Item-wise grading of the Rapid Neurodevelopmental Assessment (RNDA)

(>2-5yrs): Item number/age

normal=1, mild=2, moderate=3, severe=4

Name of the child: DOB: Child’s ID:

Age of the child: Sex: DOE: Tester ID:
Assessment #: Name of the tester:

I. Gross Motor:
Item # Grade Item # grade Item # grade Item # grade Item # grade
I.9.1/25-<30 I.10.1/30-<36 I.11.2/36-<42 I.13.1/48-60
I.9.2/25-<30 I.10.2/30-<36 I.12.1/42-<48 I.13.2/48-60
I.9.3/25-<30 I.11.1/36-60 I.12.2/42-60
II. Fine Motor:
Item # grade Item # grade Item # grade Item # grade Item # grade
II.9.1/25-<30 II.10.1/30-<36 II.11.1/36-<48 II.12.2/42-<48 II.13.3
/48-60
II.9.2/25-<30 II.10.2/30-<42 II.11.2/36-<42 II.12.3/42-<48
II.9.3/25-<30 II.10.3/30-<36 II.11.3/36-<42 II.13.1/48-60
II.9.4/25-<30 II.10.4/30-<36 II.12.1/42-60 II.13.2/48-60
III. Vision:
Item # grade Item # grade Item # grade Item # grade Item # grade
III.9.1/25-60
III.9.2/25-<36
IV. Hearing:
Item # grade Item # grade Item # grade Item # grade Item # grade
IV.9.1/25-<36
IV.11.1/36-60
V. Speech:
Item # grade Item # grade Item # grade Item # grade Item # grade
V.9.1/25-<36
V.11.1/36-<42
V.12.1/42-60
VI. Cognition:
Item # grade Item # grade Item # grade Item # grade Item # grade
VI.9.1/25-<36 VI.9.5/25-60 VI.10.2./30-<36 VI.12.1/42-<48
VI.9.2/25-<30 VI.9.6/25-60 VI.11.1/36-<48 VI.12.2/42-60
VI.9.3/25-<36 VI.9.7/25-60 VI.11.2/36-<42 VI.13.1/48-60
VI.9.4/25-<30 VI.10.1/30-<36 VI.11.3/36-<42 VI.13.2/48-60

54
VII. Behavior:
Item # grade Item # grade Item # grade Item # grade Item # grade
VII.9.1/25-60 VII.9.3/25-60 VII.9.5/25-60 VII.9.7/25-60
VII.9.2/25-60 VII.9.4/25-60 VII.9.6/25-60
VIII. Seizures:
Item # grade Item # grade Item # grade Item # grade Item # grade
VIII.9.1/25-60

55
 REFERENCE FOR
SCORING
FUNCTIONAL IMPAIRMENT
Note: Degree of impairment must take into account the total score for individual functional
domains. In each domain the degree of impairment should be divided by the total score for
that domain expressed as percentage of impairment.

No problem <5%
mild 5-25%
Moderate >25-50%
Severe >50%

No. of items in each Mild Moderate Severe

functional domain
0.5 1 2

1
(total score - 2 0.5 1 2
i.e 100% impairment)

2
(total score- 4 0.5 -1 >1 - 2 >2
i.e. 100% impairment)

3
(total score - 6 0.5 - 1.5 >1.5 - 3 >3
i.e. 100% impairment)

4
(total score- 8 0.5 - 2 >2 - 4 >4
i.e. 100% impairment)

5
(total score - 10 0.5 - 2.5 >2.5 - 5 >5
i.e.100% impairment)

6
(total score- 12 1-3 >3 - 6 >6
i.e. 100% impairment)

7
(total score- 14 1 - 3.5 >3.5 - 7 >7
i.e.100% impairment)

8
(total score- 16 1-4 >4-8 >8
i.e.100% impairment)

56
 PART II

INSTRUCTIONS FOR ADMINISTRATION

(0-5 years)
PRIMITIVE REFLEX
 P. Primitive Reflexes

P. 1. Rooting (birth)

Rooting reflex is well established by 32 wks of gestation. The reflex is

demonstrable in the newborn period and then fades during the early
months.

Method:
Place infant supine, head in the midline.
Touch each corner of the mouth in
turn and stroke laterally.

Response:
Turning of the head in the direction of
the stimulus, simultaneous opening of
the mouth and extension of the tongue.

P. 2. Sucking (birth)
Sucking and swallowing are coordinated sufficiently for oral feeding as
early as 28 weeks of gestation. By 32 to 34 weeks of gestational age the
normal newborn infant is able to maintain a concerted synchronous action
for production oral feeding. Maturation continues and linkage of
breathing, sucking, and swallowing is not achieved fully until 37 weeks of
gestational age or more.

Method:
This reflex is assessed by placing the
index/little finger (pad towards palate)
in the mouth of the infant.

Response:
The rhythm and strength of the
sucking response is noted.

