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Ananya Child Development and Early Intervention Clinic

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1. General Information

Parent Disclaimer: This tool is not a substitute for clinical diagnosis. Consult a healthcare professional for a comprehensive evaluation.
A. Child's Gender*
B. Child's Age*

2. Fine Motor Skills

Skills involving small muscle movements, especially in the hands, like grasping or drawing.
A. Can your child pick up small objects using thumb and one finger?*
B. Can your child stack two or more blocks?*
C. Can your child turn the pages of a book one at a time?*
A. Can your child draw a straight line?*
B. Can your child use a spoon without spilling?
C. Can your child open a jar or turn a doorknob?*
A. Can your child cut paper with safety scissors?*
B. Can your child open bottles, jars, or bag zips?*
C. Can your child button their own shirt?*
A. Can your child draw a square shape on paper?*
B. Can your child lace up their own shoes?*
C. Can your child use a Spoon and Fork properly?*
A. Can your child draw a triangle shape on paper?*
B. Can your child tie their own shoelaces?*
C. Can your child write their own name?*
A. Can your child write legible sentences?*
B. Can your child use tools like scissors and rulers accurately?*
C. Can your child tie complex knots?*
A. Can your child write legibly and consistently with a pen or pencil?*
B. Can your child manipulate small objects with precision, such as tying shoelaces or using keys?*
C. Can your child accurately cut along a line or shape using scissors?*
A. Can your child write legibly and quickly?*
B. Can your child handle tools for schoolwork, like using a compass or protractor, with precision?*
C. Can your child write legibly for extended periods, such as taking notes during a class lecture, without hand fatigue?*
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Fine Motor Skills Recommendation

3. Gross Motor Skills

Abilities using large muscles for movements like walking, running, and balancing.
A. Can your child walk without support?*
B. Can your child kick a ball forward?*
C. Can your child climb onto furniture unassisted?*
A. Can your child run without tripping?*
B. Can your child jump with both feet off the ground?*
C. Can your child kick a ball forward?*
A. Can your child climb stairs alternating feet?*
B. Can your child hop on one foot?*
C. Can your child ride a tricycle?*
A. Can your child hop on one foot more than once?*
B. Can your child catch a ball thrown towards him/her from 5 feet away?*
C. Can your child balance on one foot for at least 5 seconds?*
A. Can your child skip/hop for 10 steps in one go?*
B. Can your child swing on a swing set, pumping their legs themselves?*
C. Can your child perform a somersault?*
A. Can your child ride a bicycle without training wheels?*
B. Can your child catch a small ball using only their hands?*
C. Can your child perform basic dance steps?*
A. Can your child successfully engage in activities that require hand-eye coordination, such as catching a ball from 10 feet away?*
B. Can your child handle utensils like a fork and knife proficiently while eating?*
C. Can your child perform tasks that require both hands working together in a coordinated way, such as tying a knot or opening a jar?*
A. Can your child maintain balance on one foot for at least 20 seconds without support?*
B. Can your child execute activities that require sequential movements, like hopping over a series of obstacles?*
C. Can your child perform activities that require coordination of both upper and lower body, like carrying a tray with water glasses or tea cups while navigating through a crowded space?*
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Gross Motor Skill Recommendation

4. Language & Communication Skills

How your child speaks, understands, interacts, and communicates with others.
A. Does your child respond to simple commands like "come here"?*
B. Can your child say at least three words?*
C. Does your child point to objects or pictures when they are named?*
A. Can your child form two-word sentences (e.g., "want milk")?*
B. Does your child know their own name and age?*
C. Can your child identify basic colours?*
A. Can your child speak in full sentences?*
B. Can your child name at least ten different objects?*
C. Can your child understand and follow a three-step command? For example, "Pick up your toy, put it in the box, and then close the lid."*
A. Can your child tell a simple story consisting of 10 lines?*
B. Can your child form complete sentences in any language to ask for something specific, like requesting a particular snack or toy?*
C. Can your child understand spatial words like "under" or "above," regardless of language?*
A. Can your child speak clearly enough to be understood by people outside the family?Can your child speak clearly enough to be understood by people outside the family?*
B. Can your child understand and answer who, what, where, why questions?*
C. Can your child understand the concept of opposites (e.g., hot/cold, fast/slow)?*
A. Can your child engage in detailed conversations, including back-and-forth dialogue?*
B. Can your child read a simple paragraph, understand its meaning and explain to you in his/her own words?*
C. Can your child understand simple figurative expressions, like saying something is "as fast as a car" to describe speed, in any language?*
A. Can your child write a short essay or story that includes an introduction, body, and conclusion?*
B. Can your child understand and correctly use figurative language, like explaining what the phrase "time flies" means?*
C. "Can your child follow complex multi-step directions, such as 'Go to your room, pick up the blue book from your desk, and bring it to me in the living room'?"*
A. Can your child articulate abstract concepts or emotions, such as explaining what "justice" or "freedom" means to them?*
B. Can your child understand and interpret complex texts, like comprehending the main ideas of a news article or a book?*
C. Can your child follow and engage in group discussions by both listening to others and contributing meaningful ideas?*
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Language & Communication Recommendation

