An Introduction to ASQ-3™

An Introduction to ASQ-3™
Ages & Stages Questionnaires®, Third Edition (ASQ-3™) A Parent-Completed Child Monitoring System ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

What are ASQ-3 and ASQ:SE?
Parent- or caregiver-completed screening tools that encourage parent/caregiver involvement Series of questionnaires for children ages 1 month to 5 ½ years Tools to accurately identify children at risk for developmental or social-emotional delay Parent/Caregiver completed. All of the research on the ASQ was conducted with a primary caregiver completing the form, so we know little about how accurate results are if, for example, a childcare provider completes the tool. (For the ASQ:SE, caregivers need to have at least 20 hours of contact with the child during the week). Optional Activity: Ask Participants, "Why is it important to include parents in the screening process?” Possible answers include: Parents know children best, so they are good sources of information Parents can learn about child development Parents are seen as the expert, which can be empowering Includes parents as part of the team Facilitates communication between provider and parent regarding child’s development ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 Domains ASQ-3 Communication Gross motor Fine motor
Problem solving Personal-social Review slide. ASQ-3 covers 5 Domains of Development. Explain that ASQ:SE was developed as a companion tool to ASQ in order to address the need for age-appropriate tools to monitor very young children’s behavior and address parental concerns. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 and ASQ:SE Materials
ASQ-3 Starter Kits Starter Kit includes: User’s Guide Questionnaires on paper Questionnaires on CD-ROM Quick Start Guide ASQ Online keycode (to be used after purchase of a subscription to ASQ Online.) The ASQ-3 Starter Kit will include both paper copies of questionnaires and a CD-ROM with PDFs of questionnaires. ASQ-3 User’s Guide includes general age-specific activities in English and Spanish. ASQ-3 Quick Start Guide provides quick access to ASQ-3 administration and scoring basics and is available in English and Spanish. There are other translations of the ASQ available through the publisher. If participants are interested in finding out about a specific language, they can contact the Subsidiary Rights department at Paul H. Brookes Publishing Co., Inc. for more information. Other products are available as well, see for more information. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Screening Assessment A brief assessment procedure designed to identify children who should receive more intensive diagnosis or evaluation from local early intervention (EI), early childhood special education (ECSE), health, mental health agencies. Exercise: Materials: Overhead projector w/transparency paper & marker or flipchart pad & markers 1) Ask participants to identify what types of screening tools they have used in their agencies. 2) Ask participants to identify 1 word that typifies screening. Write these words down and discuss screening using those words. (Examples: funnel, sand sifter, snapshot) Also, remind participants (see slide "ASQ and ASQ:SE Development") that ASQ and ASQ:SE items are not to be used as targets for intervention or for goals/objectives. The results can let you know, however, what development domain or behavioral area to focus interventions efforts on. Examples of Screening tools: The Ages & Stages Questionnaires® (ASQ) , DIAL-3, Early Screening Inventory (ESI), Revised Developmental Screening Inventory (RDSI), Parent’s Evaluation of Developmental Status (PEDS). Examples of SE Screening Tools: Temperament and Behavior Scales (TABS), BITSEA (Brief Infant/Toddler Social-Emotional Assessment), Devereux Early Childhood Assessment (DECA) Developmental screening similar in theory to health screenings such as a quick hearing or vision screen. Answers the question: "Does the child need further evaluation?" ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Adapted from Macias, M. (2006) D-PIP Training Workshop
WHY SCREEN? Under Detected Clearly Typical Clearly Atypical ? Adapted from Macias, M. (2006) D-PIP Training Workshop ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Professional Assessment