60
P. 3. Palmar Grasp (birth)

Present clearly at 28 wks gestation. Strong at 32 wks gestation. Strong

enough & associated with extension of upper limbs (when lifted from bed )
at 37 weeks of gestational age. The palmar and plantar grasp reflexes are
easily demonstrable in the neonate, but then fade rapidly and are seldom
seen after 4 or 5 months of age.

Method:
The infant should be lying supine with the head in the midline. Each side
is tested, separately or together, by placing an index finger in the palm of
the hand.

Response:
Strong flexion of the fingers.

P. 4. Moro Reflex (birth)

Moro reflex is a particularly useful diagnostic reflex. It is present

consistently and is so easily elicitable in the newborn period that only
variation from the fully normal response at this time is a reliable
indication of probable abnormality. It is not normally elicitable after 6
months of age, when its persistence indicates abnormality.

Asymmetry of the Moro reflexes will be produced by lower motor neuron

lesions, whereas upper motor neuron lesions do not produce asymmetry.

In infants with impaired consciousness or with basal ganglia lesions, it

can be quite difficult to elicit this reflex. Therefore, the threshold at which
the reflex can be elicited should also be noted.

61
Method:
When the infant’s condition permits, we prefer to elicit the Moro reflex by
the “head drop” method. The infant is held suspended in a supine position
raised at 45 degree with one hand behind the back and the other
supporting the head; her/ his arms should be over the chest. The head is
held in a midline position and dropped back 10 degree.

Response:
Consists of opening of hands and extension and abduction of the upper
extremities followed by anterior flexion of the upper extremities. The
response is based on the observation of the arm movements only. The test
may be repeated 2/3 times to get a detailed observation.

P. 5. Placing (birth)

This reflex is readily demonstrable in the new born. Persistent failure to

elicit it at this stage is thought to indicate neurological abnormality. It
fades rapidly in the early months.

Method:
The infant is held upright by encircling her/his chest
under the arms with one or both hands. Stroke the
dorsum of the infant’s foot with the edge of the table
or other examining surface. Test each side
separately.

Response:
Stimulation of the dorsum of the foot of the
neonate produces flexion of the same leg,
followed by placement of the sole of the foot on
the surface.

62
P. 6. Stepping Reflex (birth)

‘Stepping’ is not true walking, as there is no trunk support or pelvic

stability. The stepping reflex should disappear by 6 months of age.

Method:
Hold infant upright, soles of the feet touching the examination surface,
neck held straight with fingers.

Response:
Pressure upon the soles of the feet causes first flexion then extension of
the legs. As these occur on alternate sides, an impression is created of
automatic stepping.

63
GROSS MOTOR
 1. GROSS MOTOR

I. 1. 1. Posture in supine lying (birth)

Most of the neurological items assessing posture and tone are age
dependent, reflecting the increase in flexor tone in the limbs and increase
in axial tone with maturation.

Method:

Posture is assessed with the infant supine and the head in midline, after
gently uncovering the infant and taking off or loosening the nappy, with as
little disturbance as possible.

arms flexed

Abnormal posture:

opisthotonus
arms flexed, legs extended

Response:
In the supine position the infant assumes a flexed posture of all four
limbs. There is often a preference for position of head towards the right
side (right 79%, left 19%, midline 2%).

(Note: In prone position the infant lies with knees drawn up under the
abdomen with the pelvis high. Head is turned to one side. On ventral
suspension the head hangs down, with some flexion of elbows and knees.)

66
I. 1. 2. Four limb writhing movements in supine lying (birth)

Method:
Observe the supine infant. Note spontaneous movements for a couple of
minutes, preferably while the infant is awake and quiet. Both the quality
and quantity of movements are observed. Evaluate the patterns and the
sequence of movements of the whole body, rather than concentrating on
single segments, such as arms and legs.

Response:
The movements should be fluent and alternating.

I. 1. 3. Lifts chin up momentarily on prone lying (birth)

The first step towards the development of locomotion is the development of

head control - that is, the ability to support the head in all positions of the
body. The steps in this are observed in three situations: in ventral
suspension, the prone position and in the supine position.

Method:
The infant is placed prone with the head
in the midline, and the movements of the
head are noted for about 30 seconds.

Response:
Lifts chin up momentarily on prone lying.

I. 1. 4. Fleeting tensing of neck muscles on ventral suspension (birth)

Method:
The infant is suspended in a prone position in space, about 8 to 10 inches
from the surface, by one or both hands under the chest, and the attempt
to lifting of the head is noted for about 30 seconds.

Response:
Fleeting tensing of neck muscles.

67
I. 1. 5. Lifts head on pull to sitting (birth)

Method:
With the infant lying supine, grasp the shoulders and pull the baby
towards a sitting position. Posture of the head is noted, when the
shoulders are elevated to about 45 degrees.

Response:
Tries to lift head, but it drops back.

I. 2. 1. Writhing movements of four limb (1-2 months)

Method and response:

Same as in item I.1.2.

Note: The grading differs from I.1.2.

