSSMOTOR1.Doesyourchildcatchalargeballwithbothhands?(Youshouldstandabout5feetawayandgiveyourchildtwoorthreetriesbeforeyoumarktheanswer.)2.Doesyourchildclimbtherungsofaladderofaplaygroundslideandslidedownwithouthelp?3.Whilestanding,doesyourchildthrowaballoverhandinthedirectionofapersonstandingatleast6feetaway?Tothrowoverhand,yourchildmustraisehisarmtoshoulderheightandthrowtheballforward.(Droppingtheballorthrowingtheballunderhandshouldbescoredas“notyet.”)4.Doesyourchildhopupanddownoneithertherightorleftfootatleastonetimewithoutlosingherbalanceorfalling?5.Doesyourchildjumpforwardadistanceof20inchesfromastandingposition,startingwithhisfeettogether?6.Withoutholdingontoanything,doesyourchildstandononefootforatleast5secondswithoutlosingherbalanceandputtingherfootdown?(Youmaygiveyourchildtwoorthreetriesbeforeyoumarktheanswer.)FINEMOTOR1.Doesyourchildputtogetherafive-toseven-pieceinterlockingpuzzle?(Ifoneisnotavailable,takeafull-pagepicturefromamagazineorcatalogandcutitintosixpieces.Doesyourchildputitbacktogethercorrectly?)Ages&StagesQuestionnaires®,ThirdEdition(ASQ-3™),Squires&Bricker©2009PaulH.BrookesPublishingCo.Allrightsreserved.48MonthQuestionnairepage3of7E101480300YESSOMETIMESNOTYETCOMMUNICATIONTOTALYESSOMETIMESNOTYETGROSSMOTORTOTALYESSOMETIMESNOTYETSAMPLE0525101010101010605FINEMOTOR(continued)2.Usingchild-safescissors,doesyourchildcutapaperinhalfonamoreorlessstraightline,makingthebladesgoupanddown?(Carefullywatchyourchild’suseofscissorsforsafetyreasons.)3.Usingtheshapesbelowtolookat,doesyourchildcopyatleastthreeshapesontoalargepieceofpaperusingapencil,crayon,orpen,with-outtracing?(Yourchild’sdrawingsshouldlooksimilartothedesignoftheshapesbelow,buttheymaybediffer