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Assessment Rating:
A
A – Psychometrics Well-Demonstrated
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Ages & Stages Questionnaires®, Third Edition (ASQ-3™)

Developer(s):

Jane Squires, PhD and Diane Bricker, PhD

Description / Purpose:

ASQ-3 screens and assesses the developmental performance of children in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. It is used to identify children that would benefit from in-depth evaluation for developmental delays.

The ASQ-3 is a series of 21 parent-completed questionnaires designed to screen the developmental performance of children in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. The age-appropriate questionnaire is completed by the parent or caregiver.

Target Population: Children between the ages of 1 month and 66 months; there are different versions for different age groups.

Time to Administer: Approximately 10-15 minutes

Completed By: Parents and caregivers

Modalities Available: Paper and pencil, online

Scoring Information: Scoring sheets included. Computer scoring available.

Languages Available: English, French, Spanish — the rating for the measure is based solely on the English version of the measure.

Training Requirements for Intended Users: There is no minimum degree or license requirement to administer the scale.

Availability: The questionnaire is available for a fee at the ASQ's website.

Contact Information

Company: Brookes Publishing Co.
Website: agesandstages.com
Email:
Phone: (800) 638-3775
Fax: (410) 337-8539

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of "A – Psychometrics Well-Demonstrated" based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.

Show relevant research...

Squires, J., Bricker, D., & Potter, L. (1997). Revision of a parent-completed developmental screening tool: Ages and Stages Questionnaire. Journal of Pediatric Psychology, 22(3), 313-328.

Sample:

Participants — 2008 children, including a sample with medical or environmental risk factors and a normative sample

Race/Ethnicity — Not Specified

Summary:

Parents completed the ASQ beginning at a child's age of 4 months. The majority completed only one questionnaire, but some completed between 6 and 8 questionnaires, at 4-month intervals. Medical risk factors included respiratory distress, pre-maturity, and low birth weight. Environmental risk factors included poverty, low maternal age and education level, and involvement with child protective services (CPS). Reliability was measured by internal consistency. Test-retest and inter-rater reliabilities were computed for subsets of parents. Reliabilities for the ASQ were consistently high. Concurrent validity was assessed by comparing the child's ASQ with his or her classification on the Revised Gesell and Armatruda Developmental and Neurologic Examination, the Bayley Scales of Infant Development and, for children over 3 years, the Stanford-Binet Intelligence Test. The ASQ showed an overall 88% percent agreement with standardized assessments. A subset of children with disabilities showed 96% agreement with standardized assessments. The validity assessment was limited by a small sample of children with disabilities.

Squires, J. K., Potter, L., Bricker, D. D., & Lamorey, S. (1998). Parent-completed developmental questionnaires: Effectiveness with low and middle income parents. Early Childhood Research Quarterly, 13(2), 345-354.

Sample:

Participants — 96 parent-infant pairs recruited through birth announcements, public clinics, public housing projects, teen parent programs, and migrant worker sites in Oregon.

Race/Ethnicity — Caucasian, 63%, African American, 10%, Hispanic 11%, Native American, 5%, and 3% other.

Summary:

Parents completed the ASQ at home at up to eight 4-month intervals, beginning when the child was 4 months old. To assess concurrent validity, at 12, 24, and 30 months children were also given a standardized assessment using the Bayley Scales of Infant Development. Parents were divided into low and middle income groups. For low income parents the agreement between the completed ASQ and the standardized assessment ranged from 80-91%, and the agreement for middle income parents was 85-93%. This study was limited by a high attrition rate, leading to small numbers of parents completing multiple questionnaires.

Skellern, C. Y., Rogers, Y., & O'Callaghan, M. J. (2001). A parent-completed developmental questionnaire: Follow-up of ex-premature infants. Journal of Paediatrics and Child Health, 37, 125-129.

Sample:

Participants — 167 children who had been pre-mature infants recruited from a hospital in Brisbane, Australia.