I. 2. 2. Lifts chin up momentarily on prone lying (1 month)

Method and response:

Same as in item I.1.3.

Note: The response is the same as I.1.3, but grading differs.

I. 2. 3. Lifts head up momentarily on ventral suspension (1 month)

Method:
Same as in item I.1.4

Response:
Lifts head up momentarily, within 30 seconds, but not in line with the
body.

Note: Grading differs from 1.1.4.

68
I. 2. 4. Ability to lift head forward on pull to sitting (1 month)

Method:
Same as in item I. 1.5.

Response:
Lifts head slightly

I. 2. 5. Lifts and holds head up on ventral suspension (2 months)

Method:
The infant is suspended in a prone position in space, about 8 to 10 inches
from the surface, by both hands under the chest, and the attempt to
lifting of the head is noted for about 30 seconds.

Response:
Holds head up for few seconds so that its plane is in line with that of the
body.

I. 2. 6. Ability to lift head forward on pull to sitting (2 months)

Method:
Same as I.1.5.

Response:
Head is lifted in line with the body.

69
I. 2. 7. On prone, lifts chin off couch (2 months)

Method:
Same as in item I.1.3.

Response:
Lifts chin off couch within 30 seconds, recurrently.

I. 2. 8. Sitting, head is held up (2 months)

Method:
Sit the baby on a mattress on the floor so
that the legs are slightly bent and spread
at an angle of about 45 degree. Provide
support by placing hands around the
child’s body.

Response:
Observe if the head is kept erect more
than momentarily (for a few seconds).

I. 3. 1. Vertical head control (3 months)

Method:
Sit the baby on a mattress on the floor so that her legs are slightly bent
and spread at an angle of about 45 degree; or, the examiner can sit on a
chair and sit the baby on his/her knee, providing support by placing
hands around the child’s body.

Response:
Observe if the head is kept erect for 30 seconds.

70
I. 3. 2. Holds head up in ventral suspension (3 months)

Method:
Same as in item I.1. 4.

Response:
Holds head up in ventral
suspension so that its plane is
beyond that of body, for 30
seconds.

I. 3. 3. On prone, holds chin

and shoulders off couch
(3-4 months)

Method:
Same as in item I.1.3.

Response:
Holds chin and shoulders off couch so that plane of face is 45-90 degree
from couch, for 30 seconds

I. 3. 4. In sitting position, holds head well up constantly (4-5 months)

Method:
Sit the baby on a mattress on the floor, and
keep the position steady by holding the
forearms.

Response:
Holds head well up constantly (for at least two
minutes)

71
I. 3. 5. Full head control on pull to sitting (5 months)

Method:
With the infant lying supine, grasp the hands and raise baby to the sitting
position.

Response:
No head lag.

I. 4. 1. Rolls from prone to supine (6 months)

Method:
Place the infant in the prone position on the floor. Show an attractive toy
(eg. rattle) which is just out of reach but within sight. Continue moving the
toy so that the child turns over.

Response:
The infant turns from prone to supine.

72
I. 4. 2. Sits with help with straight back (6 months)

Method:
Sit the child on a mattress on the
floor by holding the child’s forearms.

Response:
Observe the child’s back to see if
he/she is sitting upright with a
straight back.

I. 4. 3. Bears large fraction of

weight on standing when
supported (6-7 months)

Method:
Stand the child upright supported, by holding the child’s forearms or by
holding the child lightly under the arms.

Response:
Observe if the child bears a large fraction of the weight on his/her legs.

73
I. 4. 4. Rolls from supine to prone (7 months)

Method:
Put the baby supine on a mattress. Show an attractive toy and slowly pass
it over child’s head to encourage to roll after the toy, onto one side.

Response:
Observe if the child turns from supine to prone when he/she is about to
reach for the object. Repeat this process for the other side.

I. 4. 5. Sitting supported on own hands (7 months)

Methods:
Sit the child on a mattress on the floor so
that his/her legs are slightly bent and spread
at an angle 45 degree. Put the hands of the
child forward between the legs on the
floor for support.

Response:
Observe if the child is able to sit with
support on own hands with straight back.

74
I. 4. 6. Readily bears full weight on legs (8 months)

Method:
Stand the child upright supported, by holding the child very lightly under
the arms or by holding the child’s forearms.

Response:
Bears full weight of body on legs.

I. 4. 7. Sits for a few seconds, unsupported (8 months)

Method:
Sit the child on a mattress on the floor,
or on the examination surface. Give
support by placing hands around the
child’s back. Gradually loosen your
hold on the child.

Response:
Observe if the child can sit
unsupported for a few seconds.

75
I.5.1. a. Tries to creep, after rolling from supine to prone (9 months)

Movement involving both arms and legs and with the trunk on the floor is
known as creeping and it usually occurs before crawling.

Method:
Put the baby in a supine position on the floor. Show an toy to attract the
child so that he/she rolls from supine to prone. Then put the toy on the
floor, in front of him but out of reach of the child, and encourage to get it.

Response:
The child tries to creep forward.

