MONTHS YEARS

1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 18 20 22 24 2 1/2 3 3 1/2 4 4 1/2 5 6

REGARDS R INITIALLY SHY R IMITATES HOUSEWORK R PLAYS INTERACTIVE

FACE WITH STRANGERS GAMES

PERSONAL - SOCIAL
PERSONAL - SOCIAL

R SMILES R R
R PLAYS PAT-A-CAKE USES SPOON SPILLING LITTLE BUTTONS UP
1 RESP.

PLAYS BALL R PUTS ON CLOTHING

R SMILES R FEEDS SELF WITH EXAMINER
SPONT. CRACKER

Ch. C. =
Sit
Pr.

METRO MANILA DEVELOPMENTAL SCREENING TEST FORM

R WASHES & DRIES
R INDICATES WANTS HANDS
2 RESISTS
(NOT CRY)
TOY PULL

=
=
R DRESSES WITH SUPERVISION
R HELPS IN HOUSE
SIMPLE TASK

CEESE CURL
SITTING
PRONE
PLAYS PEEK-A-BOO R SEPARATES FROM MOTHER EASILY
R DRINKS FROM CUP
WORK FOR TOY R DRESSES WITHOUT
OUT OF REACH R REMOVES GARMENT SUPERVISION

25
FINE MOTOR ADAPTIVE
4 FOLLOW TO 5 GRASPS 6 SIT LOOKS R 11 COPIES 12 COPIES
SCRIBBLES SPONTANEOUSLY
RATTLE FOR YARN
FINE MOTOR ADAPTIVE

MIDLINE

TEST ITEM
9
COPIES
4 FOLLOWS REGARDS R SIT TAKES TOWER OF 2
PAST MIDLINE 2 CUBES CUBES

50
Ch. C.
IMITATES IMITATES
BRIDGE DEMONSTRATES
FOLLOWS RAKES 8 TOWER OF 4
NEAT PINCER GRASP
180° Ch. C. CUBES
TOWER OF 8

75
R HANDS R CUBES
TOGETHER BANGS 2 CUBES HELD IN HANDS

IMITATES
13 DRAWS MAN IN 3 PARTS
R REACHES 7 VERTICAL LINE
THUMB PINCER GRASP
OBJECTS

DUMPS Ch. C. FROM BOTTLE SPONT.

R TRANSFERS 13
DRAWS MAN IN 6 PARTS
CUBE
DUMPS Ch. C. FROM BOTTLE DEMONSTRATION
10 PICKS LONGER LINES

ADDRESS

NAME

DATE
16
RESPONDS R 3 WORDS OTHER THAN PAPA MAMA COMPREHENDS COLD, TIRED,
TO BELL R HUNGRY
DADA OR MAMA
NONSPECIFIC

LANGUAGE
R
LANGUAGE

COMBINES 2 WORDS
R VOCALIZES
NOT CRYING TURNS TO VOICE 17
COMPREHENDS 3 PREPOSITIONS
POINTS TO 1 NAMED BODY PART

R
R 14 RECOGNIZES 3 COLORS
R
DADA OR MAMA NAMES 1 PICTURE
LAUGHS SPECIFIC
15 18 OPPOSITE
R
SQUEALS FOLLOWS DIRECTIONs
ANALOGIES
R
IMITATES SPEECH SOUNDS R USES PLURALS 19 DEFINES 6
WORDS
R GIVES 1ST AND LAST NAME
20
COMP

BALANCE ON
R PR. LIFTS BEAR SOME R KICKS BALL FORWARD 1 FOOT 10-SEC
HEAD WT. ON LEGS R STANDS MOMENTARILY
24 THROWING BALL OVERHEAD HOPS ON 1 FOOT
PR. HEAD UP 22
R
45° PULL TO SIT WALKS HOLDING ON
TO FURNITURE

GROSS MOTOR
BALANCE ON 1-FOOT 1-SEC
GROSS MOTOR

PR. HEAD UP R
90° SITS WITHOUT STANDS ALONE
JUMPS IN PLACE 27 CATCHES
SUPPORT WELL
BOUNCED BALL
21 R STOOPS AND
R R PEDAL TRICYCLE
PR. CHEST STANDS HOLDING RECOVER
UP ARM ON
SUPPORT R 25 26
WALKS WELL BROAD JUMP HEEL TO TOE WALK
R PULLS SELF TO
SIT HEAD STAND
STEADY R WALKS BACKWARD
BALANCE ON BACKWARD
R 1-FOOT 5- HEEL TOE
R GETS TO SITTING R
ROLLS OVER WALKS UP-STEPS SEC
23

1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 18 20 22 24 2 1/2 3 3 1/2 4 4 1/2 5 6

• SYMETRICAL MOVEMENTS (R) May pass by report
90% Pass at 0.6 MONTH