As a parent you naturally want your child to thrive! Understanding their developmental milestones is key for setting them up to reach their full potential.
The Ages and Stages Questionnaires are among the many tools that can help you assess and track your young child's development, but how do they work and what makes them stand out from other assessment tools?
This article will discuss the two types of Ages and Stages Questionnaires, describe how they are administered and scored, and assess their usefulness and reliability.
In this article:
ASQ Calculator: Selecting the right questionnaire
This article is a part of a series where we cover the different types of developmental care and how you as a parent can help your child flourish.
Assessing children's development
There are numerous ways to track and measure a child's development that are useful in different contexts:
These methods of assessing development focus on whether or not a child has achieved certain developmental milestones--tasks or skills that most children can do by a certain age. Tracking milestones is a way of monitoring a child's development and making sure that they are progressing neurotypically.
This article will focus on developmental screening, in particular the Ages and Stages Questionnaires (ASQ).
Developmental screening
Developmental screening is a formal assessment of a child's strengths and areas of concern at a very specific point in time.
A developmental screener does not provide a diagnosis--its purpose is identifying children who should receive additional evaluation for any developmental delays or developmental disorders.
One of the 3 developmental screening tools that the American Academy of Pediatrics (AAP) recommends for general developmental screening is the ASQ, the focus of this article.
Screening with the Ages and Stages Questionnaires
What are the Ages and Stages Questionnaires?
The ASQ includes 2 separate screening tools:
The Ages and Stages Questionnaire, Third Edition (ASQ-3), which covers 5 areas of child development
The Ages and Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2), which covers only social-emotional development
ASQ Online
The ASQs are available online from Brookes Publishing for parents to complete independently. Healthcare providers may also administer the screener via a paper copy at well-child visits.
ASQ Calculator: Selecting the right questionnaire
Each screening tool consists of a number of questionnaires specific to a child's age.
To find the right questionnaire for their child, parents and caregivers should use the ASQ Age Calculator, which factors in birth date and premature birth.
Adjusting for prematurity ensures that a child is screened based on their correct developmental age.
1. The ASQ-3
What the ASQ-3 covers
The ASQ-3 is a series of 21 individual age-specific questionnaires for children aged 1 to 66 months (5 and 1/2 years) that cover 5 important areas of child development:
1. Communication: A child's acquisition of communication skills, namely receptive language skills (listening and understanding others), expressive language skills (communicating ideas to others), and speech (articulating words that can be understood by others)
2. Gross motor skills: How a child uses the large muscles in the body, such as those in the arms, legs, and torso for activities such as sitting, crawling, and walking
3. Fine motor skills: A child's ability to move and coordinate the small muscles in the hands and fingers
4. Problem Solving: How a child plays with toys and solves problems, including making decisions and thinking creatively
5. Personal-Social: A child's developing relationships with others as well as their ability to take care of personal tasks such as feeding themselves or using the toilet independently
Each area of development has 6 questions per questionnaire.
Completing the ASQ-3
The questionnaires ask whether a child does or does not do a certain task or skill. The parent selects "Yes," "Sometimes," or "Not yet."
Sample questions from the 16-month ASQ-3:
Does your child say 8 or more words in addition to “Mama” and “Dada”? (Communication)
Does your child move around by walking, rather than crawling on her hands and knees? (Gross motor)
Does your child stack 3 small blocks or toys on top of each other by herself? (Fine motor)
After you scribble back and forth on paper with a crayon (or pencil or pen), does your child copy you by scribbling? (If she already scribbles on her own, mark “yes” for this item.) (Problem solving)
Does your child help undress herself by taking off clothes like socks, hat, shoes, or mittens? (Personal-social)
At the end is an additional "Overall" section that asks more general questions, provides an area for parent comments, and flags issues for follow-up discussions with a healthcare provider.
The ASQ-3 questionnaires generally take parents approximately 10 to 15 minutes to complete.
