DECA Assessment for 1 - 18 months
This form describes a number of behaviors seen in some infants. Please mark the box in the category that tells how often you saw the behavior. Answer each question carefully. There are no right or wrong answers. Please answer every item.
Name of Home Visitor
*
Matt
Annette
Carissa
Crissy
Krystle
Kayla
Infant's Name
*
Gender
DOB
Age
*
Name of person completing this form
*
Relationship to Infant
*
During the past 4 weeks how often did the infant.......
1. Try to do new things?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
2. Respond when spoken to?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
3. Imitate actions of others?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
4. Enjoy interacting with others?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
5. Keep trying when unsuccessful?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
6. Enjoy being cuddled?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
7. Show interest in what others were doing?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
8. Show affection for a familiar adult?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
9. Notice changes in surroundings?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
10. Seek comfort from familiar adults?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
11. Adjust his/her energy level to the type of play?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
12. Act in a good mood?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
13. Act happy when praised?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
14. Make eye contact with others?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
15. Explore surroundings?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
16. Calm down with help from a familiar adult?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
17. Express his/her dislikes?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
18.Smile back at a familiar adult?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
19. Reach for a familiar adult?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
20. Respond to his/her name?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
21. Keep trying to obtain a toy ?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
22. React to another child's cry?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
23. Smile at familiar adults?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
24. Respond positively to adult attention?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
25. Act happy?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
26. Act in a way that makes others smile or show interest?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
27. Easily go from one activity to another?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
28. Seek attention when a familiar adult is with another child?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
29. Look to a familiar adult when exploring her/his surroundings?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
30. Enjoy being around other children?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
31. Show pleasures when interacting with adults?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
32. Act happy with familiar adults?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
33. Accept comfort from a familiar adult?
*
Never
Rarely
Occasionally
Frequently
Very Frequently
Submit
Should be Empty: