An Introduction to Ages & Stages Questionnaires®: Social Emotional (ASQ:SE): A Parent-Completed, Child-Monitoring System for Social-Emotional Behaviors

Presenter: Teri Pinto, Dept. Mental Health, Office of Children’s Services Office of Children’s Services Alabama Assuring Better Child Health and Development Screening Initiative

Objectives Define and discuss the benefits of developmental screening. Describe features of the ASQ:SE. Score the ASQ:SE. Describe ASQ:SE cutoff scores. Interpret ASQ:SE information in relation to other referral considerations. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

What is the ASQ:SE? Parent- or caregiver-completed screening tool that encourages parental/caregiver involvement Series of questionnaires for children ages 3 months to 5 ½ years Tool to accurately identify children at risk for social-emotional delay ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Efficacy Test Sensitivity: 71-85% (Need further evaluation for delay) Specificity: 90-98% (Probably do not have a delay)

ASQ:SE Addresses Seven Areas ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ:SE Materials Published by Paul H. Brookes Publishing Co Materials include The ASQ:SE User’s Guide and ASQ:SE Questionnaires (box set or CD) ASQ:SE in Practice videotape Available in English and Spanish Case studies, questionnaires, and a technical report about the ASQ:SE are available on the publisher’s web site. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Types of Assessment Screening assessment Diagnostic assessment Curriculum-based (programmatic, ongoing) assessment ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Screening Assessment A brief assessment—similar in theory to health screenings such as a quick hearing or vision screen—designed to identify children who should receive more intensive diagnosis or evaluation from local Early Intervention (EI), Early Childhood Special Education (ECSE), health, and/or mental health agencies. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

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 whether the child is eligible for services (e.g., EI). ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Curriculum-Based (Programmatic, Ongoing) Assessment An in-depth assessment that helps to determine a child’s current level of functioning. This type of assessment can Provide a useful child profile Help with program planning Identify targeted goals and objectives Be used to evaluate a child’s progress over time ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Monitoring Developmental surveillance (screening at frequent intervals) of at-risk infants and toddlers not known to be eligible for special health or educational services; similar in theory to a person with diabetes monitoring his or her blood sugar ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Screening Not near cutoffs Beyond cutoffs Eligible for services Near cutoffs Professional assessment Not eligible for services Continue to monitor (rescreen) and use curriculum-based assessment to develop learning plans ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Incidence of Children Identified as Having a Disability by Age Infants: 2.4% Preschool-age: 5.8% School-age: 11.6% Source: ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Why Screen Social- Emotional Behaviors?

Social-Emotional Research Links exist between earliest emotional development and later social behavior (Cicchetti & Cohen, 1995a, 1995b; Reynolds et al., 2001). Behaviors, even in infancy, signal the need for intervention (Shonkoff & Phillips, 2000). Links exist between early risk factors, poor outcomes, and violence (Conroy & Brown, 2004). By third grade, programs for children with antisocial behavior are mostly ineffective (Greenberg et al., 2003; Walker, 2004). ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Developmental-Organizational Framework Source: Cicchetti, 1993 ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Developmental-Organizational Framework Source: Cicchetti, 1993 ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Developmental-Organizational Framework Source: Cicchetti, 1993 ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Activity What is the intent of the questions on the ASQ:SE? ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ:SE Features

Features of the ASQ:SE 6-, 12-, 18-, 24-, 30,- 36-, 48-, and 60-month intervals Between 19 (6-month) and 33 (60-month) scored questions on each questionnaire 3- to 6-month administration window on either side of interval age No need to use CDOB or adjusted age for children born prematurely ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Features of ASQ:SE Questionnaires are written at a fourth- to fifth- grade reading level. Each questionnaire includes open-ended questions related to eating, sleeping, and toileting. All intervals include the question, “Is there anything that worries you about your baby (child)? If so, please explain.” Each interval also includes the question, “What things do you enjoy most about your baby (child)?” ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Features of the ASQ:SE Competence and problem behaviors are targeted. Externalizing and internalizing behaviors are targeted. Scoring Options Points Most of the time0 or 10 Sometimes 5 Never or hardly ever 0 or 10 Is this a concern? Yes = 5 High scores falling above empirically derived cutoff points are indicative of problems. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ:SE Score Information (N=2861) IntervalRangeMedianCutoff 6-month0– month0– month0– month0– month0– month0– month0– month0– ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ:SE Case Study