5. Cognitive Skills

Abilities related to thinking, problem-solving, memory, and understanding concepts.
A. Can your child point to one body part when asked?*
B. Does your child show interest in simple games like "peek-a-boo"?*
C. Can your child fit a square block into a square hole?*
A. Can your child sort objects by shape or colour?*
B. Can your child complete a simple puzzle?*
C. Does your child understand the concept of "two"?*
A. Can your child recognize and name basic shapes?*
B. Can your child count to ten?*
C. Can your child match shapes or colours without assistance?*
A. Can your child recognize and name all basic colours?*
B. Can your child correctly identify and take out 3 objects from a set of 10?*
C. Can your child understand the concept of time (e.g., morning, afternoon, night)?*
A. Can your child recognize basic arithmetic symbols (plus, minus)?*
B. Can your child identify the letters of the alphabet?*
C. Can your child understand the concept of yesterday, today, and tomorrow?*
A. Can your child perform basic arithmetic (addition and subtraction)?*
B. Can your child group objects based on more than one attribute (e.g., colour and shape)?*
C. Can your child tell the time on a watch?*
A. Can your child perform multiplication and division?*
B. Can your child understand the concept of percentages?*
C. Can your child interpret simple graphs or charts?*
A. Can your child organise and manage their time effectively to complete homework or projects by deadlines?*
B. Can your child identify logical flaws in statements, such as spotting the error in "If it's raining, the ground is wet. The ground is wet, so it's raining"?*
C. Can your child discuss ethical or moral dilemmas, such as what they would do if they found money on the street?*
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Cognitive Skills Recommendation

6. Social & Emotional Skills

Understanding emotions, interactions, forming relationships, and connecting with others.
A. Does your child show attachment to familiar adults?*
B. Does your child exhibit fear of strangers?*
C. Does your child comfort themselves by thumb-sucking, holding a security object, etc.?*
A. Does your child play alongside other children (parallel play)?*
B. Does your child express affection openly?*
C. Can your child understand simple "please" and "thank you" etiquette?*
A. Does your child play cooperatively with other children for at least 15-20 minutes?*
B. "Does your child try to comfort a crying peer or sibling by offering a toy or a hug?"*
C. Does your child understand the concept of "mine" and "yours"?*
A. Does your child cooperate with other children and can engage in group games?*
B. Does your child follow household rules like not touching sharp objects or staying away from the stove?*
C. Can your child recognize and verbally express basic emotions like happiness, sadness, or anger?*
A. Does your child understand the concept of taking turns in games?*
B. Can your child ask 'who, what, where, why' questions during storytime or conversations?*
C. Can your child understand the concept of opposites, such as identifying that 'hot' is the opposite of 'cold' or 'fast' is the opposite of 'slow'?*
A. Does your child exhibit sportsmanship in games, including losing gracefully?*
B. Can your child distinguish between real events and pretend or imaginary scenarios, like understanding that a fairy tale is not a real story?*
C. Does your child have at least one close friend?*
A, Does your child understand the implications of gossip and rumours?*
B. Can your child recognize and manage complex emotions like jealousy or embarrassment?*
C. Can your child recognize and respond appropriately when someone is sad or upset, such as offering a comforting word or gesture?*
A. Can your child understand the consequences of actions on their future, such as how skipping school could affect their grades?*
B. Can your child navigate complex social situations, like resolving a disagreement among friends without escalating the conflict?*
C. Does your child have a nuanced understanding of friendship and relationships, such as recognizing the importance of trust and communication?*
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Social & Emotional Recommendation

7. Adaptive Functioning

Daily self-help skills, including dressing, eating, and personal hygiene.
A. Can your child drink from a cup without spilling?*
B. Can your child eat finger foods without assistance?*
C. Can your child help in dressing themselves, like putting on a hat?*
A. Can your child wash and dry their hands?*
B. Can your child undress themselves?*
C. Can your child drink from a cup without a lid?*
A. Can your child put on his or her own clothes?*
B. Can your child brush their teeth with assistance?*
C. Can your child wash their hands unassisted?*
A. Can your child pour liquid without spilling?*
B. Can your child brush their teeth without assistance?*
C. Can your child use the toilet unassisted?*
A. Can your child pack their own school bag?*
B. Can your child make a simple sandwich?*
C. Does your child understand basic road safety rules, like waiting for a signal or holding an adult's hand near traffic?*
A. Can your child prepare a simple meal (e.g., cereal, sandwich)?*
B. Can your child take a shower without assistance?*
C. Can your child make a simple purchase at a store?*
A. Can your child use basic household appliances (e.g., microwave, washing machine)?*
B. Can your child independently plan and execute a simple household chore, such as setting the table for dinner, without needing step-by-step guidance?*
C. Can your child manage simple budgeting tasks (e.g., saving and spending pocket money)?*
A. Can your child manage their own schedule and commitments?*
B. Can your child prepare a full meal?*
C. Can your child perform basic first aid?*
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Adaptive Functioning Recommendation

