Presentation on theme: "An Introduction to the Ages and Stages Questionnaires (ASQ): A Parent-Completed Child Monitoring System Jantina Clifford, Ph.D. firstname.lastname@example.org (541)346-2599."— Presentation transcript:
1 An Introduction to the Ages and Stages Questionnaires (ASQ): A Parent-Completed Child Monitoring SystemJantina Clifford, Ph.D.(541)University of OregonEarly Intervention Programeip.uoregon.edu
2 Objectives Define and discuss benefits of developmental screening. Identify risk and protective factors related to child development.Describe features of ASQ.Score ASQ.Describe ASQ cut-off scores.
3 ObjectivesInterpret ASQ information in relation to other referral considerations.Understand importance of sensitive communication of screening resultsDiscuss the process for referring children to appropriate agencies.Discuss appropriate follow-up activities.
7 ASQ Materials User’s Guide Questionnaires (box set or CD) Videos ASQ on a Home VisitASQ: Scoring and InterpretationASQ Learning ActivitiesAvailable in English, Spanish, Korean, French. Other translations available (contact publishers for more information)
8 ASQ Materials and Information Paul H. Brookes PublishingOfficial web site:Periodic updates available at:
10 Screening AssessmentA brief assessment procedure designed to identify children who should receive more intensive diagnosis or evaluation from local early intervention (EI) or early childhood special education (ECSE) agencies.Similar in theory to health screenings such as a quick hearing or vision screen.
11 Diagnostic (Professional) Assessment An in-depth assessment of one or more developmental areas to determine the nature and extent of a physical or developmental problem and determine if the child is eligible for early intervention services.
12 Curriculum-Based Assessment (Programmatic, On-going Assessment) An in-depth assessment that helps to determines a child’s current level of functioning. This type of assment can:provide a useful child profilehelp with program planningidentify targeted goals and objectivesbe used to evaluate child progress over time
13 MonitoringDevelopmental surveillance (Screening at frequent intervals) at-risk infants and toddlers not known to be eligible for special health or educational servicesSimilar in theory to a person with diabetes monitoring his/her blood sugar
14 Screening Professional Assessment Beyond CutoffNear CutoffNot near cutoffProfessionalAssessmentContinue to Monitor (Re-Screen) & use Curriculum-Based Assessment to develop learning plansEligibleNot Eligible
16 Risk factors for developmental delay Health/Biological Risksadvances in medical technologylack of prenatal careEnvironmental/Social Risksteen & single parentspovertyalcohol and drugsexposure to violence
17 Protective FactorsVariables which serve to correct or decrease negative influences of being at risk:characteristics of the individualsupportive relationships and environments withinand outside the familypositive expectations for achievement and a belief in the child’s abilitiesmeaningful participation and involvement in family, school, and community
18 Incidence of children identified as having a disability by age (2005) 2.4%11.6 %5.8%)
19 Benefits of developmental screening Identifies children at risk forpossible developmental delaysDetects child’s strengths and needsProvides an opportunity toAddress family concernsEducate parents on child developmentEmpower parents
20 More Benefits… Builds rapport and trust with family Increased communicationParent and staff enjoyImproves health and developmentaloutcomes through Early InterventionservicesBuilds community collaborationand support for staff
21 Individuals with Disabilities Education Act (IDEA) Each state must “identify, locate, and evaluate” children who are in need of special education and related services regardless of the severity of the disability (IDEA Part B sec. 612(3))Child find efforts for infants and toddlers must be consistent with those for children age 3 and above (IDEA Part C sec. 635 (5)).
22 Infants, Toddlers & Preschoolers: Where are they? Health SystemsDoctor’s OfficesClinicsHome visiting programsEducational SystemsPreschools/daycareEarly head startEarly literacy programsSocial ServicesFoster careSheltersWIC
23 Why Engage Families In Screening? Parents are reservoirs of rich information,useful for providersParental involvement reduces costScreening helps structure observations, reportsand communications about child developmentScreening may become a teaching toolEncourages parent involvemen on the intervention team.
24 Activity: Rotating Review Number off by 5Go to flip chart with your numberWork together to answer the questionRotate to the next flip chart at the signal
25 Features of the Ages and Stages Questionnaires (ASQ)
26 Features of the ASQ19 Questionnaire intervals: 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24 (3 months) 27, 30, 33, 36 (6 months) 42, 48, 54, 60
28 Features of the ASQ Cover sheet Information sheet Allows for program to personalizeInformation sheetDate of completion: Is the questionnaire “in the window”?Corrected Date of Birth (CDOB)is made for babies born 3 or more weeks premature,up to- but not including- 24 months .Written at 4th to 5th grade reading level
29 Features of the ASQ 6 questions in each area Questions are in hierarchical orderThe most difficult questions (#5 and #6) are average skills for children of that age (i.e., a 12 month skill for a 12 month child).Questions are answered “yes”,“sometimes”, and “not yet”.
