
FINE MOTOR
(continued)
4. Ask your child to trace on the line below with a pencil. Does your child
trace on the line without going off the line more than two times?
(Mark
“sometimes” if your child goes off the line three times.)
5. Ask your child to draw a picture of a person on a blank sheet of paper.
You may ask your child, “Draw a picture of a girl or a boy.” If your child
draws a person with head, body, arms,
and
legs, mark “yes.” If your
child draws a person with only three parts (head, body, arms, or legs),
mark “sometimes.” If your child draws a person with two or fewer parts
(head, body, arms, or legs), mark “not yet.” Be sure to include the
sheet of paper with your child’s drawing with this questionnaire.
6. Draw a line across a piece of paper. Using child-safe
scissors, does your child cut the paper in half on a
more or less straight line, making the blades go up
and down?
(Carefully watch your child’s use of
scissors for safety reasons.)
PROBLEM SOLVING
1. When shown objects and asked, “What color is this?” does your child
name five different colors, like red, blue, yellow, orange, black, white,
or pink?
(Mark “yes” only if your child answers the question correctly
using five colors.)
2. Does your child dress up and “play-act,” pretending to be someone or
something else? For example, your child may dress up in different
clothes and pretend to be a mommy, daddy, brother, sister, or an imag-
inary animal or figure.
3. If you place five objects in front of your child, can she count them by
saying, “One, two, three, four, five” in order?
(Ask this question without
providing help by pointing, gesturing, or naming.)
4. When asked, “Which circle is smallest?” does your child point to the
smallest circle?
(Ask this question without providing help by pointing,
gesturing, or looking at the smallest circle.)
5. Does your child count up to 15 without making mistakes? If so, mark
“yes.” If your child counts to 12 without making mistakes, mark “some-
times.”
Ages & Stages Questionnaires®, Third Edition (ASQ-3
™
),
Squires & Bricker
© 2009 Paul H. Brookes Publishing Co. All rights reserved.
54 Month Questionnaire
page 4 of 7
E101540400
YES SOMETIMES NOT YET
FINE MOTOR TOTAL
YES SOMETIMES NOT YET