Scoring the ASQ-3
Scoring the ASQ-3 is a simple process that takes only 2-3 minutes. The healthcare provider scores--or the ASQ online version automatically scores--the parents' responses by assigning points as follows:
0 points for “never”
5 points for “sometimes”
10 points for “always”
For each of the 5 developmental categories, the scorer adds up the points and compares the total number to a cutoff score for that category.
Depending on the total score, the child will fall into one of the following zones:
The scorer can check off any recommended follow-up actions. They then discuss the results with the parent and share their recommendations.
If you take the ASQ online independently, you should share the results with your healthcare provider so they can provide feedback and suggest any necessary follow-up.
2. The ASQ:SE-2
What the ASQ:SE-2 covers
The ASQ:SE-2 consists of 9 age-specific questionnaires intended for children aged 1 to 72 months (6 years) that cover 7 elements of social-emotional development:
1. Self-regulation: A child's ability to calm themselves or adjust their own behavior in response to their environment
2. Compliance: A child's ability to follow rules and directions
3. Adaptive functioning: A child's ability to successfully deal with their physical needs, such as sleeping and eating
4. Autonomy: A child's growing independence
5. Affect: A child's ability to demonstrate their feelings and feel empathy for others
6. Social communication: A child's ability to communicate with others verbally or nonverbally to express their thoughts, feelings, and needs
7. Interaction with people: A child's ability to interact with family members, peers, and others
Completing the ASQ:SE-2
The questionnaires ask whether a child engages in certain types of behavior. The parent selects "Often or always," "Sometimes," or "Rarely or never" and can also indicate if a specific question is a concern.
Sample questions from the 24-month ASQ:SE-2:
Does your child laugh or smile when you play with her?
When upset, can your child calm down within 15 minutes?
At the end is an additional "Overall" section that asks background questions about family history and elicits parent concerns, provides an area for parent comments, and flags issues for follow-up discussions with a healthcare provider.
Just like the ASQ-3, the ASQ:SE-2 questionnaires generally take parents approximately 10 to 15 minutes to complete.
Scoring the ASQ:SE-2
Scoring the ASQ:SE-2 also takes about 2-3 minutes. The healthcare provider scores--or the ASQ online version automatically scores--the parents' responses by assigning 0, 5, or 10 points to each response based on a scoring key.
The scorer then adds up the points and compares the total number to the cutoff score of 65 and suggests follow-up as follows:
As with the ASQ-3, the scorer discusses the results and any recommendations for follow-up with the parent. If you take the ASQ online independently, you should share all scoring sheets with your healthcare provider so they can provide feedback and suggest any necessary follow-up.
Validity and reliability of the ASQ
The ASQ-3 and ASQ:SE-3 both have high validity and reliability, making them excellent screening tools for developmental concerns.
Validity refers to how well a test measures what it's supposed to measure--in this case, it means that the questions asked are actually an accurate measure of child development. The validity of the ASQ-3 is 0.82 to 0.88 and the validity of the ASQ:SE-2 is 0.84.
Test-retest reliability refers to the ability of a test to produce the same results when taken multiple times, meaning that the results are consistent and can be trusted. The test-retest reliability of the ASQ-3 is 0.91 and the reliability of the ASQ:SE-2 is 0.89.
The ASQ versus other screening tools
Advantages
The main strength of the ASQ is its ease of use. It is quick to complete, can be done by parents in their own home, and is a relatively low-cost screening tool.
Another advantage is that the ASQ highlights results that fall in a “monitoring zone,” which helps to keep track of children who may be at risk of developmental delay but do not yet require intervention. It helps to ensure that these children do not fall through the cracks, but continue to receive regular monitoring.
Disadvantages
Social and emotional screening is more important than ever, especially with the recent rise in autism diagnoses and increased focus on mental health in the wake of the Covid-19 pandemic.
One major downside to the ASQ is that it separates social-emotional screening into a separate screener that many providers do not use in conjunction with the ASQ-3, thus missing an important opportunity to screen for mental health concerns.
