Janae B. Weinhold, Ph.D.
Directions: If the following behaviors are present, rank them between 0 and 5 depending on the severity and then total this group.
_____ Premature birth
_____ Prolonged labor
_____ Birth induced and/or accelerated with the use of Pitocin
_____ Born with cord around the neck
_____ Caesarian birth
_____ Prolonged separation after birth due to medical problems
_____ Medical problems at birth (jaundice, Rh factor)
_____ Weak crying response
_____ Low birth weight (under 5 pounds)
_____ Surgical procedures (circumcision)Directions: If the following behaviors are present, rank them between 5 and 10 depending on the severity and then total this group.
_____ Prenatal exposure to alcohol or drugs (prescription or illicit)
_____ Colic, rageful or inconsolable crying
_____ Recurring earaches
_____ Weak contact in eye-following response
_____ Resistance to close face-to-face contact by averting gaze
_____ Resists smiles and attempts to establish reciprocal interactions
_____ Passive, lifeless and non-responsive to adult attempts to engage
_____ Stiffening and resistance to cuddling and close holding
_____ Arches back and pushes away from adults
_____ Dislikes or avoids being held and/or touched
50 70 Low risk of Developmental Trauma