30 Features: the Overall Section Not scored but indicates parent concernsVery predictiveLooks at quality of skills (speech, movement)4, 6, 8, 10, 12 ASQ asks questions to detect cerebral palsy:Use of both hands equally?Stands flat on surfaces most of the time?Any questionable response requires follow-up
31 Features: Summary Sheet Each summary sheet is specific to an intervalSummary sheets have four sectionsChild family informationOverall sectionBar graph of the five domain scoresBubble boxes to transfer responses
32 Bell curve used to determine cutoff point Percentage of population68%ASQ Cutoff13.5 %13.5%Number of Children2.5%2.5%-2 SD- 1 SD+ 1 SD+2 SD
34 Prescreening Activities Obtain consentExplain purpose of screening and review questionnaire content.Schedule screeningMail ASQ 2 weeks before visit or leave on previous visit and ask parent to reviewAssemble materials (if necessary)
35 Correcting for prematurity Either of the following methods can be used to determine the appropriate ASQ intervalCDOBAdd weeks of prematurity to date of birth to obtain a corrected date of birth.Adjusted AgeSubtract weeks of prematurity from present age to determine corrected age.
36 Correcting for prematurity: CDOB Andrew born six weeks premature April 30, 2004.When should Andrew receive 16 month ASQ?First, calculate Andrew’s CDOB by adding 6 weeks to his date of birth.Andrew’s CDOB is June 14, 2004.Next, add 16 months to his CDOBAndrew should receive the questionnaire on or near October 14, 2005.
37 Correcting for prematurity: Adjusted age Andrew born six weeks premature April 30, 2004.Today is October 14, Which ASQ should Andrew receive?First, calculate Andrew’s actual age.Andrew’s actual age is 17 1/2 monthsNext, adjust Andrew’s actual age by subtracting 6 weeks.Andrew’s adjusted age is 16 months
38 Scoring the ASQStep 1: Total the points in each area. “yes”= 10, “sometimes”= 5, “not yet”= 0.Step 2: Transfer the area totals to the information summary page. Fill in the matching circle in the space provided.Step 3: Read the answers to overall section questions carefully and respond appropriately.Step 4: Any score falling near or into the shaded area requires further attention or assessment.
39 ASQ Omitted item? Calculation: Try to obtain answers from familyUp to 2 items per area okay to omitSee User’s Guide for additional guidanceCalculation:Step 1): Divide the total area score by the number of questions answered in that area(Example: 45 (points in PS area) /5 (questions) = 9 points).Step 2): Add this number to the total area score to get a new total score. (This number is the average score for items in that area)(Example: points = new PS total of 54 points)
40 Bell curve used to determine cutoff point Percentage of population68%ASQ Cutoff13.5 %13.5%Number of Children2.5%2.5%-2 SD- 1 SD+ 1 SD+2 SDScore
42 Follow-up/Referral Criteria Well above cut-off points.Provide follow up activities to parentsRescreen in 4-6 monthsClose to cutoffs:Provide follow up activities to practice skills in specific domain (s)Talk to parents about opportunities to practice skillsMake community referrals as appropriateRescreen in 4-6 months or sooner if necessary
43 Follow-up/Referral Criteria (con’t) Below cutoff in one or more areas:Refer to early intervention or early childhood special education agencies for diagnostic assessmentParent concern :Respond to all concerns.Refer if necessary
44 Information to guide decisions: risk and protective factors Biological / Health factorsEnvironmental factorsstressful life eventssocial supportsfamily/caregiving environmentDevelopmental historyFamily and cultural contextParent concernsExtent and frequency of contactAvailability of resources
45 Communicating Screening Results Assure the family that the discussion is confidentialReview the purpose of screeningAvoid terms such as “test”, “pass” or “fail”. (“below cutoff, near cutoff”)Review the ASQ and explain area scoresEmphasize child and family strengthsProvide specific examples of concernsInvite parents to share observations, concerns
46 Communicating Screening Results* Prepare for the meeting carefullyMake notes about behaviorsNote information you need to gather (health history etc.) from familyRole play conversation with a peerSelect a private, comfortable placeConsider cultural or language issuesKnow your community resourcesBe calm!* Adapted from the Hilton/Early Head Start Training Program Sonoma State University
48 Parent Report: Research Dinnebeil and Rule (1994) reviewed 23 studies and reported high reliability in parents report.Area specific studies supporting parent report:Cognitive (Glascoe, 1999)Communication (Ring and Fenson, 2000)ADHD and school related problems (Mulhern, 1994)Gross Motor (Bodnarchuk & Eaton, 2004)
