Ages & Stages Questionnaires® (ASQ-3)
A Parent-Completed, Child-Monitoring System
Ages & Stages Questionnaires® is a registered trademark of Paul H. Brookes Publishing Co., Inc.

Training Objectives

Define and discuss the benefits of developmental screening

Describe features of the ASQ-3

Score the ASQ-3

Describe ASQ-3 cutoff scores

Interpret ASQ-3 information in relation to other referral considerations
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly
Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.
For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

What is the ASQ-3?

Parent- or caregiver-completed screening tool that encourage parental/caregiver involvement

Series of questionnaires for children ages 1 months to 5 ½ years

Tool to accurately identify children at risk for developmental delay
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly
Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.
For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

Domains Screened by the ASQ-3
ASQ-3 (screens 5 domains):

Communication

Gross motor

Fine motor

Problem solving

Personal-social
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly
Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved.
For more information about the ASQ and ASQ:SE, see http://www.agesandstages.com

21 Questionnaire intervals:

2, 4, 6, 8, 9, 10, 12, 14, 16, 18, 20, 22, 24

27, 30, 33, 36 (spaced 3 months apart)

42, 48, 54, 60 (spaced 6 months apart)


9 month vs. 10 month forms

9 month developed for pediatricians to use at 9 month check-up.

When screening 9 month old child use 10 month
ASQ-3 as it is more stringent.

•Administration window indicated on ASQ-3 cover page.
•16 month “ window ” is 15 months, 0 days to 16 months, 30 days.

Gathers information to choose correct ASQ-3 Interval.

Date ASQ Completed

Childs Date of Birth

Prematurity question (up to 24 months)

Calculate Age at administration or Adjusted age and compare with administration window.


5 developmental areas (e.g., Communication)

6 questions in each area

Questions are in hierarchical order

Questions #5 and #6 are average skills for children of that age interval

(i.e., a 12 month skill for a 12 month child).

Response options: Yes, Sometimes, Not Yet

Written at 4th to 5th grade reading level


Un-Scored Section

Looks at quality of skills (e.g., speech)

Example: “ Does your baby use both hand equally well?
”
 “ No ” response indicates possible medical diagnosis. Important to follow up.

Parent concerns very predictive.

Any concerns or questionable responses require follow-up


Each ASQ-3 interval has unique summary sheets.

Summary sheets have five sections:

Child/family information

Bar graph with cutoffs

Overall section

Follow-up action taken (new to ASQ-3)

Optional section: Individual item responses


Obtain consent.

Explain purpose of screening and review questionnaire content.

Schedule screening.

Select Correct ASQ-3 Interval.

If possible, provide parent with ASQ-3 prior to administration.

Assemble materials (if necessary).


Date ASQ Completed: October 14, 2008.

Child’s Name: Andrew

Child’s Date of Birth: April 30, 2007

Vicky (mother) filling out questionnaire.
What is Andrew ’ s actual Age at ASQ
Administration in months and days?

Date ASQ Completed: October 14, 2008.
Child’s Date of Birth: April 30, 2007
=
2008 10 (9)
2007 4 mo
1 year 5 mo
14 (+30) days
30 days
14 days
Andrew ’ s Age at administration is 17 months 14 days

Choosing the correct ASQ-3 when the child is premature.

Adjusted age:

Subtract weeks of prematurity from child’s age at administration to create an adjusted age.

Use adjusted age to choose appropriate
ASQ-3 interval.

Andrew was born 6 weeks premature.
What is Andrew ’ s Adjusted Age?
17 months 14 days – 6 weeks = 16 months
(Andrew’s Age at administration)
Andrew’s adjusted age is 16 months.
Andrew should receive the 16 month ASQ.


Yes = the child is performing the skill

Sometimes = the child is performing the skill on occasion, but not always

Not Yet = the child is not yet performing the skill

Step 1 : Review responses. If any missing items, try to obtain answers. If items inappropriate, omit item.
Step 2. Calculate area totals: “ yes ” = 10;
“ sometimes ” = 5; “ not yet ” = 0.
Step 3: If any items omitted, calculate new area total (example to follow).

Step 4: Review overall section responses. Ask for further clarification and make notes if needed.
Step 5: Transfer information to ASQ-3 Summary Page.

ASQ-3 Omitted item?
Create a new total area score so child is not penalized.
1) Divide total area score by the number of items answered in that area.
45 (area score)

5 (items) = 9 points.
2 ): Add this average item score to the total area score to get a new total score.
45 + 9 points = new total of 54 points


Values in the chart’s un-shaded areas = child appears to be developing typically

Values in the grey shaded areas (“Monitoring Zone”)
= child may need extra practice and experience in this domain, child’s progress should be monitored. (-
1.00-(-)1.99 SD below the mean)

Values within the charts black shaded areas = child should be referred for further evaluation. (-2 SD below the mean)

16 Month ASQ-3 Scoring Chart
Andrew, Case Study

Number of children
0
ASQ-3 “ Bell Curve ”
(Not to Scale)
Monitor
Zone
ASQ-3
Cutoff
15.8%
32%
-2SD -1SD
Scores (in points) on ASQ
52.2%
60

Follow-up &
Referral Criteria

Above monitor zone

Provide follow up activities & rescreen in 6-12 months.

All areas scored in white zone

Monitor zone

Score is between 1-2 SD below average. (1 area in grey zone)

Provide follow up activities to practice specific skills.

Rescreen in 6 months in areas of concern.

Make community referrals as appropriate.

Follow-up/Referral Criteria (cont.)
Below cutoff in one or more areas:
 Score is below 2 standard deviations below average. (2 or more areas in grey zone or 1 or more areas in black.)
 Refer for further assessment

Example of Follow-Up Actions
Andrew, Case Study


“The ASQ is a tool to check on your child’s development.”

“Your child will be able to do some of the items, but not all of the items.”

“Answers help show your child’s strengths and any areas where your child may need support or more practice”

ASQ-3 User’s Guide

Includes information on planning screening systems and procedures

Provide example letters, activities, and case studies

Contain technical reports

Cover all topics in depth