Screens, Questionnaires and More

Screens, Questionnaires, and more….


During each well visit or “physical”, parents will be asked a lot of questions – both written and verbal about your child’s development, personality and emotional wellbeing.  These universal screens and questionnaires are recommended to evaluate and summarize certain developmental and diagnostic situations.  We only as that you answer ALL of the questions to the best of your knowledge.  

Denver Developmental Screen – DDST
The DDST screen is a widely used assessment for examining the developmental progress of infants and preschool age children. It asks questions about personal social aspects such as smiling and gross motor skills (arm & leg movement).   It helps us identify infants who are developing differently from the norm and determine if further evaluation is needed.  We use this screen for the newborn and 1 month old visit.

Edinburgh Postnatal Depression Scale
Postpartum depression is the most common complication of child bearing.  This 10 item questionnaire helps us identify symptoms of clinical depression. We use this screen for new moms at the 1 month visit and through the 6 month visit.

Ages and Stages - ASQ
Quality interaction between parent and child is critical to support early development and eventual school readiness.  This first level screen relies on parents as experts, and is an excellent resource for parents who want to know what to expect and different stages of development.  The questions are designed to identify children who may be at risk for social or emotional difficulties as well as highlight the child’s strengths. It takes about 10 minutes to fill out, and is best done at home with children in their usual environment. We use this tool when children are 2 months to 5 years of age.

Modified Checklist for Autism in Toddlers – MCHAT
The MCHAT is a 2 step screen, done at 18 and 24 months of age, and designed to identify children who should receive a more thorough assessment for possible early signs of Autism or developmental delay. It may take 10 minutes to complete.

Pediatric Symptom Checklist – PAC-17
This is a 17 question parent and youth report, which contains a series of statements describing the child’s emotions and behaviors. Parents and child are asked to indicate to what degree the statement describes the child, with response options of “never”, “sometimes” and “often”. It takes 5-10 minutes to complete. We implement the parent questionnaire at 6 yrs. of age and the self-questionnaire at the 11 yr. old well exam visit.

Adolescent Risk Questionnaire
This is a confidential form that addresses high risk lifestyles and choices in teens. We define CONFIDENTIALITY as the assurance that nothing that your child answers in this form or tells their provider in private will be discussed with anybody else without their permission. Exceptions would be made if we are concerned that they would hurt themselves or somebody else, and we need to get them help as soon as possible. If that is the case, we will inform them first.