Moreover, the ASQ-3 takes a less holistic approach to child development than certain other screening tools, which ask about other factors--such as reading to a child, postpartum depression, and alcohol abuse in the home--that can also significantly impact development.
The role of developmental screening tools
Studies have shown that developmental screeners can provide valuable information to healthcare professionals and help in identifying infants and young children with developmental concerns as soon as possible.
However, they should not be the only type of developmental monitoring or be relied upon to provide definitive recommendations for early intervention.
Instead, screening questionnaires should be considered only one element in a larger system of care. Healthcare providers, parents, and other caregivers should also be continuously monitoring your child’s development to make sure that they stay on track.
This will allow your child to receive any relevant diagnosis if there is a delay, begin intervention services as early as possible, and help them lead their best life!
If you'd like guidance and a simple way to stay informed about your child's development, visit Pathfinder Health! You can take developmental screening tests online and have the results evaluated by our team of child development experts.
Frequently Asked Questions
1. What is the ASQ-3 questionnaire?
The ASQ-3 is a developmental screening questionnaire for children from birth to 66 months (5 and 1/2 years). It looks at development in five different areas and makes recommendations for monitoring or specialist referrals if needed.
2. What is the difference between ASQ and ASQ:SE?
The ASQ-3 measures progress in a child’s development of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. The ASQ:SE-2 focuses only on social-emotional development.
3. Is the ASQ free?
There is usually a fee for ASQ screening at physician’s offices. However, numerous organizations, such as Easterseals and state and local Children & Family services offer the screening test for free.
4. How long does it take to complete the ASQ?
Both the ASQ-3 and the ASQ:SE-2 take about 10 to 15 minutes to complete. It takes 2-3 minutes for a healthcare provider to score the screener. If you take the online version, it’s scored automatically within moments.
5. How many ASQ questionnaires are there?
The ASQ-3 screener, which covers 5 developmental areas, includes 21 questionnaires for children between 1 and 66 months. The ASQ:SE-2, which covers social-emotional development, includes 9 questionnaires for 1 to 72 months.
6. What do ASQ scores mean?
Each of the 5 developmental areas of the ASQ-3 is scored separately. The total for each is compared to a unique cutoff score that determines whether a child is low or no risk, in the monitoring zone, or below the cutoff and should be referred for further evaluation.
7. What is a normal ASQ score?
There is no “normal” score. Each of the five developmental areas of the ASQ-3 has a unique cutoff score between 0 and 60. Higher scores are indicative of lower risk for developmental delays or conditions.
8. How often should the ASQ-3 be administered?
At a minimum, the AAP recommends that every child be screened at 9, 18, and 30 months, although the ASQ provides forms for more frequent screening if there are any concerns. A child should be rescreened after 2-3 months if the ASQ flags a possible delay.
The Takeaway
Regular developmental screening can help identify any delays or areas of concern so you can get your child the help they need for their continued development. It's an important part of the continuous developmental monitoring that helps them flourish.
So if you or your healthcare provider haven’t already been screening your child’s development, check out the ASQ or another screening tool as soon as possible!
Sources:
Brain Plasticity and Behaviour in the Developing Brain. Bryan Kolb, PhD and Robbin Gibb, PhD. J Can Acad Child Adolesc Psychiatry. 2011 Nov; 20(4): 265–276.
Comparative Accuracy of Developmental Screening Questionnaires. R. Christopher Sheldrick, PhD, Susan Marakovitz, PhD, Daryl Garfinkel, Alice S. Carter, PhD, and Ellen C. Perrin, MD. JAMA Pediatr. 2020 Apr; 174(4): 366–374.
Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. Ashley H. Hirai, PhD, Michael D. Kogan, PhD, Veni Kandasamy, MSPH, Colleen Reuland, MS, and Christina Bethell, PhD. JAMA Pediatr. 2018 Sep; 172(9): 857–866.
