Materials Needed to

Administer

Items marked with an asterisk(*) are included in the ASQ-3 Materials Kit;

visit www.agesandstages.com to order.

TM

2 Month Questionnaire

Baby bottle*

Block (small)* [use for object]

Toy (small)*

Mirror*

Cheerios or other small food

9 & 10 Month Questionnaire

12 Month Questionnaire

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

2 Month Questionnaire

Baby bottle*

Block (small)* [use for object]

Toy (small)*

Mirror*

Cheerios or other small food

9 & 10 Month Questionnaires

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Baby bottle (clear)*

Ball (small)*

Blocks or toys (small): 2*

Book (with pictures)*

Bowl*

Crayon*

Mirror*

Shoelace* [use for string]

Stuffed toy*

Toy (small)*

Cheerios or other small food

Child's clothing (e.g., coat, hat,

jacket, pants, shoes, shirt,

Spoon*

Stuffed toy*

Toy (small)*

Cheerios or other small food

Child's clothing (e.g., hat, mittens,

pants, shoes, socks)

Furniture (something to climb

onto, like a chair)

Paper

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Baby bottle (clear)*

Ball (small)*

Blocks (small): 6 or more*

Book (with pictures)*

Bowl*

Crayon*

Mirror*

Spoon*

Stuffed toy*

Toy (small)*

Furniture (something to climb

onto, like a chair)

Paper

Materials Needed to

Administer

Items marked with an asterisk(*) are included in the ASQ-3 Materials Kit;

visit www.agesandstages.com to order.

TM

2 Month Questionnaire

Baby bottle*

Block (small)* [use for object]

Toy (small)*

Mirror*

Cheerios or other small food

12 Month Questionnaire

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Baby bottle (clear)*

Ball (large)*

Ball (small)*

Blocks (small): 6 or more*

Book (with pictures)*

Bowl*

Crayon*

Cup*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy]

Mirror*

Spoon*

Furniture (something to climb

Spoon*

Stuffed toy*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

Child's clothing (i.e., coat)

or a towel

Furniture (something to climb

onto, like a chair)

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Baby bottle (clear)*

Ball (large)*

Beads*

Blocks (small): 6*

Book (with pictures)*

Crayon*

Cup*

Fork*

Shoelace*

Spoon*

Stuffed toy*

Jar (clear plastic with screw lid)*

[may use instead of windup

or a towel

Wagon, stroller, or other toy on

wheels

Cup*

Fork*

Shoelace*

Spoon*

Stuffed toy*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

Cheerios or other small food

onto, like a chair)

Light switch

Paper

Stairs or steps

Wagon, stroller, or other toy on

wheels

Materials Needed to

Administer

Items marked with an asterisk(*) are included in the ASQ-3 Materials Kit;

visit www.agesandstages.com to order.

TM

Ball (large)*

Beads*

Blocks (small): 7*

Book (with pictures)*

Crayon*

Fork*

Mirror*

Shoelace*

Stuffed toy*

Toy (small)*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

onto, like a chair)

Stairs or steps

Towel

Wagon, stroller, or other toy on

wheels

Shoelace*

Spoon*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

Child's clothing (e.g., coat, jacket,

loose-fitting pants, shirt)

Furniture (something to climb

onto, like a chair)

Towel

Wagon, stroller, or other toy on

wheels

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Ball (large)*

Beads*

Blocks (small): 7*

Book (with pictures)*

Crayon*

Fork*

Mirror*

Shoelace*

Stuffed toy*

Toy (small)*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

onto, like a chair)

Stairs or steps

Towel

Wagon, stroller, or other toy on

wheels

Shoelace*

Spoon*

Jar (clear plastic with screw lid)*

[may use instead of windup

toy or doorknob]

Child's clothing (e.g., coat, jacket,

loose-fitting pants, shirt)

Furniture (something to climb

onto, like a chair)

Towel

Wagon, stroller, or other toy on

wheels

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Ball (large)*

Ball (small)*

Beads*

Blocks (small): 4*

Book (with pictures)*

Crayon*

Mirror*

Scissors (child safe)*

Shoelace*

Spoon*

Paper

Shoe

Stairs or steps

Wagon, stroller, or other toy on

wheels

Materials Needed to

Administer

Items marked with an asterisk(*) are included in the ASQ-3 Materials Kit;

visit www.agesandstages.com to order.

TM

2 Month Questionnaire

Baby bottle*

Block (small)* [use for object]

Toy (small)*

Mirror*

Cheerios or other small food

12 Month Questionnaire

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Ball (large)*

Ball (small)*

Beads*

Blocks (small): 4*

Book (with pictures)*

Crayon*

Mirror*

Scissors (child safe)*

Shoelace*

Spoon*

Zipper* [use one on stuffed toy

or child's clothes]

Child's clothing (e.g., coat, jacket,

Paper

other toy on

wheels

Puzzle (5- to 7- piece

interlocking)*

Scissors (child safe)*

Zipper* [use one on stuffed toy

or child's clothes]

Child's clothing (e.g., coat, jacket,

shirt)

Container with food to scoop

(such as applesauce)

Shoe

Soap, water, and towel

Spoon (large) or scoop

Stairs or steps

Materials Needed to

Administer

visit www.agesandstages.com to order.

TM

Ball (large)*

Ball (small)*

Bowl*

Buttons* [use them on stuffed

toy or child's clothes]

Coloring book*

Crayon*

Puzzle (5- to 7- piece

interlocking)*

Scissors (child safe)*

Child's clothing (e.g., coat, jacket,

shirt, loose-fitting pants)

Container with food to scoop

Paper

Coloring book*

Crayon*

Scissors (child safe)*

Toy (small)*

Zipper* [use one on stuffed toy

or child's clothes]

Child's clothing (e.g., coat, jacket,

shirt, loose-fitting pants)

Container with food to scoop

Soap, water, and towel

Spoon (large) or scoop

Toothbrush and toothpaste