Ages and Stages Questionnaires

Last Updated

November 10, 2016

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Purpose

The ASQ-3 is system of 21 age-specific developmental screening questionnaires designed to assess the following areas of child development: 1) gross motor, 2) fine motor, 3) communication, 4) problem solving, and 5) personal-social.

Link to Instrument

Instrument Details

Acronym ASQ-3

Area of Assessment

Behavior
Cognition
Communication
Coordination
Developmental
Dexterity
Infant & Child Development
Personality
Social Relationships

Assessment Type

Observer

Cost

Not Free

Actual Cost

$295.00

Cost Description

ASQ-3 Starter Kit: $275; User’s Guide: $50; Questionnaires: $225; Materials Kit: $295

Diagnosis/Conditions

Pediatric + Adolescent Rehabilitation

Pediatric Disorders

The ASQ-3 is a screening tool used to identify children who may be at risk for developmental delays and with children who are developing typically.
Age intervals include: 2 , 4, 6, 8, 9, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60.
Instructions for each questionnaire are included with each individual form. Respondents, who can be either parents or caregivers, are asked to consider a range of questions regarding the child's ability to perform a range of developmentally-appropriate tasks.
Scores calculated by summing individual item responses for each domain:
Yes = 10
Sometimes = 5
Not Yet = 0
Item level scores range from "typical development," "need for monitoring," to need for further assessment."

Number of Items

Baby bottle
Large ball
Small ball
Beads
Wordless picture book
Storybook with pictures
Small blocks
Bowl
Coloring book
Crayons
Cup
Child-sized fork
Multiple jars
Mirror
Puzzle
Child-safe scissors
Shoelace
Child-sized spoon
Stuffed doll
Keys on a ring
Toys
Storage container
Manual/booklet
Itemized kit list

20 minutes

Each questionnaire is expected to take 15-20 minutes to complete.

Required Training

Reading an Article/Manual

Pediatric Populations

0 - 2

years

Preschool Child

2 - 5

years

Instrument Reviewers

Reviewed by Aliza Rothstein, OTR/L, University of Illinois at Chicago.

ICF Domain

Body Structure
Body Function
Activity
Participation
Environment

Measurement Domain

Cognition
Emotion
Motor
Sensory

Professional Association Recommendation

While the American Academy of Pediatrics (AAP) recommends developmental screening at Well Child visits when indicated, the use of the ASQ-3 tool is not endorsed by the AAP.

Considerations

The ASQ-3 is available from the publisher in English and Spanish. Previous versions of the tool are also available in French and Korean from the publisher.
The ASQ-3 has been translated, culturally validated, and published in many languages, including but not limited to:

- Spanish, Arabic, Persian, French, Korean, Chinese, Portuguese, Hindi, Dutch, Thai, Norwegian, Turkish, and Afrikaans.

The ASQ-3 has been used in many countries and cultural groups, including but not limited to:

- Chile, Brazil, Canada, Lebanon, Spain, United Kingdom, United States, Colombia, Australia, Aboriginal communities, and Canadian Nation/Mohawk communities.

Take care to note client’s cultural background to determine appropriateness of screening tool

Validity was decreased from original validation in US with translation when translated for use in another country (Rubio-Codina et al, 2016)

Cut-Off Scores

Developmental Delay (Squires, Twombly, Bricker, & Potter, 2011; n = 579)

Total scores of 75 or less on a given questionnaire indicates risk for developmental delay.

Normative Data

Typically Developing and Developmental Coordination Disorder (King-Dowling, Rodriquez, Missiuna, & Cairney, 2015; 159 children between ages 43 and 65 months)

Developmental Coordination Disorder Risk (Combined 42, 48, 54 and 60 month questionnaires)

ASQ Motor Total Score: (Mean= 95.5, SD= 16.2)
ASQ Gross Motor Score: (Mean= 49.5, SD= 11.5)
ASQ Fine Motor Score:(Mean= 46.1, SD= 11.3)

Typically Developing Children (Combined 42, 48, 54 and 60 month questionnaires)

ASQ Motor Total Score: (Mean= 106.7, SD= 14.7)
ASQ Gross Motor Score: (Mean= 55.4, SD= 7.8)
ASQ Fine Motor Score: (Mean= 51.3, SD= 10.4)

Test/Retest Reliability

Developmental Delay Rubio-Codina et al, 2016; n = 1522; ASQ-3 n = 770)

Problem Solving - Excellent: (ICC= .80)
Communication - Excellent: (ICC= .92)
Fine Motor - Poor: (ICC= .37)
Gross Motor - Excellent: (ICC= .90)
Personal-Social - Excellent: (ICC= .73)

(Squires, Twombly, Bricker, & Potter, 2011; n = 145)

Excellent, with domains ranging from - (ICC=.75-.82)

Interrater/Intrarater Reliability

Developmental Delay

Excellent: (ICC=.93) (Marks & LaRosa, 2012)
Adequate: (ICC=.43-.69) (Squires, Twombly, Bricker, & Potter, 2011; n = 107)

Internal Consistency

Developmental Delay (Squires, Twombly, Bricker, & Potter, 2011; n = 18,572)

Poor to Excellent internal consistency: (Cronbach’s alpha range between .51 and .87) for 20 age intervals from 2 months to 60 months in 5 developmental domains.

Criterion Validity (Predictive/Concurrent)

Developmental Delay (Squires, Twombly, Bricker, & Potter, 2011; n= 579)

Concurrent Validity

The ASQ-3 was determined to have lower concurrent validity when compared to other developmental screening tools when used with children less than 30 months of age (Rubio-Codina et al, 2016).