Screening Not near cutoff (no risk) Beyond cutoff (high risk) Near cutoff (risk) Professional Assessment Continue to Monitor (Re-Screen) & use Curriculum-Based Assessment to develop learning plans This is an example of how screening with ASQ and ASQ:SE fits into a system to help identify children at risk for developmental delays. The process starts at the top by screening all children, and then children fall into 3 categories: Not Near Cutoff (Above ASQ-3 Monitoring Zone, Well Below ASQ:SE) Near Cutoff (Monitoring Zone of ASQ-3) Beyond Cutoff (Below ASQ-3, Above ASQ:SE) Children who fall beyond the cutoff are sent to local Part C or Part B Early Intervention/Early Childhood Special Education, health or mental health agencies for further diagnostic evaluation. NOTE: One of the dilemmas you will encounter when screening for social-emotional delays is the lack of appropriate referral agencies—especially for babies and toddlers. You can start with EI/ECSE agencies, but if no specific EI/ECSE mental health or behavioral programs exist consider referrals to parenting programs, home visiting health, or other mental health programs. We are pioneers in this field and need to use tools to justify our referrals, document the need for services, and advocate to our agencies/government for the need for more services. Children who fall near the cutoff are either sent for diagnostic evaluation and/or provided access to community-based or prevention programs and monitored closely. Follow-up will depend on program resources and state eligibility criteria. Children who are not near the cutoff should also be monitored. In many programs (e.g., Early Head Start, state preschools), children should also be assessed with a curriculum-based assessment tool to determine learning goals or targets for intervention. Important Point! Note that children who are eligible for services are no longer screened. These children may be assessed with a curriculum-based assessment to determine functional goals to work on but at this point the screening tool is not needed anymore (and in most cases would be inappropriate to continue using). Eligible Not Eligible ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Incidence of children identified as having a disability by age (2011)
2.79% 10.76 % 5.99% This slide illustrates the need for early identification of disabilities. From birth to 3, 2.79% of children are receiving EI services, by preschool 5.99% are receiving ECSE services, but by school age nearly 11% are identified with some degree of disability. By screening and monitoring we hope to identify more children at younger ages. In fact, rates for EI and ECSE both increased from 2008 to 2011 (they were 2.66% and 5.68%, respectively in 2008), and decreased for children ages 6-17, down to 10.77% from 11.18% in This is not proof that increased identification and services in the early years has impacted the number of children requiring special education in the later years, but it is hopeful! Activity: Ask participants, "Why do you think the number of children increases at each age group?" Possible explanations: 1) We are missing children in our screening efforts Children are acquiring delays (suggested by Ramey & Ramey (1992), Werner, Sameroff and Chandler) due to negative caregiving environments Note: Part B ages 6-17= 10.76%, as calculated by dividing 5,413,474 (# of children in Part B ages 6-17 in 2011) by 50,297,640 (# of children ages 6-17 in U.S. population in 2011) Data taken from: Table B1-1. "Number of children and students served under IDEA, Part B, by age group and state: Fall 2011" and Table P-9, "Estimated resident population ages 3 through 21, by state and age group: "ideadata.org" ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Detection Rates of Children with Existing Delays
Without Screening Tools With Screening Tools Developmental Disabilities 14-54% identified Sheldrick et al, 2011 70-80% identified Squires et al, 1996 Mental Health Problems 20% identified Lavigne et al, 1993 80-90% identified Sturner, 1991 Research mentioned in this slide emphasizes the importance of using screening measures - even the "experts" i.e., pediatricians, miss many children if they do not use a high-quality screening tool. The AAP recommends screening all young children at 9, 18, and 24 (or 30) months. (American Academy of Pediatrics: Developmental Surveillance and Screening of Infants and Young Children, Pediatrics, (2011), 108, 1, ) Sheldrick, R.C., Merchant, S. & Perrin, E.C. (2011) Identification of developmental and behavioral problems in primary care: A systematic review. Pediatrics, July 4, downloaded 7/18/2011 from: Palfrey, J. S., Singer, J.D., Walker, D.K. & Butler, J.A. (1994). Early identification of children’s special needs: A study in five metropolitan communities. Journal of Pediatrics, 111, Squires, J., Nickel, R.E., & Eisert, D. (1996). Early detection of developmental problems: Strategies for monitoring young children in the practice setting. Journal of Developmental and Behavioral Pediatrics, 17(6), Lavigne, J., Binns, H., Christoffel, K., Rosenbaum, D., Arend, R., Smith, K., et al. (1993). Behavior and emotional problems among preschool children in pediatric primary care: Prevalence and pediatricians' recognition. Pediatrics, 91, Sturner, R.A. (1991). Parent questionnaires: Basic office equipment? Journal of Developmental and Behavioral Pediatrics, 12, Courtesy of START ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features of the Have participants take out their 16-month ASQ-3 while reviewing features of ASQ-3. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Intervals
