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ASK JANE 
A: (From ASQ developer Jane Squires and ASQ researcher Jantina Clifford): While the ASQ and ASQ:SE have been translated into many different languages, research on using the tools in other countries has only been published for some of these translations. Currently, the ASQ is commercially available in 4 languages (English, Spanish, French, and Korean), and the ASQ:SE is available in 3 languages (English, Spanish, and Norwegian). Research that has been conducted examining the use of translated versions of the ASQ and ASQ:SE in other countries suggests that most questionnaire items do not exhibit significant differences in average scores. In fact, data collected in Norway, using a Norwegian translation of the ASQ, was so similar to U.S. data that for a time the Norwegian data set was used to help establish cut-offs for newer questionnaire intervals in the U.S. for which little data were available. This being said, using a translated version of the ASQ or ASQ:SE with a population culturally different from the U.S. should always be approached with caution. Current studies that have been conducted with commercially available translations of the ASQ and ASQ:SE have been mostly done in developed countries, where it is quite likely that children’s caregiving environments offer many of the same opportunities as in the U.S., and developmental expectations for young children are also likely similar. When using an adapted version of the ASQ or ASQ:SE in the context of a developing country or with rural populations, it is important to closely examine results when concerns are detected, looking closely to see if low scores on the ASQ may be due to lack of exposure or opportunity to the skill or materials. In addition, items may be misinterpreted if there is ambiguity or misrepresentation in the translation. For many languages there may be different dialects, such that translated items may be misinterpreted across dialects. In addition, as previously mentioned, cultural practices and expectations may vary. Most often differences in cultural practices will be found in the personal-social domain in the ASQ, which includes a combination of adaptive (self-help) and social skills, both of which are highly influenced by caregiver expectation. For example, in Vietnam, children may not be encouraged to dress or feed themselves until much older than many American children such that two or more questions in the personal-social domain that addressed dressing or eating might cause a low score, which would likely be due to lack of opportunity as opposed to developmental delay. Ideally, item functioning and mean scores would be examined for each adaptation of the ASQ and ASQ:SE and its intended population. Currently, we are just finishing experimental versions of Vietnamese and Chinese translations of the ASQ-3 and are looking for sites in the U.S. and Vietnam where large populations of Vietnamese-speaking and Chinese-speaking families are served to pilot test our adaptations. We are interested in learning more about a) the quality of the translation, b) the appropriateness of skills and suggested materials for the Vietnamese and Chinese cultures, and c) if there are large differences in developmental expectations that might warrant separate cut-offs for use with Vietnamese and Chinese children, especially in Vietnam and China. If your program is interested in participating in the pilot studies of the Vietnamese and Chinese translations of ASQ-3, please contact Kimberly Murphy at kamurphy@uoregon.edu. If you are interested in learning more about the process we used in adapting the ASQ into Vietnamese or Chinese, please consult the ASQ-3 User's Guide where we have provided recommendations for the adaptation process. We are very interested in pursuing our examination of the Vietnamese and Chinese translations, and look forward to continuing this process with other languages and cultures as the need arises.
A: We are currently conducting research on the reliability of the ASQ-3 and ASQ:SE related to early detection of autism. Developmental pediatrician Robert Nickel, M.D., has conducted two pilot studies related to ASQ and autism detection, each with about 100 children, and has found over 95% agreement between the ASQ classification (i.e., typical, risk) and children with DSM-IV diagnoses of autism. That is, he has found that children who were brought to a developmental clinic for suspected ASD and who failed the ASQ (most often in the communication and personal-social domains) were identified as having ASD on clinical tests and assessments. Because this is a clinical population with suspected developmental problems, however, the agreement with the ASQ is inflated. We hear from many programs around the United States that are using the ASQ:SE for autism screening and feel that it works very well together with an interview with parents. Some programs that use the ASQ-3 choose to follow up with the M-CHAT for children that score in the risk range, particularly in the communication and personal social-domains. We hope to have more empirical data about the use of ASQ-3 and ASQ:SE and autism detection by the end of 2010. Q: How were the developmental items chosen for inclusion in ASQ-3? Why is each developmental item important? A: Each ASQ-3 questionnaire includes 30 questions that are divided into five areas of development (communication, gross motor, fine motor, problem solving, and personal-social). Each item addresses important developmental milestones, targets behavior appropriate for the developmental quotient range of 75-100 for each age interval, and addresses behavior that is easy for parents to observe. These items were developed by examining the content of developmentally based, norm-referenced tests and resources, such as Q: There is overlap between the age administration windows for the 9 Month ASQ-3 and 10 Month ASQ-3 questionnaires. The new 9 Month questionnaire has an age administration window of 9 months, 0 days through 9 months, 30 days, while the 10 Month questionnaire has an age administration window of 9 months 0 days through 10 months 30 days. Which questionnaire should my program use to screen children between 9 months, 0 days and 9 months, 30 days? A: We developed the new 9 Month ASQ-3 questionnaire for use by medical practitioners who are conducting developmental screening at 9-month well-child visits, as recommended by the American Academy of Pediatrics. With the previous edition of ASQ, pediatricians found it difficult to switch between administering the 8 Month and 10 Month questionnaires depending on the child’s age. The developmental skill items and overall questions are identical on the 9 and 10 Month ASQ-3 questionnaires; the difference between the two