Race/Ethnicity — Not Specified

Summary:

Study children were followed up using the ASQ at 12, 18, 24, or 48 months. Children were also assessed during a clinic visit using a set of standardized tests including subscales of the Griffith Mental Development Scales, the Bayley Scales of Infant Development and the Neuro-Sensorimotor Development Assessment. Results indicate a negative predictive value of 98% and a positive predictive value of 40%, indicating a high likelihood that children who pass the ASQ are developing normally, although with some likelihood that normal children would be referred for further evaluation. Results were conflicting for some children with subtle neurological impairments. The authors suggest that the ASQ can be used as one component of programs to assess later development delay in children who were premature.

Elbers, J., McNab, A., McLeod, E., & Gagnon, F. (2008). The Ages and Stages Questionnaires: feasibility of use as a screening tool for children in Canada. Canadian Journal of Rural Medicine, 13(1), 9-14.

Sample:

Participants — 43 children assessed following open-heart surgery and 68 children from a community health center.

Race/Ethnicity — Not Specified

Summary:

Questionnaires were sent to families before the children's 4-, 8-, 12-, 16-, 20-, 24-, 30-, and 36-month birthdays. At the end of the third year, 25 children remained in the cardiac group and 59 in the community group. The ability to detect developmental delay in the cardiac group was 75%. That is, of 4 children identified as delayed by the ASQ, 3 were also identified by a specialist. No children with specialist-identified delays were reported to have been missed by the ASQ in the community sample. In this sample 7 children were identified with possible delays and 1 of those was also identified by a specialist. The authors note that this sample was from a relatively affluent community, and so those most likely to benefit from early intervention were not included.

Hornman, J., Kerstjens, J. M., de Winter, A. F., Bos, A. F., & Reijneveld, S. A. (2013). Validity and internal consistency of the Ages and Stages Questionnaire 60-month version and the effect of three scoring methods. Early human development, 89(12), 1011-1015.

Sample:

Participants — 1457 [1063 preterm-born children (36 weeks gestational age) and 394 term-born children (38–42 weeks gestational age)]

Race/Ethnicity — Not Specified

Summary:

Parents received a questionnaire including the ASQ-60 (second edition) and questions on socio-demographic background, school type, and birth characteristics approximately 8 weeks before the child's fifth birthday (first, we sent the ASQ 8–10 weeks before their child's fifth birthday, but because of a more rapid completion by parents than expected, we changed the time of sending to 2–6 weeks before their birthday later in the study). Our psychometric evaluation of the ASQ-60 revealed that its internal consistency and validity were good. Out of the three available scoring methods, the ‘ASQ total score’ had the best psychometric performance, but the ‘ASQ domain score’ could be the most useful if a higher sensitivity is preferred.

Veldhuizen, S., Clinton, J., Rodriguez, C., Wade, T. J., & Cairney, J. (2014). Concurrent Validity of the Ages and Stages Questionnaires and Bayley Developmental Scales in a General Population Sample. Academic pediatrics.

Sample:

Participants — 587

Race/Ethnicity — Not Specified

Summary:

This study evaluated the agreement between the most popular such instrument, the Ages and Stages Questionnaires (ASQ) and the third edition of the Bayley Scales of Infant Development (BSID-III). Participants were a community sample of children aged 1 month to 36 months who received both the ASQ and the BSID-III. Sensitivity, specificity, and positive and negative predictive values were calculated. BSID-III prevalence was 2.9% (95% confidence interval [CI] 1.7–4.6) with published norms and 7.7% (95% CI 5.6–10.1) with distribution-based thresholds, while 18.2% (95% CI 15.2–21.6) of children were positive on the ASQ. For published BSID-III norms, sensitivity was 41% (95% CI 18–67) and specificity 82% (95% CI 79–85). Results with distribution-based thresholds were essentially identical. Performance was somewhat better among children over 1 year (sensitivity 50%, specificity 87%). For subscales, sensitivities were generally lower (range 0–50%) and specificities higher (range 92–96%). In the general population sample, agreement between the ASQ and BSID-III fell short of the levels recommended for screening. In particular, sensitivity was consistently low, with more than half of cases missed. Although specificity was much better, the false-positive rate remained fairly high, with 5 false-positive findings for every true case. Agreement for individual domains was also poor to fair. Previous studies have reported somewhat better agreement.