Introducing the ASQ:SE to Parents “This questionnaire asks questions about your child’s social-emotional growth. Your answers will help me determine what type of information I may be able to gather for you.” “Some of the questions are not very specific; just answer based on your feelings or opinions about your child’s behavior.” ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Introducing the ASQ:SE to Parents Review response options: Most of the time: Child is performing behavior most of the time or too often. Sometimes: Child is performing behavior occasionally but not consistently. Rarely or never: Child is not performing or rarely performs the behavior. Discuss the “concerns” option. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Administering the ASQ:SE Have parents complete the questionnaires as independently as possible. Some questions on the ASQ:SE, such as those regarding eating problems (for all intervals) and perseverative behaviors (for children 18 months and older) may require clarification. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Scoring the ASQ:SE Determine a child’s total score: # of questions with X ___ x 10 = ____ # of questions with V ___ x 5 = ____ # of concerns ___ x 5 = ____ Total points on each page = ____ Transfer points on each page to the ASQ:SE Information Summary. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

ASQ:SE Omitted Item(s) Try to obtain answers from the family. It is okay to omit up to 2 items for the 6- to 18-month questionnaires and up to 3 items for the 24-month and over questionnaires. See The ASQ:SE User’s Guide for additional guidance. Calculation: Step 1: Divide the total score by the number of questions answered on the ASQ:SE. For example, 105 total points/30 questions = 3.5 points. Step 2: Add this number, which is the average score for items on this questionnaire, to the total score to get a new total score. For example, = new total score of points. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Review Questionnaires with Parent(s) Discuss the child’s strengths, and reinforce positive parent – child interactions. Discuss items that individually score 10 or 15 points. Discuss answers to open-ended questions. Review the child’s score, and compare it to the cutoffs. Remember that cutoffs on the ASQ:SE are very different from those on the ASQ! Discuss referral considerations. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Referral Considerations  Time/setting factors  Developmental factors  Health factors  Culture/family factors ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Interpreting Scores The “sometimes” issue The subjectivity issue Validity of report Teen parents Parents involved in protective services First-time parents/isolated parents Parents actively involved with drugs and alcohol Parents with mental illness ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Questionable Scores Have another caregiver complete the ASQ:SE. Gather additional information: Observe the child. Use a professionally administered screening tool. Assess parent – child interactions. Assess the caregiving environment. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Possible Follow-up Below cutoff: Provide ASQ:SE activities and monitor the child. Close to cutoff: Follow up on concerns. Provide information, education, and support. Re-administer the ASQ:SE. Make referrals as appropriate. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Possible Follow-up Above cutoff: Refer to EI/ECSE. Refer to local community agencies: Feeding clinic Church groups Community groups, YMCA, Birth to Three Parenting groups Early Head Start Refer to primary health care provider. Refer for mental health evaluation. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Communicating Screening Results Assure the family that the discussion is confidential. Review the purpose of screening. Avoid terms such as test, pass, or fail. (instead, use below cutoff or near cutoff) Review the ASQ:SE and explain area scores. Emphasize child and family strengths. Provide specific examples of concerns. Invite parents to share their observations and/or concerns. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Communicating Screening Results* Prepare for the meeting carefully: Make notes about behaviors. Note information you need to gather (e.g., health history) from the family. Role-play the conversation with a peer. Select a private, comfortable place to meet. Consider cultural or language issues. Know your community resources. Be calm! * Source: Hilton/Early Head Start Training Program, Sonoma State University ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Infant Mental Health Interventions Deborah Weatherston Wayne State University, Merrill-Palmer Institute 1. Concrete service assessment or assistance 2. Emotional support 3. Developmental guidance 4. Early developing relationship support 5. Infant – parent psychotherapy** 6. Advocacy **Requires a trained mental health professional ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

The ASQ:SE User’s Guide Excellent resource Includes information on scoring and interpreting scores Provides activities and case studies Covers all topics in depth ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Summary Screening 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. Social-emotional issues are very complicated. Use available resources to make decisions about what steps to take after screening. ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly. Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, go to

Jane Squires, Ph.D., Jantina Clifford, Ph.D., or Liz Twombly, M.S. University of Oregon For more information, please contact: