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Rehab Measures: Ages and Stages Questionnaires-Third Edition

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Link to Instrument 

Title of Assessment

Ages and Stages Questionnaires-Third Edition 

Acronym

ASQ-3

Instrument Reviewer(s)

Aliza Rothstein, OTR/L, University of Illinois at Chicago

Summary Date

11/10/2016 

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.

Description

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."  

Area of Assessment

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

Body Part

Not Applicable 

ICF Domain

Body Structure; Body Function; Activity; Participation; Environment 

Domain

Cognition; Emotion; Motor; Sensory 

Assessment Type

Observer 

Length of Test

06 to 30 Minutes 

Time to Administer

There are a total of 21 questionnaires; each questionnaire is expected to take 15-20 minutes to complete. Importantly, each questionnaire is specific to a particular age range. Accordingly, only one questionnaire would be used at any given time for a single child.

Number of Items

30 items per questionnaire. 

Equipment Required

A starter kit is available for purchase from the test publisher; this kit includes a variety of stimuli that can be useful for completing the assessment, including:
  • 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, use manual/booklet, and itemized kit list.

Training Required

No formal training is required; however, training through DVD & manual is available.

Type of training required

Reading an Article/Manual 

Cost

Not Free 

Actual Cost

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

Age Range

Infant: birth-23 months; Preschool Child: 2-5 years 

Administration Mode

Paper/Pencil 

Diagnosis

 

Populations Tested

Pediatric Populations: Children ages 2 - 60 months.

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

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%)

Construct Validity (Convergent/Discriminant)

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).

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

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)

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.

 

Year published

2009 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 11/10/2016 5:26 PM  by Jason Raad 
Last modified at 11/10/2016 6:05 PM  by Jason Raad