I. 5. 1. b. Progresses by rolling without any difficulty (9 months)

The great limitation of this movement is that it is not possible for the child
to look in the direction of movement or at the object he is moving towards
all the time, whereas in other forms of movement the child is able to do so.
For most children, therefore, rolling is an early transient form of
movement which may occur accidentally or be indulged in for pleasure. It
might he used occasionally for the purpose of moving to another point or
to reach an object. Some disabled children have to use this as their only
means of movement, and in these cases its limitations, and therefore their
difficulties in making this a functionally useful movement, must be kept in
mind.

Method:
Put the baby in supine on a mattress on the floor. Put a toy on the floor to
attract the child so that when the child reaches for the toy he/she must
progress by rolling.

Response:
Observe the child’s quality of progression by rolling. The rolling must
involve supine-to-prone, followed by prone-to-supine, at least once.

76
I. 5. 2. Independent sitting (9 months)

Method:
Sit the child on a mattress on the floor or on the examination surface.
Give support by placing hands around the child’s lower back. Gradually
loosen hold on the child.

Response:
Observe if the child can sit unsupported for few minutes.

I. 5. 3. Stands holding on to furniture (9 months)

Method:
Stand the child supported, holding
with hands, onto a furniture at the
child’s chest level.

Response:
Observe the child’s ability to
keep standing holding onto the
furniture for at least one minute.

77
I. 5 .4. Sits unsupported, steadily, without risk of falling (10 months)

Method:
Sit the child on a mattress on the
floor and observe if the sitting
posture can be maintained
without support and with no
risk of falling.

Response:
Can sit unsupported and steadily.
Does not fall over.

I. 5. 5. Pulls self from lying to sitting position (10-11 months)

Method:
Lie the child supine on a mattress on the floor.

Response:
Observe whether the child can pull himself up from lying to sitting
position.

78
I. 5. 6. Pulls self to standing position holds on (10-11 months)

Method:
Put an attractive toy on the seat of a nursery chair (or table) in front of the
child, who is sitting on a mattress on the floor, to attract him/her. Steady
the chair and encourage the child to take the toy.

Response:
Observe if he/she pulls self to standing position and holds on to the chair
(or table).

I. 5. 7. Crawls, with abdomen off couch / or bottom shuffles

(11 months)

Crawling-in which the trunk is held off the floor and supported by all four
limbs. Crawling can be a most effective means of movement, but if the
infant wants to use his hands he must stop and fall back to a sitting
position. From a crawl position some infants are able to pull themselves to
standing.

Method:
Sit the child on a mattress on the floor.
Put an attractive toy in front of him,
but beyond his/her reach.

Response:
Observe how the child proceeds
by crawling or bottom shuffling
towards the toy.

79
I. 6. 1. Walks sideways (12 months)

Method:
Stand the child at one side of a nursery table. Put a toy on the other side
of the table.

Response:
Observe if the child walks sideways, holding on to the edge of the table.

I. 6. 2. Stands alone, when placed in that position (13-14 months)

Method:
Stand the child by supporting him/her
by placing your hands around the body
of the child. Slowly loosen the grip of
your hands.

Response:
Observe if the child stands alone for
a moment when he/she is unsupported.

80
I. 6. 3. Can stand up from floor independently (15-17 months)

Method:
Sit the child on the floor. Show an attractive toy at a higher level so that
the child has to stand to get it.

Response:
Observe if the child stands up without any support.

I. 7. 1. Walks alone several steps (18-23 months)

Method:
Stand the child unsupported. Show an attractive toy beyond reach.

Response:
Observe if the child is able to walk a few steps alone.

I. 8. 1. Runs (24 months)

Method:
Put a toy such as a ball on the floor away from him/her. Encourage him to
run to get it.

Response:
Observe the running.

81
I. 8. 2. Kicks a ball (24 months)

Method:
Put a ball on the floor. Then ask the child
to kick it.

Observe:
Kicks the ball

I. 8. 3. Climbs stairs (24 months)

Method:
Stand the child at the lower end of a
staircase. Put a toy at the upper end.
Encourage him/her to climb the stairs to
get the toy.

Response:
Observe if the child is able to climb the stairs holding rail, both feet per
stair.

I. 9. 1. Runs (25 -<30 months)

Method:
Item same as I.8.1.

I. 9. 2. Kicks a ball (25- <30 months)

Method:
Item same as I. 8.2.

82
I. 9. 3. Climbs stairs holding rails (25 - <30 months)

Methods:
Item same as I. 8.3.

1. 10. 1. Jumping from height of 8” one foot

leading (30 - <36 months)

Method:
Stand the child at a height of 8”. Encourage
him/her to jump forward.

Response:
The child should jump, with at least, one foot
leading. If not able to jump from required
height, try at a lower height, ie, <8”.

1. 10. 2. Climbs stairs with alternate feet,

holding one hand or rail (30 - < 36 months)

Method:
Stand the child at the lower end of a staircase. Put a toy at the upper end.
Encourage him/her to climb the stairs to get the toy.