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) There are 21 ASQ-3 intervals. Note that intervals are spaced 2 months apart until 24 months, 3 months apart from months, and 6 months apart from months. The 9 month interval was designed for health care providers who do 9 month well baby check-ups. It has the same items as the 10 month questionnaire (would recommend only using this interval in health settings to coordinate with well child check-ups). ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Cover Page
Administration window indicated on ASQ-3 cover page 16-month "window" is for children ages 15 months 0 days through 16 months 30 days Programs can personalize questionnaires by replacing the logo of the mother and child (on the top right) ASQ-3 administration windows have been "stretched" so that there is always an appropriate ASQ-3 interval to administer. Note: If a child’s score is questionable and his/her age is on the younger or older end of these stretched windows, this should to be taken into consideration when interpreting results and making referral decisions. Handout: "ASQ-3 and ASQ:SE Age Administration Charts". Explain that this chart can be used to identify the correct interval of ASQ-3 and ASQ:SE based on a child’s chronological or adjusted age. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Cover Page Gathers information to choose correct ASQ-3 interval
- Date ASQ Completed - Child’s Date of Birth - Prematurity question (up to 24 months) Calculate Age at administration or Adjusted age and compare with administration window Choosing the correct ASQ-3 interval is one of the major challenges to the ASQ system. Program staff should carefully calculate a child’s Age at Administration in months and days. See ASQ-3 User’s Guide for detailed guidance (page 67). Use the Age Calculator at This online tool is great for determining a child’s age in months and days! Age Adjustments must be made when a child is born more than 3 weeks premature, up to but not including 24 months. How to calculate an adjusted age will be discussed in detail later in the presentation during "Andrew’s" scoring exercise. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: Important Points to Remember
“Important Points to Remember” are critical to increased accuracy of the ASQ. They are designed to address common discrepancies between parents’ and professionals’ report of child development. Accuracy is improved when a familiar caregiver reports on observable behaviors in a familiar, comfortable environment over time, when a child is well fed, rested and healthy, and when the caregiver tries out questions that they are not sure of. This also increases the educational impact of the tool. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Areas & Questions
5 developmental areas 6 questions in each area Response options: Yes, Sometimes, Not Yet Written at 4th to 6th grade level ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Areas & Questions
Questions ordered in a hierarchy Questions #5, #6 are average skills for child of that age (i.e., a 16-month skill for a 16-month child) Hierarchical order: This is an important feature to emphasize. Across the series of questionnaires, the questions range in difficulty from approximately a 75 developmental quotient (DQ) to a 100 DQ. See User’s Guide page XX for item level information on DQ’s. DQ is calculated by taking a skill age level divided by the age of the child. For example, on the 16 month questionnaire in the communication area, the item difficulty looks like this: #1 and #2 are approximately 12 month skills (DQ=75; 12mo/16mo) #3 and #4 are approximately 14 month skills (DQ=88; 14 mo/16mo) #5 and #6 are approximately 16 month skills (DQ=100; 16mo/16mo) This is a very different tool from a screening tool such as the Denver, which can tell you that a 16 month old child has communication skills at a 20 month age. State "If a child received a yes on every question in the ASQ, what can we say about that child’s development?" Answer: That the child is typically developing, right at age level only. More Difficult ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Overall Section
Un-Scored Section Looks at quality of skills (e.g., speech) - Example: "Does your baby use both hands equally well?" - "NO" response indicates possible cerebral palsy; important to follow up Parent concerns are very predictive Any concerns or questionable responses require follow-up Overall section - Important for decision making. Captures qualitative information that may not be picked up on the quantitative items - example would be stuttering or stammering which could be identified by the overall question "Does your child talk like other children his/her age?" A child may pass the "scores" in the communication area, but still need services. Responses from the overall section should always be considered when making referral decisions. Call local Early Intervention or Early Childhood Special Education to get more information about any questionable responses on the Overall Section or refer to child’s primary health care provider for health-related concerns. ASQ-3 includes new overall questions: Early language development concerns Behavioral concerns Articulation concerns ASQ-3 User’s Guide includes information on overall question considerations and referral options, see table 6.3 page 73. Handout: Overall Questions Chart ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Summary Sheet
