Ages & Stages Questionnaires® (ASQ-3)

A Parent-Completed, Child-Monitoring System

Ages & Stages Questionnaires® is a registered trademark of Paul H. Brookes Publishing Co., Inc.

Define and discuss the benefits of developmental screening

Describe features of the ASQ-3

Score the ASQ-3 Describe ASQ-3 cutoff scores Interpret ASQ-3 information in

relation to other referral considerations

Training Objectives

ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

Parent- or caregiver-completed screening tool that encourage parental/caregiver involvement

Series of questionnaires for children ages 1 months to 5 ½ years

Tool to accurately identify children at risk for developmental delay

What is the ASQ-3?

ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

ASQ-3 (screens 5 domains):

Communication

Gross motor

Fine motor

Problem solving

Personal-social

Domains Screened by the ASQ-3

ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

Features of the Ages and Stages

Questionnaires (ASQ-3)

21 Questionnaire intervals:

2, 4, 6, 8, 9, 10, 12, 14, 16, 18, 20, 22,

24

27, 30, 33, 36 (spaced 3 months apart)

42, 48, 54, 60 (spaced 6 months apart)

Features: ASQ-3 Intervals

9 month vs. 10 month forms

9 month developed for pediatricians to use at 9 month check-up.

When screening 9 month old child use 10 month ASQ-3 as it is more stringent.

ASQ-3 Intervals

Features: ASQ-3 Cover Page

•Administration window indicated on ASQ-3 cover page.

•16 month “window” is 15 months, 0 days to 16 months, 30 days.

Date ASQ Completed

Childs Date of Birth

Prematurity question (up to 24 months)

Calculate Age at administration or Adjusted age and compare with administration window.

Features: ASQ-3 Cover Page

Gathers information to choose correct ASQ-3 Interval.

5 developmental areas (e.g., Communication) 6 questions in each area Questions are in hierarchical order Questions #5 and #6 are average skills for

children of that age interval

(i.e., a 12 month skill for a 12 month child).

Response options: Yes, Sometimes, Not Yet Written at 4th to 5th grade reading level

Features: ASQ-3 Areas & Questions

Un-Scored Section Looks at quality of skills (e.g., speech)

Example: “Does your baby use both hand equally well?”

“No” response indicates possible medical diagnosis. Important to follow up.

Parent concerns very predictive. Any concerns or questionable responses require

follow-up

Features: ASQ-3 Overall Section

Each ASQ-3 interval has unique summary sheets.

Summary sheets have five sections: Child/family information Bar graph with cutoffs Overall section Follow-up action taken (new to ASQ-3) Optional section: Individual item

responses

Features: ASQ-3 Summary Sheet

How to Administer ASQ-3

Obtain consent.

Explain purpose of screening and review questionnaire content.

Schedule screening.

Select Correct ASQ-3 Interval.

If possible, provide parent with ASQ-3 prior to administration.

Assemble materials (if necessary).

Prescreening Activities

ASQ-3 Administrat

ion: Andrew Scoring Exercise

Date ASQ Completed: October 14, 2008.

Child’s Name: Andrew

Child’s Date of Birth: April 30, 2007

Vicky (mother) filling out questionnaire.

Andrew: ASQ-3 Cover Page

What is Andrew’s actual Age at ASQ Administration in months

and days?

Date ASQ Completed: October 14, 2008.Child’s Date of Birth: April 30, 2007

2008 10 (9) 14 (+30) days2007 4 mo 30 days

1 year 5 mo 14 days

Age at Administration: Andrew

=Andrew’s Age at administration is 17 months 14 days

Choosing the correct ASQ-3

when the child is premature.

Adjusted age: Subtract weeks

of prematurity from child’s age at administration to create an adjusted age.

Use adjusted age to choose appropriate ASQ-3 interval.

17 months 14 days – 6 weeks = 16

months(Andrew’s Age at administration)

Adjusted Age: Andrew

Andrew was born 6 weeks premature. What is Andrew’s

Adjusted Age?

Andrew’s adjusted age is 16 months.Andrew should receive the 16 month ASQ.

Possible Responses to the ASQ

Yes = the child is performing the skillSometimes = the child is performing

the skill on occasion, but not alwaysNot Yet = the child is not yet

performing the skill

Step 1: Review responses. If any missing items, try to obtain answers. If items inappropriate, omit item.

Step 2. Calculate area totals: “yes”= 10; “sometimes”= 5; “not yet”= 0.

Step 3: If any items omitted, calculate new area total (example to follow).

Scoring the ASQ-3

Step 4: Review overall section responses. Ask for further clarification and make notes if needed.

Step 5: Transfer information to ASQ-3 Summary Page.

Scoring the ASQ-3 (cont.)

Create a new total area score so child is not penalized.

1) Divide total area score by the number of items answered in that area.

45 (area score) 5 (items) = 9 points.

2): Add this average item score to the total area score to get a new total score.

45 + 9 points = new total of 54 points

ASQ-3 Omitted item?

Understanding ASQ Summary

Values in the chart’s un-shaded areas = child appears to be developing typically

Values in the grey shaded areas (“Monitoring Zone”) = child may need extra practice and experience in this domain, child’s progress should be monitored. (-1.00-(-)1.99 SD below the mean)

Values within the charts black shaded areas = child should be referred for further evaluation. (-2 SD below the mean)

16 Month ASQ-3 Scoring Chart

Andrew, Case Study

Number of

children

Scores (in points) on ASQ0 60

ASQ-3 “Bell Curve” (Not to Scale)

Monitor Zone

32%

ASQ-3 Cutoff

52.2%15.8%

-1SD-2SD

Follow-up &Referral Criteria

Above monitor zone

Provide follow up activities & rescreen in 6-12 months.

All areas scored in white zone

Monitor zone

Score is between 1-2 SD below average. (1 area in

grey zone)

Provide follow up activities to practice specific skills.

Rescreen in 6 months in areas of concern.

Make community referrals as appropriate.

Follow-up/Referral Criteria (cont.)

Below cutoff in one or

more areas:

Score is below 2 standard

deviations below average. (2 or

more areas in grey zone or 1 or

more areas in black.)

Refer for further assessment

Example of Follow-Up Actions

Andrew, Case Study

Talking to Families

“The ASQ is a tool to check on your child’s development.”

“Your child will be able to do some of the items, but not all of the items.”

“Answers help show your child’s strengths and any areas where your child may need support or more practice”

Includes information on planning screening systems and procedures

Provide example letters, activities, and case studies

Contain technical reports Cover all topics in depth

ASQ-3 User’s Guide