## Materials Needed to Administer

### Infant 2–16 Months

#### 12 Month Questionnaire
- 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, socks)  
- Crib rail or supportive furniture

#### 14 Month Questionnaire
- Baby bottle (clear)*  
- Ball (small)*  
- Blocks (small): 6 or more*  
- Book (with pictures)*  
- Bowl*  
- Stuffed toy*  
- Toy (small)*  
- Spoon*  
- Crayon*  
- Cheerios or other small food  
- Child's clothing (e.g., hat, mittens, pants, shoes, socks)  
- Furniture (something to climb onto, like a chair)

#### 16 Month Questionnaire
- Baby bottle (clear)*  
- Ball (small)*  
- Blocks (small): 6 or more*  
- Bowl*  
- Crayon*  
- Book (with pictures)*  
- Mirror*  
- Spoon*  
- Stuffed toy*  
- Child's clothing (e.g., hat, mittens, pants, shoes, socks)  
- Cheerios or other small food  
- Furniture (something to climb onto, like a chair)

---

## Materials Needed to Administer

### Toddler 18–33 Months

#### 22 Month Questionnaire
- 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)*  
- Cheerios or other small food  
- Child's clothing (e.g., coat) or a towel  
- Light switch

#### 24 Month Questionnaire
- Baby bottle (clear)*  
- Ball (large)*  
- Beads*  
- Blocks (small): 7*  
- Book (with pictures)*  
- Crayon*  
- Shoelace*  
- Spoon*  
- Stuffed toy*  
- Jar (clear plastic with screw lid)*  
- Cheerios or other small food  
- Child's clothing (i.e., coat) or a towel  
- Furniture (something to climb onto, like a chair)

---

## Materials Needed to Administer

### Preschool 36–60 Months

#### 48 Month Questionnaire
- 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 (such as applesauce)  
- Ladder with rungs  
- Paper  
- Soap, water, and towel

#### 54 Month Questionnaire
- Ball (large)*  
- Ball (small)*  
- Spoon (large) or scoop  
- Toothbrush and toothpaste  
- Container with food to scoop (such as applesauce)  
- Paper  
- Pencil  
- Soap, water, and towel

### TM  
Items marked with an asterisk(*) are included in the ASQ-3 Materials Kit; visit www.agesandstages.com to order.