Denver II

Examiner:

Name:

DDM, INC. 1-800-419-4729

CATALOG #2115

Date:

Birthdate:
ID No.:

MONTHS

12

15

18

YEARS

24

PREPARE CEREAL
BRUSH TEETH. NO HELP

Percent of children passing

25
50
75

PLAY BOARD/CARD GAMES

90

DRESS. NO HELP

TEST ITEM

May pass by report

PUT ON TSHIRT

Footnote no.

NAME FRIEND

(See back of lorm)

86%

COPYO

WASH & DRY HANDS

DRAW PERSON 6 PARTS

BRUSH TEETH WITH HELP

COPYO DEMONSTR.

PUT ON CLOTHING
PICK LONGER LINE

FEED DOLL

COPY+

REMOVE GARMENT

DRAW PERSON 3 PTS

USE SPOON/FORK

88%

COPYQ

HELP IN HOUSE

THUMB WIGGLE
DRINK FROM CUP

OPPOSITES2

IMITATE ACTIVITIES
TOWER OF 6 CUBES

PLAY BALL WITH EXAMINER

WAVE BYEBYE
TOWER OF 2 CUBES

INDICATE WANTS

u0

PLAY PAT-A-CAKE

FEED SELF

TOWER OF 4 CUBES

DEFINE 5 WORDS

WORK FOR TOY

UNDERSTAND 4 PREPOSITIONS
SPEECH ALL UNDERSTANDABLE

PUT BLOCK IN CUP

REGARD OWN HAND

Ill
IC
w
0.

SPONTANEOUSLY

KNOW

BANG 2CUBES
HELO IN HANDS

SMILE
RESPON
SIVELY

TAKE 2 CUBES

COUNT 1 BLOCK

THUMB-FINGER
GRASP

USE OF 2 OBJECTS
NAME 1 COLOR

RAKE RAISIN

LOOK FOR YARN

IC

~
:I!

HEELTOTOE WALK
BALANCE EACH FOOT 5 SECS.

SPEECH HALF UNDERSTANDABLE

REGARD RAISIN

BALANCE EACH FOOT 4 SECS.

POINT 4 PICTURES

HANDS

~
~<(

BALANCE EACH FOOT 6 SECONDS

NAME 4 PICTURES

FOLLOW 180

>

KNOW2
ADJECTIVES

KNOW 2 ACTIONS

REACHES

4 ACTIONS

USE OF 3 OBJECTS

PASS CUBE

REGA RO
FACE

4 COLORS

DUMP RAISIN, DEMONSTRATED

SCRIBBLES

SMILE

COUNT 5 BLOCKS

KNOW 3 ADJECTIVES

Ill

..J
<(

IMITATE VERTICAL LINE

NAME

..J
<(

DEFINE 7 WORDS

TOWER OF 8 CUBES

BODY PARTS-6
BALANCE EACH FOOT 3 SECONDS

NAME 1 PICTURE

TOGETHER

HOPS

COMBINE WORDS

GRASP
RATILE

BALANCE EACH
FOOT 2 SECONDS

POINT 2 PICTURES

FOLLOW PAST
MIOLINE

6WORDS

BALANCE EACH
FOOT 1 SECOND

3 WORDS

FOLLOW
TO
MIDLINE

2WOROS

BROAD JUMP

THROW BALL OVERHAND

ONE WORD

JUMP UP

(Check boxes for 1st, 2nd, or 3rd tes

DADA/MAMA SPECIFIC

KICK BALL FORWARD

ii:
JABBERS

RUNS

Typical

WALK UP STEPS

COMBINE SYLLABLES

I I I I

TEST BEHAVIOR

No

DADA/MAMA

Compliance (See Note 31)

WALK BACKWARDS

NON-SPECIFIC

WALK WELL

IMITATE SPEECH SOUNDS

STAND ALONE

TURN TO VOICE
SINGLE SYLLABLES

STOOP AND RECOVER

Complies

1
1

Yes
Interest in Surroundings

STAND2 SECS.

RATILING SOUND

c,
<(

:::,

ez

<(
..J

SQUEALS

LAUGHS

PULL TO
STAND

"'000/AAH"
VOCALIZES
SITNO
SUPPORT

RESPOND TO BELL

PULL TO SIT NO HEADLAG

ROLL OVER

IC

CHEST UPARM
SUPPORT

STAND
HOLDING ON

Alert
Somewhat Disinterested
Seriously Disinterested

I
I 1

I
I
I
I

2
2

I I
3

... ...

3:
O>

:,.,:_

I I I
2

ca,
-"'
c

I
I
I

GETTO
"C
SIDING
"C
0
Cl

"'

a:i
--;
"C
c

ee

::,
.0

c
-a,
c"'

LL

:,.,:_
Ill

HEAOUP45"

Fearfulness
Rarely Complies
None

Mild

Always Complies

Usually
TURN TO

e::,
.0

:g

~i~o
EQUAL

BEAR WEIGHT ON

3:

LEGS SITHEAO

<D
O>

O>

HEAD UP 90

IC

O>

STEADY

c,._

O>
co
O>
O>

Extreme

MOVEMENTS

,.....

MONTHS

,.....
2

,..

,---,---,,--,-..,..-,.--,.......,....
4

--,--.,....
12

-,-15

..,...."""'..,.."""'..,..
18

24

~
3

YEARS