questionnaires is in the cutoff scores for each age interval. If your program screens children along a continuum, as opposed to a one-time screening, I would recommend using the 10 Month ASQ-3 questionnaire for children ages 9 months, 0 days through 9 months, 30 days as we currently have more data collected on the 10 Month interval. Q: As our program moves toward a Response to Intervention/Recognition and Response model with our infant through 5 year olds, we would like to use ASQ-3 as a tool for progress monitoring, as well as a screener for possible disabilities. Is ASQ currently being used as a progress monitoring tool? Does doing so violate any of the statistical properties of the instrument? A: ASQ was developed and has been validated as a developmental screening tool. ASQ-3 reliably and accurately identifies children with delays that should receive in-depth assessment. The developers recognize that programs are interested in using ASQ for other purposes, such as eligibility determination, goal development, and progress monitoring. We suggest that programs follow the recommended practices issued by professional organizations in the field and use tools and other measures that have been specifically developed for assessment or progress monitoring. We do not recommend using ASQ-3, or other screening tools, for assessment or progress monitoring purposes until research has been conducted that demonstrates the validity of ASQ for those purposes. However, we recognize that programs are limited by expertise, time, and cost. Using ASQ-3 for assessment or progress monitoring purposes is superior to using a measure that lacks adequate psychometric data or conducting no assessment or progress monitoring at all. If you choose to use ASQ-3 for purposes other than developmental screening, we advise you to qualify the outcome or results by noting the use of ASQ and how the choice may potentially affect the outcomes. For more detail on using ASQ for purposes other than developmental screening, please read Developmental Screening Measures: Stretching the Use of the ASQ for Other Assessment Purposes in the January/March 2010 issue of Infants & Young Children. Q: Why was ASQ, 2nd edition, revised? Why should I purchase ASQ-3™ rather than continuing to use the 2nd edition? A: Since the publication of the second edition of ASQ in 1999, there has been widespread use of ASQ by a variety of education, health, and social services programs. Over the past ten years, many of these programs have shared their questionnaire results with us, and we amassed a large amount of data across all age intervals from a variety of families and children in diverse settings. Knowing that this information would be helpful in improving the generalizability of ASQ results, we used data from more than 18,000 completed questionnaires to restandardize the cutoff scores for ASQ-3™. We believe ASQ-3™ results will be more accurate for a variety of populations, resulting in less overreferral and underreferral. We also received lots of constructive feedback about administration and scoring from thousands of ASQ users, which we’ve incorporated into the new edition. We recommend that programs screening children for developmental delays purchase the new ASQ-3™. In addition to improved reliability based on the new cutoff scores, the third edition includes two new questionnaires: the 2 Month questionnaire, which lets programs screen infants as young as 1 month, and the 9 Month questionnaire, which meets the American Academy of Pediatrics guideline to screen children at 9 months. The new edition also allows for anytime screening—the administration age ranges for each questionnaire have been widened to accommodate screening of children between 1 month and 66 months of age. We added a monitoring zone to the scoring results for ASQ-3™, which assists programs by highlighting children’s skills that are not below the cutoff scores but may need close attention and monitoring. Item revisions and new overall questions have also been added to each questionnaire, making the questionnaires easier for parents to understand and asking about important skills such as behavioral concerns. The translation for ASQ-3™ in Spanish was revised and reviewed by a panel of Spanish-speaking experts, ensuring that the questionnaires are clear for Spanish-speaking parents. Another benefit of ASQ-3™ is its compatibility with the new online management and questionnaire completion system. Programs can now manage all of their ASQ screening results and follow up electronically, and they can choose to allow parents to complete questionnaires online. Q: A new monitoring zone has been added to ASQ-3™. How should my program use the monitoring zone? A: The scoring summary sheet for ASQ-3™ now includes a monitoring zone, which represents a range of scores that are at least 1 but less than 2 standard deviations below children’s mean performance in each developmental area. This monitoring zone helps programs identify a child’s skills that are not below the cutoff but may need close attention and monitoring. When a child’s score falls in the monitoring zone, your program has several options. Your program may decide to schedule a follow-up screening for the child, perhaps in 3 months. Your program may also choose to send ASQ learning activities to the child’s parents to encourage practice of skills in a certain developmental area. ASQ learning activities are provided in the ASQ-3™ User’s Guide and in the separate book Ages & Stages Learning Activities. Your program also has the option of referring children with scores that fall in the monitoring zone, based on parent and caregiver concerns. We encourage programs to use the monitoring zone in the way that works best for them. Submit your question for ASQ developer Jane Squires! Dr. Squires will regularly answer selected questions, drawing from her up-to-date wisdom from the field and the latest research. About Jane: Jane Squires, Ph.D., is Professor and Director, Center on Human Development/University Center for Excellence in Developmental Disabilities and the Early Intervention Program, University of Oregon, Eugene. Dr. Squires has directed several research studies on the Ages & Stages Questionnaires® and Ages & Stages Questionnaires®: Social-Emotional and has also directed national outreach training activities related to developmental screening and the involvement of parents in the monitoring of their child’s development. |
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Q: We are conducting research about maternal health and infant health and development in a low-income, rural commune in Viet Nam. Have the ASQ-3 or ASQ:SE have been used in a developing country context, such as Viet Nam? What are your views about the use of the tools in these contexts?