Each ASQ-3 interval has unique summary sheets Summary sheets have 5 sections: - Child/family information - Bar graph with cutoffs - Overall section - Follow-up action taken (new to ASQ-3) - Optional section: Individual item responses The summary sheet (score form) provides a complete summary of questionnaire information. This form could be used to share information with other community agencies who families are involved with and who also have a requirement to screen children. For example, Early Head Start may conduct the screening, but share information with a child’s primary health care provider by sending them a copy of the Summary Form. When sharing results, the optional individual item response section should be completed as then all of the information from the screening is contained on that one sheet. Important to Remember: If you are sending this form to another agency/person, the receiving agency must understand ASQ-3 and how to interpret ASQ-3 scoring information. Recommended Handout: "ASQ-3 Information for Health Providers". This handout can also be referred to when debriefing "Andrew’s Scoring Exercise,” especially for participants who may be sharing information or assisting families in sharing information with pediatricians or other health providers. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: Flexibility in ASQ-3 Administration
Method(s) mail-out, home visit, interview, online, clinic Setting(s) Child care/school setting, doctor’s office, home Intervals all or selected intervals ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features: ASQ-3 Cultural Adaptability
Alternative administration methods for individuals from different cultural backgrounds Alternative materials for individuals from different cultural backgrounds Scoring permits omission of inappropriate items Normative sample includes diverse populations Culture can affect the developmental expectations of parents as well as the type and quantity of opportunities that children are provided to practice certain skills. It is important to take this into consideration when interpreting questionable results. The normative sample was used to establish cut-off scores and will be mentioned later in the presentation in the Research section, but you could also mention it here. It is important to understand that while the normative sample includes children across races, the majority of children in the sample were Caucasian. Since culture is sometimes related to race, this could be a consideration when working with children who are not Caucasian. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Prescreening Activities
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 Review slide. Recommended Handout: "Introducing the ASQ-3 to Caregivers". Review numbers 1-6 with participants. Activity: Participants can practice introducing ASQ-3 to a parent. Have them work in pairs. One person is the "home visitor", one is Vicky, who has a young child named Andrew. The "home visitor" should review the first part of the "Introducing the ASQ-3 to Caregivers" handout that describes the purpose of screening, describes the ASQ areas and the scoring options. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

How To Set Up Equation For Calculating Child’s Chronological Age
PRACTICE: Alice Date ASQ-3 Completed: Sept 9, 2012 Child’s Date of Birth: January 3, 2010 Child was born 4 weeks early. What is her chronological age in months? What is her adjusted age in months? Questionnaire interval: Justin Date ASQ-3 Completed: June 10, 2012 Child’s Date of Birth: March 29, 2011 Child was born 8 weeks early. What is his chronological age in months? What is his adjusted age in months? Sharee Date ASQ-3 Completed: January 5, 2012 Child’s Date of Birth: August 20, 2011 Child was born 3 weeks early. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Choosing the Correct ASQ-3 when the Child is Premature
Correct for prematurity when the child is born 3 or more weeks early, until 24 months Create "Adjusted Age" Subtract weeks of prematurity from child’s age at administration. Use adjusted age to choose appropriate ASQ-3 interval Premature (defined as): Children under 2 years, born 3 or more weeks premature. Adjusted Age is used to determine which ASQ-3 interval to give to the child if he or she is premature. See ASQ-3 User’s Guide for further guidance on correcting for prematurity. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Scoring the ASQ-3 Step 1: Review responses. If any missing items, try to obtain answers. If item is 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 (see next slide for example) Up to 2 items in one area can be omitted. See ASQ-3 User’s Guide for further guidance. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Scoring the ASQ-3 Omitted Items x
