Developmental Screening Checklist - Teacher

Your Name: Date Checklist Completed:

Site: Relationship to the Child:
Background Information
Name of Child: Date of Birth: / /
Length of time at site: Did the child attend child care Y☐ N☐
Does the child have siblings? Y ☐ N ☐ If so, what is their position in the family?
Does the child have difficulties with: VISION ☐ HEARING ☐ MOTOR SKILLS ☐
Is the child: EALD ☐ CHILD IN CARE ☐ ABORIGINAL/TORRES STRAIT ISLANDER ☐
Has the child been diagnosed with any disorders/disabilities (e.g., Autism)?
Medical history (e.g., grommets, medications):
EYLF Outcome 5: Children are effective communicators – Children interact verbally and non-verbally with
others for a range of purposes
Expressive language - please tick the box that best applies
☐No communicative intent
☐Non-verbal but has some communicative intent (e.g. uses gesture or leads adults to items of desire or uses AAC)
☐Uses jargon, babble, echolalia
☐Has a few words and can request using words and/or signs
☐Can get simple message across using short phrases (may supplement with gesture)
LANGUAGE

☐Speaks in short sentences, but struggles with more complex ideas and needs
☐Age appropriate communication skills (e.g. speaks in longer sentences using connecting words, generally with
appropriate grammar and specific vocabulary)
Receptive language- please tick the box that best applies
☐Limited comprehension of even familiar routines and expectations, requires physical support (e.g. taking by hand
etc.) to follow
☐Has developed some understanding of familiar routines and expectations but requires adult prompting and support
to follow
☐Can follow a visual schedule with support
☐Can independently follow routines (occasional verbal reminders)
☐Can follow simple 1 step instructions
☐Can follow 2 or more step instructions and can understand simple questions (e.g. “What is this?”)
☐Age appropriate comprehension (e.g. can understand more complex questions [i.e. “What will happen next?”])
EYLF Outcome 1: Children have a strong sense of identity- Children develop their emerging autonomy,
inter-dependence, resilience and sense of agency
EYLF Outcome 3: Children have a strong sense of wellbeing – Children take increasing responsibility for
their own health and physical wellbeing
Self-Care- please tick all the boxes that apply
☐Requires total support for all personal care (feeding, dressing, toileting)
☐Unable to dress or undress self
PHYSICAL

☐Assists with dressing/undressing – moves limbs

☐Can remove large clothing items – jumpers, pants
☐Can remove shoes, socks
☐Can put on large clothing items
☐Can put on shoes, socks
☐Can undo buttons, zips
☐Can do up buttons, zips
☐Can drink from a sipper cup
☐Can drink from a cup
☐Can feed using fingers
☐Can feed using spoon
 ☐Has no toileting awareness (in nappies)
☐In nappies but some toileting awareness is developing
☐Is toilet timed
☐Can use a toilet but requires verbal and/or physical prompts
☐Can utilise a toilet independently
☐Age appropriate self-care skills
Gross motor- please tick the box that best applies
☐Is ungainly whilst moving around the environment, and may trip often
☐Can manoeuvre around the environment but difficulties with coordination and motor planning (e.g. hopping,
climbing, balancing etc.)
☐Sound gross motor skills (e.g. can negotiate steps, playground equipment, run and jump)
☐Adept gross motor (e.g. good ball skills such as throwing, catching, and kicking)
Fine motor skills- please tick the box that best applies
☐Unable to open containers, food packaging, taps and will not request assistance
☐Requires support for some types of containers/food packaging and will request assistance
☐Can open containers, packaging and pick up small items with pincer grip
☐Can cut along a line with scissors
☐Can manipulate beads, thread items
☐Age appropriate fine motor skills
EYLF Outcome 1: Children have a strong sense of identity – Children learn to interact in relation to others
with care, empathy and respect.
EYLF Outcome 2: Children are connected with and contribute to their world - Children develop a sense of
belonging to groups and communities and an understanding of the reciprocal rights and responsibilities for
active community participation
Social- please tick the box that best applies
☐No social interest
☐Emerging social interest with peers (i.e. may observe others and play in the same area with same materials or
alongside peers)
☐Has social intent (e.g. associative play), but unable to share, wait, take turns – requires high levels of adult support
☐Can engage in simple interactions with peers with adults scaffolding and supporting
☐Has basic interaction skills but requires support for negotiation and conflict
SOCIAL