Note: If you hold the child’s one hand with your hand, the other hand of
the child should be free.

83
Response:
The child should able to climb the staircase with alternate feet.

1. 11. 1. Jumping from height of 8” with

both feet together (36 - 60 months)

Method same as 1.10.1.

Response:
The child should jump with both feet together.

1. 11. 2. Climbs stairs with alternate feet without holding

(36 - < 42 months)

Method:
Stand the child at the lower end of a staircase. Put a toy at the upper end.
Encourage the child to climb the staircase without support.

Response:
The child should able to climb the stairs without support with alternate
feet.

84
1. 12. 1. Stands on one leg for 2 seconds
(42 - < 48 months)

Method:
The examiner demonstrates to the child to
stand on one leg. Encourage the child to
stand on one leg.

Response:
The child should able to stand on one leg at
least for 2 secs.

1.12.2. Descends stairs (42- 60 months)

Method:
Encourage the child to
descend the staircase.

Response:
The child should
descends the stairs with
alternate feet holding
rails. Or, both feet per
stairs, not holding rails.

1.13.1. Stands on one leg for 4 seconds (48 - 60 months)

Method same as 1.12.1.

Response:
The child should able to stand on one leg at least for 4 seconds.

1.13.2. Hops on one foot on the spot for 2 times (48 -60 months)

Method:
The examiner demonstrates to the child .Then encourages the child to hop
on one foot on the spot.

Response:
The child should hop on one foot at least 2 times.

85
FINE MOTOR
 II. FINE MOTOR (Manipulation)

II. 1. 1. Hand posture (birth - 1 month)

Method:
Observe the baby when awake and
alert, at rest.

Response:
Intermittent fisting, with thumbs in or
out of the palms.

Abnormal hand posture:

Showing thumb adduction Showing opposition of index

finger and thumb, with the other
three fingers extended

II. 2. 1. Posture of the hands and thumb (2 months)

Method:
Observe the child when awake
and alert, at rest.

Response:
Note the posture of the hands which
should be lightly fisted, with thumbs out.

88
II. 3. 1. Hand posture (3-5 months)

Method:
Observe the child when awake
and alert, at rest.

Response:
Hands should be open most of the time.

II. 3. 2. Holds objects placed in hands (3-4 months)

Method:
Sit the baby on mother’s lap or supine in a mattress. Place a rattle in the
child’s hand. Test both hands separately.

Response:
Observe if he/she retains object placed in the hand for several moments.

89
II. 3. 3. Holds both hands together in the midline (4 months)

Method:
Sit the baby on mother’s lap or lie supine on a mattress.

Response:
Observe if both the hands come together in the midline.

II. 3. 4. Reaches for, and grasps an object in front (5 months)

Method:
Sit the baby on a mattress on the floor, or lie the baby supine. A brightly
colored toy is placed about 8 - 10 inches directly in front of the child,
within his/her reach. Test both hands separately. Hold one hand as the
child reaches with the other.

Response:
Observe if he/she can reach and grasp the object with each hand.

90
II. 4. 1. Palmar grasp (6-8 months)

Fingers press the object into center of palm, thumb adducted.

Method:
Sit the baby on mother’s lap supported upright at a table on which one
cube is placed in front of the child and within his/her reach. If the child
does not immediately grasp the cube, attract child’s attention by tapping
near the cube, and then move your hand quickly away from it. Test this
item with both hands separately.

Response:
Observe if the child grasps the cube using the palm of his/her hands.

Radial - Palmar Grasp:

Fingers on far side of object press it against

opposed thumb and radial side of palm.

91
II. 4. 2. Transfers object (7-8 months)

Method:
Sit the baby on mother’s lap supported upright at a table on which a cube
is placed in front of the child within his/her reach and allow him to grasp
the cube. Offer another cube to the hand holding the first cube.

Response:
Observe if the child transfers the first cube from one hand to the other.

92
II. 5. 1. Digital grasp of 1 inch cube (9-10 months)

Object held with opposed thumb and fingertips, space visible between.

Method:
Sit the baby on mother’s lap
supported upright at a table on
which one cube is placed in front
of the child and within his/her reach.

Response:
Observe if the child grasps the cube using fingers with a gap between the
palm and the cube.

II. 5. 2. Inferior pincer (11 months)

Method:
Sit the baby on mother’s lap supported
upright at a table on which a small
object such as a smartie or a homeopathy
pellet is placed in front of the child and
within his/her reach.

Response:
Observe if the child grasps the object
using 3 fingers (ie, the first and second
fingers at the ends of the phalanges, and the thumb)

93
Note:
Variation of the inferior pincer grasp:
The child might grasp with ventral
surfaces of thumb and index finger,
distal thumb joint extended.

II. 6. 1. Superior pincer (12-14 months)

Method:
Sit the baby on mother’s lap supported upright at a table on which a small
object such as a smartie or a homeopathy pellet is placed in front of the
child and within his/her reach.