Up to 2 items in one area can be omitted. See ASQ-3 User’s Guide for further guidance. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Scoring the ASQ-3 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™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Omitted Items "Score Adjustment Chart" See ASQ-3™ User’s Guide Table 6
Omitted Items "Score Adjustment Chart" See ASQ-3™ User’s Guide Table 6.2, ASQ-3™ Quick Start Guide Up to 2 items in one area can be omitted. See ASQ-3 User’s Guide for further guidance. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 Information Summary Sheet (Sections 1 & 2)
This is what the summary sheet should look like. Draw participants’ attention to the approximate "bubbling" in the Personal-social domain, as well as the capitalized responses in section #2 pertaining to the Overall responses. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

68% of population scores in this "average" range
Standard Bell Curve 68% of population scores in this "average" range Number of People This diagram represents a "standard bell curve" and illustrates how a general population may perform on an in-depth standardized assessment. The %s of the population reported in each section of this bell curve are theoretical (not based on ASQ-3 research) and is shown to illustrate the concept of means and standard deviations. Show where average (or the mean) is on the graph. Explain that standard deviations (SDs) are a term for the amount of variability on test scores. SDs are determined through a statistical procedure that looks at the variability of scores between people taking a test. Sometimes there is a lot of variability in scores on a test, and sometimes there is very little. Standard deviations are a number (e.g., 10 points). Sometimes standard deviations are large, or they can be quite small, depending on how much scores in a particular sample deviate from the mean. When we conducted research on the ASQ, some domains had fairly small SDs (e.g., gross motor) and some were quite large (e.g., some communication and fine motor intervals). On the right side of this graph are scores that are above average on a test (the far right quadrant, with 2.5% of individuals scoring 2 SDs above the mean, could be considered an A+). On the left side are scores that are below average on a test (the far left quadrant, with 2.5% of individuals scoring 2SDs below the mean, could be considered a fail on a test). Explain that the ASQ-3 cut offs are set at 2 standard deviations below the mean—however, remind participants that the percentages of individuals that fall into each category on this graph are theoretical, and based on an in-depth assessment. Later in the presentation, the "ASQ Bell Curve" will be presented. On this slide, an example of a bar graph with cutoffs particular to the 16 month ASQ has been provided to illustrate that: Cut-offs are set at 2 standard deviations below the mean The monitoring zone is set at 1 to 2 standard deviations below the mean Any score above the monitoring zone would be considered in the average range. Important: When reviewing this slide, be sure not to equate the dark shaded area on the ASQ summary sheet with the word "fail’. As discussed later, this is a word to avoid when reviewing screening results. The term "below the cut-off" is the preferred language to use. 2.5% 13.5% 13.5 % 2.5% Average (Mean) -2 SD - 1 SD + 1 SD +2 SD Performance on Test ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

16 Month ASQ-3 Scoring Chart Andrew, Case Study
The stars on this scoring chart illustrate where the average (mean) scores are located for the 16 month questionnaires. Again, the monitor zone (lightly shaded) is 1SD to 2SD below the mean. The darkly shaded area begins at 2SD below the mean. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 Information Summary (Sections 3, 4, & 5)
Section 5 is optional. Item responses may be helpful for receiving agencies or for inputting data. Section 4 is where plans for follow-up are documented. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 Score Interpretation and Recommendation for Follow-Up
Consider the following to determine appropriate follow-up Total ASQ-3 Area Scores Overall Responses (Parent Concerns) Additional Considerations What other factors may have impacted the child’s screening results? Instruct participants to form small groups and together discuss Andrew’s ASQ-3. Participants should generate ideas and questions regarding: Further information they would like to have regarding Andrew and Vicky Ideas for possible activities that can be done in a home environment as well as potential referral sources available in their community Debrief the activity focusing on: Communication Fine Motor and Problem Solving See: "16-Month ASQ Scoring Exercise for Andrew" in Trainer’s Materials ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Additional Considerations Biological / Health factors Family and cultural context stressful life events caregiving environment Environmental factors opportunity to practice skills Developmental history Extent and frequency of contact Availability of resources Exercise: Materials: Flip Chart/Markers Instead of showing this overhead, have participants share what types of information related to the child/family they consider prior to making referrals. State "Assessment scores are just one piece of information that we use to make decisions about what to do. What other type of information do you gather to help make those decisions?" Write down responses on flip chart/discuss answers. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

