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.

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 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 Twombly Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, see

 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 Twombly Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, see

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 Twombly Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved. For more information about the ASQ and ASQ:SE, see

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

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

ASQ-3 Administration: Andrew Scoring Exercise

 Date ASQ Completed: October 14,  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, Child’s Date of Birth: April 30, (9)14 (+30) days mo30 days 1 year 5 mo14 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 skill  Sometimes = the child is performing the skill on occasion, but not always  Not 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 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. ( (-)1.99 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 ASQ 060 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 3-6 months.  All areas scored in white zone  Monitor zone  Score is between 1-2 SD below average. (only 1 area in grey zone)  Provide follow up activities to practice specific skills.  Rescreen in 3-6 months in areas of concern.  Make community referrals as appropriate (e.g. hearing).

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”

 Use quicktext:.ypccasqscoring  We will be actively working on making the quicktext easier to use over the coming months…  Suggestions are welcome and requested. Recording in Epic! (a PCC note in the text)* *if you don’t know what I’m talking about in terms of notes in the text, you’ve missed quite a bit so please view this again in NON-slideshow format, reading all the notes below…