(CREDI) 0-5 MONTHS Date: _____________________________ Child Date of Birth: __________________ Interviewee ID: _____________________ Child Age (in Months): _______________ Assessor Instructions: Administer the set of items that corresponds with the child’s age band. Remember to show caregivers the corresponding full-page illustration for those items that include an image. Before administering SAY (to caregivers): Now I am going to ask you about the types of things your child is currently able to do. Please answer "yes" or "no" to these questions. If you are unsure, you can also answer by saying know.” Please keep in mind that children learn and grow at different rates, “don’t so it is fine if your child can't yet do these things. Some of these skills children only achieve at older ages. If there is any question you feel uncomfortable answering, please let me know and we can move to the next question. Item # Item Image Response A1 Does the smile when others smile at him/her? Yes No DK A2 Does the child grasp onto a small object (e.g., your finger, a Yes No DK spoon) when put in his/her hand? A3 Does the child recognize you or other family members (e.g., Yes No DK smile when they enter a room or move toward them)? A4 Does the child show interest in new objects by trying to put Yes No DK them in his/her mouth? A5 When on his/her stomach, can the child hold his/her head Yes No DK and chest off the ground using only his/her hands and arms for support? A6 Can the child pick up a small object (e.g., a small toy or small Yes No DK stone) using just one hand? A7 When lying on his/her back, does the child grab his/her feet? Yes No DK A8 Does the child look at an object when someone says "look!" Yes No DK and points to it?
(CREDI) 0-5 MONTHS Date: _____________________________ Interviewee ID: _____________________ Child Date of Birth: __________________ Child Age (in Months): _______________ Assessor Instructions: Administer the set of items that corresponds with the child’s age band. Remember to show caregivers the corresponding full-page illustration for those items that include an image. Before administering SAY (to caregivers): Now I am going to ask you about the types of things your child is currently able to do. Please answer "yes" or "no" to these questions. If you are unsure, you can also answer by saying “don’t know.” Please keep in mind that children learn and grow at different rates, so it is fine if your child can't yet do these things. Some of these skills children only achieve at older ages. If there is any question you feel uncomfortable answering, please let me know and we can move to the next question. Item # Item Image Response A1 Does the smile when others smile at him/her? Yes No DK A2 Does the child grasp onto a small object (e.g., your finger, a spoon) when put in his/her hand? Yes No DK A3 Does the child recognize you or other family members (e.g., smile when they enter a room or move toward them)? Yes No DK A4 Does the child show interest in new objects by trying to put them in his/her mouth? Yes No DK A5 When on his/her stomach, can the child hold his/her head and chest off the ground using only his/her hands and arms for support? Yes No DK A6 Can the child pick up a small object (e.g., a small toy or small stone) using just one hand? Yes No DK A7 When lying on his/her back, does the child grab his/her feet? Yes No DK A8 Does the child look at an object when someone says "look!" and points to it? Yes No DK
CREDI-Short-Form-21Feb2018.docx