How might culture or values influence these activities? Feeding, Dressing Reading and Writing Tools Playing with Toys Blocks, stuffed animals, shopping carts Sports (e.g., balls) These are all activities/materials you will find on the ASQ. Discuss how cultural values and parenting practices may impact a child’s performance on these different activities. Examples of issues that may arise: Feeding/Dressing: Some cultures feed and dress their babies much longer than "western" cultures and do not encourage self-feeding or children dressing themselves. Reading/Writing: Some cultures have strong oral traditions; writing may not be emphasized, especially at very young ages...may also be considered a safety issue. Playing with Toys: Some cultures place a high value on socializing and may not encourage solitary play with toys. Sports: Some cultures may have strong gender roles and not allow or encourage girls to participate in sport-type activities. Excerpts from: Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice. Community-University Partnership for the Study of Children, Youth, and Families. Edmonton, Alberta, Canada. *Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice. CUP Partnership, Alberta Canada. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Example of Follow-Up Actions Andrew, Case Study
This slide demonstrates potential decisions that might be made for Andrew and Vicky. Note that referral to EI/ECSE (i.e., further evaluation) has not been selected as the family has chosen to try other options first. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Above monitoring zone Provide follow up activities and rescreen in 4-12 months Monitoring zone Score is between 1-2 standard deviations below average Provide follow-up activities to practice skills in specific developmental areas Rescreen within 2 months in areas of concern Make referrals as appropriate Monitoring will depend on program’s contact with families as well as program’s resources. Programs may choose to rescreen in areas of concern soon after the initial screening, or they may choose to stick with their program’s pre-determined screening schedule. For children 1-month to 2-years a 4-6 month monitoring schedule is recommended, and for children 2- to 5½-years a 6-12 month monitoring schedule is recommended. Referrals: It is important to know your state’s eligibility requirements as in some cases, a referral for evaluation may be appropriate for a child who is low in the monitoring zone. It is also important to follow-up with community-based referrals that do not require meeting an eligibility requirement based upon potential delay. Examples are: parenting programs, Early Head Start, home visiting or family support programs for housing or adult mental health. Handout (optional): "Referral Decision Matrix" ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Below cutoff in one or more areas Score is 2 standard deviations or more below average Refer for further assessment Rescreen if not eligible for EI or ECSE Parent Concern Respond to all concerns Refer if necessary Handout (optional): "Referral Decision Matrix" ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

ASQ-3 "Bell Curve" 60 (Not to Scale) Number of children -1SD -2SD
Scores (in points) on ASQ 60 ASQ-3 "Bell Curve" (Not to Scale) 32% 52.2% 15.8% -1SD -2SD This is what the ASQ-3 "bell curve" looks like although this graph is not to scale. As you can see, there is no right hand side of the graph. That’s because the best a child can perform on the ASQ is right at average (or 60 points). We did not test higher skills to determine if a child was above average. In addition, note that the percentages of children that score within each category of the bell curve are quite different from a standard bell curve. The percentages on this graph represent the averages of all children in our normative sample, on all intervals, all domains that fell into the following categories: 52.2% of the normative sample scored from 60 points to -1 SD (in the well above cutoff area). 32% of the normative sample scored in the Monitoring Zone (between -1 SD and -2 SD below the mean or average) in one area (or more). 