8. Behavioural Issues

Patterns of actions or reactions that might be of concern, like aggression or withdrawal.
A. Does your child frequently have temper tantrums during activities like mealtime or bedtime that last for more than 10 minutes and are difficult to manage?*
B. Does your child frequently bite or hit others?*
C. Can your child sit still for short periods, such as while reading a story?*
A. Does your child frequently defy or challenge adult requests, such as refusing to put away toys when asked?*
B. Does your child show extreme separation anxiety from primary caregivers, such as crying excessively when left with relatives or ayahs?*
C. Does your child often seem unusually withdrawn, avoiding social interactions during family gatherings*
A. Does your child frequently interrupt conversations?*
B. Does your child struggle with sharing toys?*
C. Does your child exhibit mood swings, such as going from happy to irritable, when transitioning between activities or places?*
A. Does your child continue to defy rules like running indoors or using toys improperly even after multiple corrections?*
B. Does your child struggle to calm down after playing tag or receiving an exciting gift?*
C. Does your child struggle with making eye contact during conversations?*
A. Does your child frequently argue with adults, especially during mealtime or bedtime routines?*
B. Does your child exhibit signs of excessive shyness or withdrawal during social events or group activities?*
C. Does your child frequently interrupt others, especially while they are speaking or engaged in an activity?*
A. Does your child have emotional outbursts, such as crying or yelling, that seem disproportionate to situations like losing a game or receiving a minor correction?*
B. Does your child show signs of anxiety, like excessive worrying or phobias?*
C. Does your child exhibit repetitive behaviours (e.g., hand-flapping, rocking)?*
A. Does your child exhibit mood swings that seem extreme, such as going from joyful to angry in a short span of time without a clear reason?*
B. Does your child engage in risky behaviour, like climbing high places or running across the street without looking, without considering the potential consequences?*
C. Does your child frequently challenge authority figures, such as teachers or parents, by openly defying rules or instructions?*
A. Does your child engage in behaviours that are risky, such as attempting stunts or dares that could result in injury?*
B. Does your child exhibit signs of emotional withdrawal that seem excessive, such as avoiding social interactions for extended periods, even with close family and friends?*
C. Does your child frequently clash with authority figures, such as arguing with teachers or openly defying household rules?*
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Behavioural Issues Recommendation

9. Sensory Processing

A. Does your child react negatively to new textures like grass or sand?*
B. Is your child sensitive to lights or sounds that don't seem to bother other kids?*
C. Does your child avoid or seem bothered by messy activities like finger painting?*
A. Is your child disturbed by everyday sounds such as a vacuum cleaner or a dog barking?*
B. Does your child have difficulty transitioning from one activity to another, for example, from playtime to mealtime?*
C. Does your child refuse to touch certain textures like sand, playdough, or wet food?*
A. Does your child get overly upset by loud noises or bright lights?*
B. Is your child extremely picky about food textures, such as refusing to eat mushy foods like 'khichdi' or crunchy foods like 'papad'?*
C. Does your child become clingy or irritable in new settings like a different park or relatives home?*
A. Is your child extremely sensitive to smells?*
B. Does your child still have difficulty adapting to new textures of clothing or food?*
C. Does your child exhibit a strong aversion to everyday sounds like a vacuum cleaner or clapping?*
A. Is your child overly sensitive to environmental stimuli like sirens or fireworks?*
B. Is your child extremely picky about food textures, such as refusing to eat mushy foods like 'khichdi' or crunchy foods like 'papad'?*
C. Does your child have difficulty adapting to changes in lighting or volume?*
A. Does your child show noticeable discomfort or irritation with certain textures, such as refusing to wear certain fabrics or eat specific foods?*
B. Does your child exhibit a strong preference or aversion to certain smells, such as reacting strongly to the scent of specific foods or cleaning products?*
C. Does your child have difficulty focusing on tasks like homework or reading when there's background noise, such as TV or people talking?*
A. Does your child exhibit sensitivity to specific textures in food, such as avoiding foods that are crunchy or slimy?*
B. Is your child overly sensitive to loud noises, such as covering their ears during everyday events like traffic or household appliances being used?*
C. Does your child have difficulty adapting to changes in temperature, like becoming overly distressed during hot or cold weather?*
A. Does your child have difficulties with sensory overload in crowded or noisy environments?*
B. Is your child overly sensitive or intolerant to specific food textures or tastes?*
C. Does your child have difficulties adjusting to new sensory experiences (e.g., new clothing materials)?*
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Sensory Processing Recommendation
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ASD Risk Level
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ADHD Risk Level
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Developmental Delay Risk Level
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Emotional Disorders Risk Level
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Intellectual Disorder Risk Level
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Learning Delay Risk Level
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10. Parent/Guardian & Child Details

Enter details for both the parent/guardian and child to ensure accurate assessment feedback.
Child's Name*
Location*
Consent*