Response:
Observe if the child grasps the object using 2 fingers, using the tip of the
index finger and the thumb.

94
II. 6. 2. Release (12-14 months)

Method:
Sit the child on a nursery chair or on mother’s lap. Put a small cube into
the child’s hand. Then tell the child, “Give it to me”, with your hand out
palm upwards.

Response:
Observe if the child releases the cube successfully into your hand.

II. 6. 3. Precise release of a tiny object into a small container

(15-24 months)

Method:
Sit the child on a nursery chair. Place a ‘muri’ (Puffed rice) and an opened
container with a 1 inch diameter mouth and ask the child to ‘put the muri
into the container’.

Response:
Observe release into container.

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II. 7. 1. Feeds self (18-23 months)

Method:
Place some ‘muris’ (Puffed rice) on a bowl in front of the child.

Response:
Observe if the child is able to reach, grasp, put into the mouth the food
item.

II. 8.1. Drinks water from a glass (24 months)

Method:
Put a glass of water in front of the child.

Response:
Observe the child reach and grasp the glass, bring it to the mouth, and
drink the contents.

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II. 8. 2. Throws a ball (24 months)

Method:
The examiner demonstrates to the child how to throw a ball, which should
be light and with a minimum 16 cm diameter. Then give the ball to the
child and ask him/her to throw.

Response:
Observe the child throwing the ball.

Note: At this age the child throws the ball using both arms or either arm,
flexion of elbows, trunk leaning forward.

II.9.1. Precise release of a tiny object into a small container

(25-<30 months)

Method:
Same as II.6.3.

Response:
Observe release into container.

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II.9.2. Drinks water from a glass (25-<30 months)

Method:
Same as II.8.1

Response:
Observe the child reach and grasp, bring it to the mouth, and drink the
contents.

II.9.3. Throws a ball (25-<30 months)

Method:
Same as II.8.2.

Response:
Observe the child throwing the ball.

II.9.4. Scribbles (25-<30 months)

Method:
Sit the child at a nursery table. Place a slate or paper on the table, in front
of the child. Draw horizontal scribble on the slate/paper, start moving the
crayon from your right to your left. Then place the crayon on the
slate/paper, with the writing end pointing away from the child and ask the
child to do the same.

Response:
The child should scribble without clumsiness with preferred hand.

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II.10.1. Laces 1 bead (30-<36 months)

Method:
Demonstrate to the child. Then offer the child the lace and one bead, and
ask the child to lace the bead.

Response:
The child should lace a bead using both hands without clumsiness.

II.10.2. Unscrews lid (30-<42 months)

Method:
Sit the child on a chair or on the floor. Give a small screwing
bottle/container which is loosely closed and ask the child to open it.
Note: If necessary, demonstrate.

Response:
Observe if the child unscrew the bottle/container without clumsiness.

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II.10.3. Throws a ball with one hand, 3 feet (30-<36 months)

Method:
The examiner demonstrates to
the child how to throw a ball
with one hand. The ball
should be light and with a
minimum size of a tennis ball.
Then give the ball to the child
and ask her/him to throw.

Response:
Observe the child throwing
the ball with one hand at least
3 feet.

II.10.4. Draw a line (30-<36 months)

Method:
Sit the child at a nursery
table. Place a slate or paper
on the table, in front of the
child. Draw a horizontal or
vertical line on the
slate/paper. Then place the
crayon on the slate/paper,
with the writing end pointing
away from the child and ask
the child to do the same.

Response:
The child should draw a line without clumsiness with the preferred hand.

II.11.1. Throws a ball with one hand, 5 feet (36-<48 months)

Method:
Same as II.10.3.

Response:
Observe the child throwing the ball with one hand at least 5 feet.

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II.11.2. Laces 2 beads (36-<42 months)

Method:
Demonstrate to the child. Then
offer the child the lace and 2
beads, and ask him/her to lace
them.

Response:
The child should lace 2 beads
without clumsiness.

II.11.3. Draws a circle (36-<42 months)

Method:
Sit the child at a nursery table.
Place a slate or paper on the
table, in front of the child. Draw
a circle on the slate/paper. Then
place the crayon on the
slate/paper, with the writing end
pointing away from the child and
ask the child to draw a circle.

Response:
The child should draw a circle or half circle with preferred hand, without
clumsiness.

II.12.1. Screws bottle (42-60

months)

Method:
Sit the child at a nursery chair or
on the floor. Give the child a
small screwing bottle/container
with its lid open & ask the child
to close the bottle/container.

Note: If necessary, demonstrate.

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Response:
Observe if the child closes the bottle by screwing the lid, without
clumsiness.

II.12.2. laces 3 beads (42-<48 months)

Method:
Item same as II. 10.1. Offer 3 beads.

Response:
The child should lace 3 beads without clumsiness.

II.12.3 Draws a cross (42-<48 months)

Method:
Sit the child at a nursery table. Place a slate or paper on the table, in front
of the child. Draw a cross on the slate or paper. Then place the crayon on
the slate/paper, with the writing end pointing away from the child and ask
the child to draw a cross.

