If at any age your child has:
- limited play, self-care, skilled hand or tool use, productive activity, or social participation as expected for age
- sensory preferences or aversions that limit any of the above
- short attention span for age
- limited food repertoire, and/or strong food preferences/aversions
- overly clumsy, jerky movements, apparent weakness, balance problems
- delayed developmental milestones
- poor eye contact and interaction with parents/family
- have suck/swallow/breathe coordination
- control head and neck as expected for age
- give eye contact or seem "connected" (consider age)
- hold hands in fists
- kick feet when on back
- smile
- calm or accept comfort when upset
- play with rattles
- watch a parent's/caregiver's face
- follow a moving object with eyes
- reach towards objects/faces
- turn eyes or head toward sounds, bright colors, and lights
- begin exploring objects with hands and mouth
- make cooing sounds when interacting with caregivers
- watch a parent's/caregiver's face, and show happiness
- sit independently
- accept a variety of textures/types of food
- move toy from one hand to the other
- play with toes
- roll from stomach to back
- recognize familiar faces
- share back-and-forth sounds and facial expressions
- babble or repeat sounds like "da-da"
- attempt Pat-a-Cake, So Big, etc.
- pick up Cheerios or other small items
- poke or point with finger
- crawl on hands and knees and pull self to standing position with support
- take a few steps independently
- play with a variety of toys or objects
- put objects into containers
- stack at least two blocks
- drink from a cup or sippy cup
- hold arms and legs out while being dressed
- say at least three to five words
- point to named body parts
- consistently feed self with a spoon and drink from a cup
- turn one page at a time in books
- push, pull, and dump, following simple directions
- pull off shoes, socks, and mittens
- look at pictures in books
- walk completely unaided
- scribble spontaneously when provided with marking tool
- ride tricycle using pedals
- use fingers and thumb to hold marker or crayon (not fisted grasp)
- open door independently
- imitate parents/caregivers
- build a tower with four blocks
- sing phrases of songs
- use two and three word sentences
- play simple group games
- take interest in coloring or drawing
- cut paper in half
- share toys with adult prompting
- use toilet by self
- put on shoes (without tying)
- dress self independently
- take turns in play, or play cooperatively with other children
- draw a person with at least five recognizable parts
- eat with a fork and spoon
- count to 10
- attempt to copy letters and numbers (age 5 ½)
- bathe self with minimal assistance
- ride a bike with training wheels
- draw recognizable pictures with basic shapes
- consistently print letters of name
- count to 20
- tie shoes
- frustration, anxiety, and undesirable behaviors regarding writing tasks
- muscle aches, pains, fatigue, cramps, or tremors when writing
- immature grasp of writing tool
- discrepancy between cognitive skills and performance
- noticeable difference in speed of completion, or quality of writing as compared to agemates
- increased difficulty with cursive writing and lengthy writing tasks
- lack of independence with self-care activities or play/leisure time
- difficulty with planning, sequencing, and organization
- frustration and/or difficulty with other activities requiring skilled hand/tool use