☐Has age appropriate social skills (e.g. is able to interpret the actions & needs of peers at play and cooperate, and has
developed friendships)
Play- please tick the boxes that apply
☐Sensori-motor level (sucking, banging, waving), manipulative play (investigating properties of play materials), or lining
up or ordering toys
☐Cause and effect toys - pushing buttons & pull levers to light up/make sound
☐Functional play – using real life toys as they are intended (e.g. filling up a dump truck and tipping it out etc.)
☐Simple pretend play with limited actions or sequences using home scripts (e.g. feed dolly, ‘talk’ on phone),
substituting random objects for something else in play (e.g. block is an aeroplane or phone). Might play in parallel to
others.
☐Developing pretend play – can play for periods of time being a certain character utilising out of home themes (e.g.
going to hospital). Can substitute objects flexibly for something else (a block is a plane and then a person and then a
fishing rod). More social /cooperative involvement with others in play.
☐Has age appropriate play skills (e.g. elaborate pretend play. Can play with others over subsequent days on the same
abstract theme [e.g. pirates, flying to the moon], knows how to ‘read’ the play - where to enter and exit, can negotiate
character roles).
EYLF Outcome 4: Children are confident and involved learners – Children develop a range of skills and
processes such as problem solving, inquiry, experimentation, hypothesising, research and investigation
EYLF Outcome 5: Children are effective communicators – Children begin to understand how symbols and
COGNITIVE

pattern systems work

Attention- please tick the box that best applies
☐Cannot direct attention to where indicated
☐Fleeting attention for motivating tasks only
☐Flits from activity to activity
☐Brief attention (few minutes or less) on simplified adult directed activities
☐Can maintain attention for extended periods of time on a self-chosen activity
☐Can maintain attention for 5-10 minutes on an adult directed activity
☐Age appropriate attention skills
 Visual skills- please tick the boxes that best apply
☐Cannot direct attention to where indicated
☐Can imitate simple actions
☐Can do simple inset puzzles
☐Can build with blocks/construction
☐Can do complex puzzles
☐Can independently navigate an iPad/computer
☐Recognizes name and/or some written words
Concept knowledge- please tick the boxes that best apply
☐No concept knowledge
☐Knows some colours (e.g. red, blue, green, yellow)
☐Knows some shapes (e.g. circle, square, star)
☐Knows some positional concepts (e.g. in, on, under)
☐Has an understanding of number (e.g. can count with 1:1 correspondence to 5)
☐Knows name, age, gender
EYLF Outcome 4: Children are confident and involved learners – Children develop dispositions for learning
such as curiosity , cooperation, confidence, creativity, commitment, enthusiasm, persistence, imagination
and reflexivity
Group times- please tick the box that best applies
☐Resists group times, wanders off
☐With adult support will come to the mat and sit with an adult, but has difficulties attending and minimally participates
☐With adult support will come to the mat and with scaffolding will participate in group activities
☐Needs some prompting and support to participate appropriately
☐Will observe peers and imitate actions
PRE-ACADEMICS

☐Age appropriate participation at group time

Table top activities- please tick the box that best applies
☐Cannot be engaged in adult directed activities
☐Can engage in a very simple activity with hand-over-hand support
☐Can engage in a simple activity with scaffolding and support (e.g. visuals)
☐Can engage in an activity with adult support to initiate and to maintain attention
☐Can independently complete a simplified task (with or without the use of visuals)
☐Age appropriate skills in completing table top tasks
Pencil skills- please tick the boxes that apply
☐Refuses to hold a pencil
Holds a pencil in a  fist grip,  palmar grip,  tripod grip
☐No representational drawing – scribbles or makes marks on page
☐Emerging functional drawing – circles etc
☐Beginning to draw a representational person – head, eyes, mouth
☐Can draw a person and/or other representational items (e.g. house, tree, car etc.)
☐Can copy name and attempts to write letters
☐Independently writes name and/or some words
☐Intricate drawings of interest topics
Behaviour- please tick the boxes that best apply
BEHAVIOUR

☐Has difficulties separating from parents on arrival

☐High activity levels – extremely active and impulsive
☐Displays high anxiety levels – cries easily/tearful, wary, reluctant to talk
☐Withdraws from social interaction
☐Low frustration tolerance leading to angry/aggressive outbursts towards ☐ peers ☐ staff
☐Difficulties coping with change and/or transitions
☐Significant levels of uncooperative/ non-compliant behaviour/self-directed behaviour
☐Atypical behaviour – ritualistic behaviour, repetitive behaviour, obsessional interests
Safety and risk- please tick the box that best applies
SAFTEY

☐Requires a secure environment due to no boundary awareness and/or absconding behaviour

☐Requires high levels of supervision due to unsafe behaviours (e.g. climbing furniture, mouthing/eating non-food
items)
☐Requires supervision in a range of activities for safety (e.g. playground, using equipment [scissors/hammers])
☐Is able to use equipment and resources safely
Any Additional Information:

This document is an adaptation of an original checklist developed by psychologist Liz Bowden.