15.8% of our normative sample scored at or below 2 SD in one area (or more) of the ASQ-3. This information is important to know when interpreting ASQ results. While one area with a low score is reason to refer a child, it is important to look at referral considerations closely (such as opportunity) when interpreting results. It is also important to look at the degree to which the ASQ score is below cutoff. 15.8% is a fairly high percentage of children who score below the cutoff in at least one area. However, this is a screening tool. Once results are quickly debriefed with parents, it becomes very apparent that some of these one area low children are there because of lack of opportunity to try activities (especially in areas such as fine motor/personal social). Opportunity has to be considered prior to referring children, especially if they are only falling below cutoff in one area. It is not shown on this graph, but good to know that only 5.8% of the normative sample scored at or below 2 SD in two areas (or more) on the ASQ-3. When a child scores at or below in 2 or more areas, or is significantly below cutoff in any area, it is quite unusual. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Communicating Screening Results
Review the purpose of screening Avoid terms such as "test,” "pass," or "fail" (use "below/above cutoff," "in monitoring zone") Review ASQ-3 and explain area scores Offer ideas for next steps including: activities resources referral for further evaluation Support family in decision making process Discussion: What is the primary reason for administering ASQ? For most programs the goal is to help identify children that might be at risk for developmental delay and to help parents take the next steps toward a potential referral for EI/ESCE. It is important that the parents decide what the next steps might be that seem appropriate for their child and family. Our job is to offer options and provide support and guidance. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Communicating Screening Results
Prepare for the meeting carefully Make notes about behaviors Note information you need to gather from family (health history, etc.) Role-play conversation with a peer Select a private, comfortable place Consider cultural or language issues Know your community resources Be calm—remember, you are there to help the family take the next steps… Possible Activity: Role-Play If your audience has not had much experience with screening or assessment, it is very important to discuss how the results of screening will be shared with families. Often times people don’t realize how difficult this process may be for families when their child falls below cutoff scores or when concerns arise. Roles that could be assigned include the parent, the "professional" who is responsible for explaining and discussing follow-up options or referral possibilities, other family members, a childcare provider, etc. Having a completed ASQ (one that indicates potential concerns) helps provide a framework for role playing. Possible questions may be: How is the family feeling about the child’s development at this point in time? Do they have concerns? What are the next steps they would like to take, and how can the provider support them? Make sure to build from child and family strengths and explore concerns in areas where there are low scores. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Parent Report: Research
Dinnebeil & Rule (1994) reviewed 23 studies and reported high reliability in parents’ report Area specific studies supporting parent report: Cognitive (Glascoe, 1999) Communication (Ring & Fenson, 2000) ADHD and school-related problems (Mulhern, 1994) Gross Motor (Bodnarchuk & Eaton, 2004) Purpose of slide: to present evidence for validity of parent report. Bodnarchuk, J.L. & Eaton, W.O. (2004). Can parent reports be trusted? Validity of daily checklists of gross motor milestone attainment. Applied Developmental Psychology, 25, Diamond, Karen E; le Furgy, William G. Screening for developmental handicaps: Outcomes from an early childhood screening program. [Journal; Peer-Reviewed Status-Unknown] Physical & Occupational Therapy in Pediatrics. Vol 8(1) 1988, Dinnebeil, L.A. & Rule, S. (1994). Congruence between parents' and professionals' judgments about the development of young children with disabilities: A review of the literature. Topics in Early Childhood Special Education. 14(1),1-25. Glascoe, F.P. (1999). Using parents’ concerns to detect and address developmental and behavioral problems. J Soc Pediatr Nurs Jan-Mar;4(1):24-35. Mulhern, Serena; Dworkin, Paul H; Bernstein, Bruce. Do parental concerns predict a diagnosis of attention-deficit hyperactivity disorder? [Journal; Peer Reviewed Journal] Journal of Developmental & Behavioral Pediatrics. Vol 15(5) Oct 1994, Ring, E.D. & Fenson, L. (2000) The correspondence between parent report and child performance for receptive and expressive vocabulary beyond infancy. First Language, 20 (59) ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Discrepancies between Parent and Professional Report