49 Parent Report: Factors that may effect accuracy Characteristics of parents:Impaired mental functioningMental health issuesCultural and language differencesInvolvement with child protective agenciesLow literacy
50 Qualities of assessment tools Validity “accuracy”Reliability “consistency”Adequate normative populationCultural sensitivityComprehensivenessAttractiveness to children
51 Validity of the ASQ by interval ASQ Total N % Agreement%%%%%%%%%%
52 ValiditySpecificity: how accurately a tool identifies ` children without problemsSensitivity: how accurately a tool identifies children with problems
53 Validity: Sensitivity, Specificity, Over and Under-referral rates IntervalSens.Spec.Under-ref.Over-ref.451%84%12.5%11.98%878%88%3.46%9.66%1285%86%1.83%11.93%1673%81%3.19%16.49%2065%90%5.7%8.23%2480%82%1.33%16.37%3075%2.08%13.19%3692%1.45%7.25%481.94%13.59%6083%100%3.33%16.67%Overall76%87%4.0%11%
54 Overall Validity of ASQ? SampleAgreementSensitivitySpecificityUnder-referredOver-referred
55 Reliability of the ASQInterobserver reliability of infants classifications between ASQ completed by parents and by professional examinersN=112Agreement = 94%Test-retest reliability of infant’s classifications on ASQ completed by parents at two-to-three week intervalsN=175Agreement=94%
56 Normative Sample: Total number of questionnaires in each interval 4 month8 month12 month16 month20 month24 month30 month36 month48 month60 monthOverall:15001405118510579308986095352861258530
57 Ethnicity of Normative Sample for children ages 4 – 36 months N=1287 Caucasian %Native American/Alaskan 14.6%African American %Latino/Hispanic 4%Biracial %Asian/Pacific Islander 0.4%
58 Cultural adaptability of the ASQ Alternative administration methodsAlternative materials suggested on the questionnaireNormative sample includes diverse populationsScoring allows for omission of inappropriate items
59 Coordinating, Planning and Managing Screening Efforts
60 ASQ User’s Guide, 2nd Edition Excellent resourceCovers all topics in depth
61 Interagency Collaboration What other agencies are screening children?What ages? What domains? What tools?Coordinate training effortsCoordinate services to:Decrease duplicationSave resourcesDetermine your referral sourcesEstablish relationship/interagency agreementEstablish referral/feedback procedures
62 Planning a Screening Program Establish goals and objectives with stakeholdersDetermine program resourcesSelect criteria for participationOutline internal referral and feedbackproceduresDevelop policies and proceduresTrain staffPlan evaluation activities
63 Planning: ASQ format selection Method(s)mail-out, home visit, interviewSetting(s)child care settingpediatric waiting roomIntervalsallselected
64 Management Features unique to ASQ intervals windows of reliability formscut-off scoresManagement systemstickler system (card file)computer system
65 Training Materials: ASQ User’s Guide ASQ trainer’s notes Overheads (or powerpoint)Scoring ExercisesCommunication Role PlaysHome Visit VideoHandouts
66 On-going Support Before training Discuss training’s value and importance with traineeDuring TrainingAllow time for practice, questions, discussionPlan for trainees return to job after trainingAfter trainingProvide frequent practice opportunitiesCoach trainees in applying new learningProvide on-going supportEncourage and reward transfer of new skills
67 Program Evaluation Screening success. Parent satisfaction. Referral procedures:Are they working?Interagency collaborations.Are they happening?
68 Screening Success: Positive Predictive Value Proportion of children identified by theASQ as needing further assessment whowill, in fact, have intervention needs:True Positives*All Positive Screenings* Verified by in-depth evaluation
69 In SummaryScreening tools can help bridge communication with families.Screening tools can assist in making referrals to community agencies.Referrals should be based on a variety of considerations in addition to “scores”.Developmental and social emotional issues are very complicated.Use teams to make decisions about next steps after screening.
70 In Summary Managers and Supervisors play an important role in: collaborating with community partnersplanning screening programsestablishing screening policies and proceduresassuring staff competencysupporting staff implementation effortsevaluating program effectiveness
71 For More Information Please Contact: Jane Squires, Ph.D.,Jantina Clifford, Ph.D., orLiz Twombly, M.S.University of Oregoneip.uoregon.edu