Response:
The child should draw a cross or T without clumsiness, with preferred hand.

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II.13.1. Laces at least 4 beads (48-60 months)

Method:
Item same as II. 10.1. Offer 4 beads.

Response:
The child should lace at least 4 beads without clumsiness.

II.13.2. Throws a ball with one hand, 10 feet (48-60 months)

Methods:
Same as II.10.3.

Response:
Observe the child throwing the ball with one hand at least 10 feet.

II.13.3. Draws a square (48-60 months)

Method:
Sit the child at a nursery table. Place a slate or paper on the table, in front
of the child. Draw a square on the slate/paper. Then place the crayon on
the slate/paper, with the writing end pointing away from the child and ask
the child to draw a square.

Response:
The child should draw a square or joined two lines without clumsiness,
with preferred hand.

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VISION
 III. VISION (visual behavior)

Note: A torchlight is used in a dark room and other lures are used in
well-lighted rooms so that the lure looks bright.

III. 1. 1. Response to light (glowing torch beam /diffuse light) (birth)

Method:
Position the baby lying supine or on the examiners lap on extended arms.

Use a pen torch to focus light on the eyes. For glowing light source the
torch beam is covered with a yellow cloth or with a ‘oogly’ (yellow
translucent finger puppet).

For response to diffuse light from outside the window, hold the child
supine on the extended arms and turn slowly from relative shadow inside
the room toward light source from the window.

Response:
Blinks and/or regards light (torch beam/glowing light}. Blinks/shifts
eyes/turns towards diffuse light.

III. 1. 2. Response to face (birth)

Method:
The infant may be held on the examiner’s lap or tested in a propped up
supine position. With the examiner’s face 12 - 18 inches in front of the
baby’s face, move slowly in a horizontal and vertical arc. Avoid talking to
the baby during this item.

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Response:
Regards face.

III. 1. 3. Response to spinning wooly ball (birth)

(Note: A spinning red woolen ball is an excellent stimulus for infants of all
gestational ages and is easy to handle inside and outside an incubator).

Method:
The infant is tested in a propped up supine position and the stimulus is
presented at a distance of 15-25cm, starting in the midline and moving
laterally in either direction, then vertically.

Response:
Regards the wooly ball.

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III. 2. 1. Regards face (1 month)

Method:
Same as III. 1. 2. If no face regard, then test with a reflecting object at a
distance of 15 - 25 cm.; if no response, then test with a light source.

Picture: Same as III. 1. 2

Response:
Regards face.

III. 2. 2. Regards woolly ball (1 month)

Method:
Same as III. 1. 3. If no fixing on the ball, then test with a reflecting object
at a distance of 15 - 25 cm.; if no response, then test with a light source.

Picture: Same as III. 1. 3

Response:
Regards the wooly ball.

III. 2. 3. Fixates and follows face (2 months)

Method:
Same as III. 1. 2. If no fixation on face, then test with a reflecting object at
a distance of 15 - 25 cm.; if no response, then test with a light source.

Picture: Same as III. 1. 2

Response:
Fixates and follows face.

III. 2. 4. Fixates and follows spinning red wooly ball (2 months)

Method:
Same as III. 1. 3. If no fixing on the ball, then test with a reflecting object
at a distance of 15 - 25 cm.; if no response, then test with a light source.

Picture: Same as III. 1. 3.

Response:
Fixates and follows red wooly ball.

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III. 3. 1. Fixes and follow 2 ½ inch spinning red ball (3 - 4 months)

Method:
Positioning - Before good head
control has developed, position
the infant lying on back or up on
a shoulder. As trunk control
develops sit the infant supported
upright on mother’s lap.

Hold a spinning 2 ½ inch red

ball suspended on a string at
some 25 cm from the baby’s face
to induce visual fixation. Then
move the ball slowly and
horizontally on each side to
induce full abduction, then
vertically up and down after
moving it back in front of the
eyes.

If no response then test with

spinning wooly ball, or reflecting object at the same distance; or a glowing
torch beam at closer distance.

Response:
The infant fixes and follows the ball.

III. 3. 2. Fixates 1 inch cube from a distance of 30cm (5 months)

Method:
Position - The infant is seated supported upright on mother’s lap at a
nursery table, which is covered with a green cloth.

Show a yellow colored cube to the infant and say, ‘ooh! Look at this
beautiful thing’. Then the cube is placed on one side of the table keeping
the gaze of the child on the cube. Then release it at some point during a
sweep of your hand across the table. Observe whether the child fixes gaze
on the released cube or not.

If no response then test with spinning 2 ½ inch red ball; then with
12.5cm. wooly ball; then with a reflecting object at a distance of 25cm; or
less.

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Response:
The infant fixes gaze on the cube.

III. 3. 3. Watches moving adult from 3 meters (3-24 months)

Method:
Stand in front of the infant at a distance of 3 meters, and draw his/her
attention. Move along an arc around the visual field of the child and
observe if the eyes moves to track the moving adult.