Professional underestimation: Professionals may underestimate a child’s performance Type of task: Higher parent/professional agreement reported for easily observed behaviors Emerging Skills: Parents have a larger sample of behaviors and may report the child’s emerging skills that are not observed by professionals (ceiling items) Context: Different contexts elicit different behaviors (home, testing situations, school) These discrepancies inspired the design of ASQ. On the first page of every questionnaire are: ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Parental Characteristics that May Affect Accuracy of Parent Report
Low literacy Cultural and language differences Impaired mental functioning Mental health issues Involvement with child protective agencies This doesn’t necessarily mean not to use parent-completed tools with parents who have these characteristics, it means that the method for completing the questionnaires (e.g., mail-out, home visit) and referral decisions need to take into account these characteristics. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Cross-Cultural Considerations in Assessment and Intervention
ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

U.S. Demographics 115.8 million identify as minority race or ethnicity (2012, Esri) 52.8 million Hispanics 39.5 million African Americans 15.2 million Asians/Native Americans/Pacific Islanders By 2050, whites no longer in the majority 40% of children under 5 will be Hispanic ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Recommendations for Practitioners
Develop cultural awareness Consider families’ pre- and post-immigration experiences Use cultural brokers and interpreters during process Ask families about cultural expectations of early development Clarify language and meaning of each item Reframe questions Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice, CUP Partnership, Alberta, Canada Handout: "Comfort Levels with Parenting Practices" Activity: Have participants complete independently, then compare with another participant or in small groups. Have participants discuss different viewpoints. This activity is a good example of coming to some personal awareness about feelings participants have, and how they may differ from person to person or across different cultural groups. This can be an interesting exercise to have participants examine their preconceived view of what behaviors are socially appropriate, what parenting practices are appropriate, and what interventions are appropriate, and how our personal "culture" impacts those views. ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Incorporate non-standardized methods into the screening process Interpret screening results with caution and integrate relevant cultural data Debrief the results with the family and together determine the most appropriate follow-up to screening results Throughout the process, validate the family’s cultural belief system Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice, CUP Partnership, Alberta, Canada ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Culturally sensitive questions to gather information from family members when concerns or problems arise: Is there a problem? Why is there a problem? What do you think has caused the problem? What can be done? What types of interventions would be appropriate? Who can help? Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice, CUP Partnership, Alberta, Canada ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Selected Translations/Adaptations of ASQ-3 and/or ASQ:SE
Aboriginal Australian Afrikaans Arabic Bengali Bulgarian Changana Chinese (Simplified) Chuukese Czech Danish Dutch Finnish French Galician Georgian Greek Hmong Hungarian Italian Japanese Kinyarwanda Korean Marshallese Norwegian Portuguese (Brazil) Portuguese (Portugal) Russian Somali Swahili Swedish Tagalog Thai Turkish Ukrainian Urdu Vietnamese Instruct participants to form small groups and together discuss Andrew’s ASQ-3. Participants should generate ideas and questions regarding: Further information they would like to have regarding Andrew and Vicky Ideas for possible activities that can be done in a home environment as well as potential referral sources available in their community Debrief the activity focusing on: Communication Fine Motor and Problem Solving See: "16-Month ASQ Scoring Exercise for Andrew" in Trainer’s Materials For more information about translations, visit ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

Features of ASQ-3 that Allow for Cultural Sensitivity
2/1/2019 Features of ASQ-3 that Allow for Cultural Sensitivity Flexible administration Ability to reframe questions if needed to emphasize “intent” Ability to omit items Adaptations in multiple languages Allows for multiple caregiver completion Strength based Addresses family concerns Observations are made familiar settings with familiar adults ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, Elizabeth Twombly, and LaWanda Potter Copyright © 2014 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

An Introduction to ASQ-3™

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