Professional assessment tool
Child Developmental Assessment Form
One complete, structured form that pulls together a clinical intake & developmental history, a speech & language assessment, a DSM-based ADHD screen and an autism observation checklist — all with clear scoring guidance. It’s made to be printed and filled in by a qualified professional during a formal assessment.
This is a screening & observation aid, not a diagnostic test. A diagnosis of ADHD, autism or any condition can only be made by a qualified clinician who looks at the whole child. To get started, book an assessment (in person in Multan, or online anywhere in the world) or try our free parent check.
Written by the Inclusive Developmental and Therapy Center therapy team · medically reviewed by Dr Muhammad Suffyan, MB BS (GMC 8023727), a GMC-registered doctor at Sheffield Children's NHS Foundation Trust · Last reviewed July 2026
1 Child & referral details
2 Presenting concerns
Statement of parents / referrer — what are you concerned about?
Onset of problem — when did it begin, and what was noticed first?
3 Family history
4 Medical & birth history
Notes on general health, medication, sleep, feeding & behaviour
5 Developmental history
Mark each milestone, and note the approximate age it was reached.
| Milestone | Normal | Delayed | Approx. age reached |
|---|---|---|---|
| Smiling & eye contact | |||
| Sitting | |||
| Walking | |||
| First words | |||
| Two-word phrases | |||
| Toilet training | |||
| Feeding self | |||
| Dressing self |
6 Speech, language & communication
7 Vision & hearing screening
⚑ If the child does not respond to sound or voice, arrange a formal hearing test before concluding a language delay — do not wait.
8 Attention & activity screen ADHD · DSM-based
Rate how often each behaviour is seen, compared with children of the same age. Adapted from the DSM criteria for ADHD — a screening aid, not a diagnosis.
| Behaviour | Never | Sometimes | Often | Very Often |
|---|---|---|---|---|
| Inattention — Six or more marked “Often / Very Often” is clinically significant | ||||
| Does not give close attention to details, or makes careless mistakes in schoolwork or activities | ||||
| Has trouble sustaining attention in tasks or play activities | ||||
| Does not seem to listen when spoken to directly | ||||
| Does not follow through on instructions; fails to finish schoolwork, chores or duties | ||||
| Has trouble organising tasks and activities | ||||
| Avoids, dislikes or is reluctant to do tasks needing sustained mental effort (e.g. homework) | ||||
| Loses things needed for tasks (toys, pencils, books, tools, assignments) | ||||
| Is easily distracted by external stimuli | ||||
| Is forgetful in daily activities | ||||
| Hyperactivity — Part of the hyperactive–impulsive count (six or more combined) | ||||
| Fidgets with hands or feet, or squirms in seat | ||||
| Leaves seat when remaining seated is expected | ||||
| Runs about or climbs when and where it is inappropriate | ||||
| Has trouble playing or enjoying leisure activities quietly | ||||
| Is 'on the go' or acts as if 'driven by a motor' | ||||
| Talks excessively | ||||
| Impulsivity — Counts with hyperactivity toward the same total | ||||
| Blurts out answers before questions have been completed | ||||
| Has trouble waiting his or her turn | ||||
| Interrupts or intrudes on others (e.g. butts into conversations or games) | ||||
9 Autism observation checklist
Tick every sign observed, across all four domains. Add comments with concrete examples. This structures observation — it does not diagnose.
Communication
Delay in, or lack of, spoken language
- Delay in speaking first words
- Delay in combining words
- Delay in current language ability (quantity or quality)
Difficulty holding a conversation
- Does not make small talk (just to be friendly)
- Rarely / never initiates conversation
- Difficulty sustaining conversation
- Difficulty discussing topics chosen by another person
- Says inappropriate things
- Does not understand sarcasm or humour
Unusual or repetitive language
- Repeats what others say (echolalia — e.g. movies, people)
- Uses incorrect pronouns (e.g. "she" instead of "I")
- Speaks in an overly formal way
- Unusual volume, rate or pitch
Play that is not developmentally appropriate
- Does not imitate (e.g. vacuuming, phone)
- No / limited pretend play (e.g. with a doll or action figure)
- No imaginary play (e.g. pretending one object is another)
Restricted, Repetitive & Stereotyped Behaviours
Interests that are narrow, intense or unusual
- Nonfunctional play with toys (e.g. lining up toys)
- Repeatedly watching individual scenes in movies
- So focused on one thing that others are excluded
Unreasonable insistence on sameness / routines
- Rituals or routines that must be done in a particular way or order
- Difficulty with minor changes in routine
- Upset if objects are rearranged
- Difficulty with transitions
Repetitive motor mannerisms
- Hand flapping or wringing
- Toe walking
- Head banging or other repeated movements
Preoccupation with parts of objects
- Plays with parts of toys (e.g. doors, wheels, strings)
Social Interaction
Lack of social or emotional reciprocity
- Does not respond to his / her name
- Does not enjoy or seek out social games (e.g. peek-a-boo)
- Limited empathy towards others' feelings
Difficulty using nonverbal behaviours in interaction
- Inconsistent eye contact (unusual quality or coordination)
- Does not nod for "yes" or shake head for "no"
- Does not direct facial expressions towards others
- Does not read others' facial expressions (e.g. feelings)
- Does not go to others to be comforted when hurt
- Does not recognise personal space
Little sharing of pleasure, achievements or interests
- Does not point to indicate wants (e.g. bottle, toys)
- Does not point to indicate interests (e.g. plane, dog)
- Does not share things with others
- Is not interested in praise or compliments
Difficulty with age-appropriate peer relationships
- Limited / unusual response to peers approaching
- Limited / unusual initiation with peers
- Prefers to be alone
- Gets along only with much older or younger children
Sensory & Associated Concerns
Unusual sensory interests
- Strong sensory preferences (e.g. food textures)
- Sensory-seeking behaviour (e.g. excessive smelling or touching)
- Sensory interests direct activity more than toys or games
Unusual responses to sensory input
- Indifference to pain, heat or cold
- Sensitivity to lights or sounds
- Irritated by clothing or tactile input
Delayed motor skills
- Delayed gross motor (e.g. odd gait, poor balance)
- Delayed fine motor (e.g. handwriting, buttoning clothes)
10 Clinical summary & observations
Behaviour during assessment, strengths, and overall clinical impression
11 Impression, recommendation & referral
Recommendation
12 Therapy goals
Long-term goals
Short-term goals
Confidential clinical document. A screening & observation aid based on standard, research-based practice — not a diagnosis. Store securely and share only with those directly involved in the child’s care.