If no response keep coming closer and observe the distance at which the
child’s visual attention is engaged.

Response:
Watches moving adult.

III. 4. 1. Fixes on smartie from 30cm. distance (6-8 months)

Method:
Position- The infant is seated supported upright on mother’s lap at a
nursery table, which is covered with a green cloth.

Show the smartie to the baby and say, ‘ooh! Look at this bright thing’.
Then the smartie is placed on one side of the table keeping the gaze of the
child on it. Then release it at some point during a sweep of your hand
across the table.

If no response then test with 1 inch cube or spinning 2 ½ inch red ball, or
reflecting object, or torch beam.

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Response:
Observe whether the child fixes
his gaze on the released smartie
or not.

III. 5. 1. Fixates ‘100/1000’ or a smallest homeopathy pellet from

30cm. distance (9-24 months)

Method:
Position - The infant is seated supported upright on mother’s lap at a
nursery table, which is covered with a green cloth.

Show the 100/1000 (a <3mm sized minute sweet) or a smallest sized

homeopathy pellet to the baby and say, ‘ooh! Look at this thing’. Then the
100/1000 or pellet is placed on one side of the table keeping the gaze of the
child on it. Then release it at some point during a sweep of your hand across
the table. Observe whether the child fixes his gaze on the released object or
not.
If no response then test with smartie, or 1 inch cube or spinning 2 ½ inch
red ball; or less.

Response:
The baby will fix gaze on the sweet or pellet.

III. 9.1. Fixates ‘100/1000’ or a smallest homeopathy pellet from

30cm. distance (25 - 60 months)
Same as III. 5.1
From 36 months, test each eye separately.

III. 9. 2. Watches moving adult from 3 meters (25-<36 months)

Same as III. 3.3.

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HEARING
 IV. HEARING

IV. 1. 1., IV. 1. 2., IV. 1. 3. Response to clapper bell, rattle,

and voice (birth)

Method:
The infant is held in a propped up supine position on the mat or on the
lap, with the head supported in the midline. The auditory stimulus (a) is
presented at the ear level (b) about 15 cm. from the ear (c) keeping the
stimulus out of the line of vision. (d) Test Right ear, then left ear.

A trained assistant provides the stimulus, and tester observes the

response.

IV.1.1. Response to clapper bell:

IV.1.2. Response to rattle:

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IV.1.3. Response to voice:

Response:
Infant will brighten/startle/eyes will widen/become still /show respiratory
changes/ blink/shift of eyes to sound. The best response to any one of the
three sound sources is taken as normal.

IV. 2. 1, IV. 2. 2., IV. 2. 3. Response to clapper bell, rattle,

and voice (1-3 months)

Method:
The infant is held in a propped up supine position on the mat or on the
lap, and for the infant who is able to hold the neck up, sitting on the
mother’s lap, The head should be in the midline. The auditory stimulus (a)
is presented at the ear level (b) about 15 cm. from the ear (c) keeping the
examiner’s hand and rattle out of the line of vision. (d) Test Right ear,
then left ear.

Note: Soft whisper - 10 to 25 db; conversational speech - 25 to 55 db;

crying baby - 55 to 65 db; rattle - 60 to 80db; clapper bell. A trained
assistant provides the stimulus, and tester observes the response.

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Picture: Same as IV. 1.1, IV.1.2 and IV.1.3

Response:
Infant will brighten/startle/eyes will widen/become still/show respiratory
changes/blink/shift of eyes to sound. The best response to any one of the
three sound sources is taken as normal.

The grading of the response differs from items IV. 1.1, IV. 1.2., IV. 1. 3.

IV. 3. 1., IV. 3. 2. Response to rattle and voice (4 -6 months)

Method:
Sit the child on the mother’s lap with head in the midline. Shake the rattle
gently, or call child in a soft voice, at 45 cm from the baby’s ear at the ear
level, and out of the line of vision.

IV.3.1. Response to rattle

IV.3.2. Response to voice

Response:
Turns head towards the side from which the sound comes without actual
location of the sound source/shifts eye/alerts/changes facial expression.
The best response to any one of the two sound sources is taken as normal.

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IV. 4. 1., IV. 4. 2. Distraction Test at ear level (7-11 months)

Method:
Two people are involved in conducting the test.

The infant is seated on the mother’s lap, supported upright. The examiner
is the ‘distractor’, who sits in front of the infant at a distance of 1 to 2
meters. The assistant stands behind the mother and the child to provide a
sound stimuli.

The distractor encourages the infant’s attention towards herself/himself

by lightly playing with a ‘noiseless’ toy, then swiftly putting it out of sight
as a signal to the assistant to give the sound stimulus (rattle, voice) at 1
meter from the ear at the infant’s ear level out of his/her range of vision.
The test is done in turn on each side of the infant.

IV.4.1. Response to rattle

IV.4.2. Response to voice

Response:
Infant will turn his/her head and visually locate the source of the sound,
equally on both sides.

117