High Specificity: 85.6%
High Sensitivity 86.1%

Predictive Validity

Marks & LaRosa, 2012

High Specificity: 77.9-91.3%
High Sensitivity: 82.5-89.2%

Developmental Delays: (Halle et al, 2011)

High Specificity: (85.7%) for identifying children not at risk for developmental delay between 27-36 months.
High Sensitivity (85.9%) identifying children at risk for developmental delay between 27-36 months.
High Specificity (92.1%) for identifying children not at risk for developmental delay between 42-60 months.
High Sensitivity (82.5%) identifying children at risk for developmental delay between 42-60 months.

Schoenhaut et al., 2013; n= 306

High Specificity: 81% at 8, 18, and 30 months
Moderate Sensitivity: 75% at 8, 18, and 30 months
Low PPV: 47%
Low NPV: 9%

Developmental Coordination Disorder

Predictive Validity

King-Dowling, Rodriguea, Missiuna, & Cairney, 2015; n = 163

High Specificity: (89-96%) in motor scales for identifying children ages 3.5-5.5 years without DCD.
Low Sensitivity: (21-47%) in motor scales for identifying children ages 3.5-5.5 years with DCD.
Low PPV: (36%)
High NPV (93%)

Content Validity

Both parents and clinicians were consulted during the development of the ASQ-3.

Face Validity

Not statistically assessed, however it was determined that using a standardized screening tool, such as the ASQ-3, over physician surveillance, increased the probability of identifying developmental delays in children at 9, 18, and 24 month Well Child visits (Thomas et al, 2012).

Not statistically assessed, however it was determined that the ASQ-3 has increased in clinical use by physicians from 2002 to 2009 (Radecki et al, 2011).

Bibliography

Alotaibi, N., Reed, K., & Nadar, M. (2009). Assessments used in occupational therapy practice: An exploratory study. Occupational Therapy in Health Care, 23(4), 302-317.

American Academy of Pediatrics. (2006). Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics, 118(1), 405-420.

Armijo, I., Schonhaut, L., & Cordero, M. (2015). Validation of the Chilean version of the Ages and Stages Questionnaire (ASQ-CL) in Community Health Settings. Early Human Development, 91, 671-676.

Charafeddine, L., Sinno, D., Ammous, F., Yassin, W., Al-Shaar, L., & Mikati, M. A. (2013). Ages and Stages Questionnaires: Adaptation to an Arabic speaking population and cultural sensitivity. European Journal of Paediatric Neurology, 17(5), 471-478.

Demestre, X., Schonhaut, L., Morillas, J., Martínez-Nadal, S., Vila, C., Raspall, F., & Sala, P. (2016). Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires. Anales De Pediatría (English Edition), 84(1), 39-45.

Dionne, C., McKinnon, S., Squires, J., & Clifford, J. (2014). Developmental screening in a Canadian First Nation (Mohawk): Psychometric properties and adaptations of ages & stages questionnaires (2nd edition). BMC Pediatrics,14(23), 1-8.

El-Behadil, A., Neger, E., Perrin, E., Sheldrick, R. (2015). Translations of developmental screening instruments: An evidence map of available research. Journal of Developmental of Behavioral Pediatrics, 36(6), 471-483.

Halle, T., Zaslow, M., Wessel, J., Moodie S., & Darling-Churchill, K. (2011) Understanding and choosing assessments and developmental screeners for young children: profiles of selected measures. Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC.

King-Dowling, S., Rodriguez, M. C., Missiuna, C., & Cairney, J. (2015). Validity of the Ages and Stages Questionnaire to detect risk of Developmental Coordination Disorder in preschoolers. Child: Care, Health and Development, 42(2), 188-194.

Lopes, S., Graça, P., Teixeira, S., Serrano, A., & Squires, J. (2015). Psychometric properties and validation of Portuguese version of Ages & Stages Questionnaires (3rd edition): 9, 18 and 30 Questionnaires. Early Human Development, 527-533.

Marks, K. P., & Larosa, A. C. (2012). Understanding Developmental-Behavioral Screening Measures. Pediatrics in Review, 33(10), 448-458.

Radecki, L., Sand-Loud, N., O'Connor, K., & Olson, L. (2011). Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood: 2002-2009. Pediatrics, 128(1).

Ringwalt, S. (2008). Developmental screening and assessment instruments. The National Early Childhood Technical Assistance Center.

Rubio-Codina, M., Araujo, M., Attanasio, O., Muñoz, P., & Grantham-McGregor, S. (2016). Concurrent validity and feasibility of short tests currently used to measure early childhood development in large scale studies. PLoS ONE,11(8).

Schonhaut, L., Armijo, I., Schönstedt, M., Alvarez, J., & Cordero, M. (2013). Validity of the Ages and Stages Questionnaires in Term and Preterm Infants. Pediatrics, 131(5), E1468-E1474.

Squires, J., Twombly, E., Bricker, D., & Potter, L. (2009). Ages and Stages Questionnaires: Third Edition. Baltimore, MD: Paul H. Brookes Publishing.

Thomas, S. A., Cotton, W., Pan, X., & Ratliff-Schaub, K. (2011). Comparison of Systematic Developmental Surveillance With Standardized Developmental Screening in Primary Care. Clinical Pediatrics, 51(2), 154-159.

Veldhuizen, S., Clinton, J., Rodriguez, C., Wade, T. J., & Cairney, J. (2015). Concurrent Validity of the Ages and Stages Questionnaires and Bayley Developmental Scales in a General Population Sample. Academic Pediatrics, 15(2), 231-237.