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. BMC pediatrics, 14(1), 23.

Sample:

Participants — 587

Race/Ethnicity — 100% Native American (Mohawk)

Summary:

The purpose of this study was to assess the relevance and usefulness of the ASQ for the parents of Mohawk children and to collect the data needed to validate the tool within this context. Participants who completed the questionnaires include 17 teachers, along with the parents of 282 children (130 girls and 152 boys) between the ages of 9 and 66 months who attend the Child and Family Center Mohawk Territory, Quebec. Concurrent validity, the percentage of agreement between classifications (e.g., “delayed” or “typically developing”) according to results from the ASQ and other standardized assessments, ranged from 76% for the 4-month ASQ to 91% for the 36-month ASQ. Sensitivity (i.e., the ability of the ASQ to correctly identify children experiencing delays) ranged from 51% for the 4-month ASQ to 90% for the 36-month ASQ. Overall sensitivity was 76%. Specificity (i.e., the ability of the ASQ to correctly identify typically developing children) ranged from 81% for the 16-month ASQ to 92% for the 36-month ASQ, with an overall specificity rate of 86%. Preliminary results of the present study indicate that the ASQ is an appropriate tool for the Mohawk community.

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.

Sample:

Participants — 306

Race/Ethnicity — Not Specified

Summary:

This study assessed the concurrent validity of the parent-completed developmental screening measure Ages and Stages Questionnaires, Third Edition (ASQ-3) compared with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) in children born term, late preterm, or extremely preterm at 8, 18, or 30 months of corrected gestational ages (CGA). Data were collected from term and preterm children ages 8, 18, and 30 months’ CGA recruited from an ambulatory well child clinic in Santiago, Chile. Parents completed the ASQ-3 in their homes, and afterward a trained professional administered the Bayley-III in a clinic setting. On the ASQ-3, the presence of any domain screened, 2 SDs below the mean area score was considered a positive screen (indicating failure or delay). A Bayley-III score less than <1 SD indicated mild or severe delay. ASQ-3 showed adequate psychometric properties (75% sensitivity and 81% specificity) and modest agreement with the Bayley-III (r = 0.56). Sensitivity, specificity, and correlations between measures improved with testing age and in children who were born extremely preterm.

San Antonio, M. C., Fenick, A. M., Shabanova, V., Leventhal, J. M., & Weitzman, C. C. (2014). Developmental Screening Using the Ages and Stages Questionnaire: Standardized Versus Real-World Conditions. Infants & Young Children, 27(2), 111-119.

Sample:

Participants — 131

Race/Ethnicity — 72 Hispanics, 46 African Americans, 3 White, 4 Other

Summary:

We examined the reproducibility of the Ages and Stages Questionnaire (ASQ), a developmental screening instrument commonly used in pediatric practices, under standardized versus nonstandardized conditions in an underserved population. English- or Spanish-speaking parents of 18- or 30-month-old children completed the ASQ in the waiting room and then were randomized to repeat the ASQ in waiting room (W-W) or standardized (W-S). Results indicate that no statistically significant difference in the reliability of the ASQ was found when it was completed under different conditions (waiting room and standardized settings) by parents and guardians of 18- and 30-month-old children. Second, the reliability of the ASQ was very high in all settings, and the percentage of children who failed was not affected by the setting in which the screen was completed.

Date Reviewed: February 2015 (Originally reviewed in June 2009)