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Ages and Stages Questionaires
(ASQ)

*********

Diane Bricker, Jane Squires, Linda Mounts, LaWanda Potter,
Robert Nickel, Elizabeth Twombly and Jane Farrell

1999

Table of Contents

An Introduction to
Using the ASQ System

In this box is a series of 19 Ages & Stages Questionnaires (ASQ), which were developed to assist with the monitoring and identification of children with developmental delays from 4 months to 5 years of age. The Ages & Stages Questionnaires, Second Edition, are designed to screen young children for developmental delays—that is, to identify those children who are in need of further evaluation and those who appear to be developing typically. The ASQ system represents a novel approach to screening because the questionnaires are designed to be completed by the parents or caregivers of young children, rather than by trained professionals. (For more information about the development and developers of the ASQ system, see The ASQ User’s Guide, Second Edition.)

The ASQ USER’S Guide

The ASQ User’s Guide is a companion to these questionnaires and contains necessary information for using the entire ASQ monitoring system. Procedures for planning a monitoring program, using and scoring the questionnaires, making referrals, and evaluating the monitoring program throughout implementation are included in the User’s Guide. A number of useful sample letters and forms are provided—in both English and Spanish—in the User’s Guide, which also chronicles the development of the ASQ products since 1979. The User’s Guide includes suggested intervention activities for distribution to families, as well as a compilation of the data and analyses conducted on the questionnaires. In particular, validity, sensitivity, specificity, and overreferral and underreferral rates are addressed. An optional component, The Ages & Stages Questionnaires on a Home Visit, is a videotape that describes using the questionnaires in the home environment with families. (Ordering information for the ASQ products is provided on pages iii and iv.)

The Questionnaires

The Ages & Stages Questionnaires, which are also available in Spanish, are color coded for easy reference. They are intended to be photocopied in the course of service provision to families. (Please see the Photocopying Release on page ii.) The questionnaires can be mailed to parents and completed in the home environment, completed with the assistance of a nurse or social worker on a home visit or during a telephone interview, completed by parents at a medical clinic prior to a well-child checkup, or completed by a child’s regular caregiver at a child care center.

Each questionnaire in this box has a title page with an area containing a shaded drawing of a mother and child. A program logo or agency contact information may be placed in this shaded area so that it will appear on all duplicated questionnaires. If the questionnaires are to be used in mail-back format, the address of the program should be typed or stamped on the mail-back sheet, which is also included in this box, for easy return by parents.

Each questionnaire contains 30 questions, grouped by developmental area, about a child’s everyday activities. To promote readability and parental identification with the forms, questionnaire items are worded with alternating male and female pronouns; where possible, small illustrations are provided with the questionnaire items.

Anyone who spends time with a child on a regular basis, such as parents, caregivers, foster parents, grandparents, aunts, and uncles, is qualified to answer the questionnaire items. If parents or caregivers are not sure whether a child can do a particular activity described in a questionnaire item, they should try that activity with the child before answering the question. Household items and toys such as blocks, pencils, paper, and small jars may be needed for the child to demonstrate some of the targeted skills. A list of materials needed for completion of each questionnaire can be found in Appendix E of the User’s Guide. Parents can take a few minutes observing the child and trying activities before answering all of the questions.

Because a screening tool is brief, mistakes will occur; children will be referred for further assessment who do not have delays, and children with delays will not be identified as needing further assessment. Thus, results from the ASQ will not identify which children have delays and which ones do not. Rather, the results will suggest which children should be referred for further evaluation and which ones appear to be developing typically. Because serial or sequential monitoring has been shown to be more effective than one-time screenings, completing the questionnaires at regular intervals as a child develops may prove to be more effective and cost efficient than one-time screening programs conducted by professionals. In addition, the Ages & Stages Questionnaires involve parents as screeners of their young child’s development and may enhance parents’ knowledge of their child’s developmental status while involving them as partners in the assessment process.

No one questionnaire or screening tool will be culturally appropriate for all children and families. Modifications may need to be made, such as translating certain phrases into a native language and substituting items with ones the parents may have at home (e.g., using matzos for crackers and flat stones for blocks). Some items may have to be omitted altogether if they are unsuitable for a family.

If parents cannot read English or Spanish at a fourth- to sixth-grade level, someone can read the items aloud and help parents to complete the questionnaire. There are, however, some parents who may not answer the questionnaire accurately. Parents with limited cognitive abilities and those abusing alcohol or other drugs are examples of parents who may have difficulty. Other professionally administered screening tools, which are suggested in The ASQ User’s Guide, may be more appropriate for children in these families.

Scoring Procedures

The Information Summary Sheet is an optional page that can accompany each questionnaire or can be completed and maintained by programs as a record of the child’s performance on a questionnaire. Cutoff grids appear on each Information Summary Sheet that can easily be compared with the child’s performance at that age interval to determine whether the child should be referred for further evaluation. At the bottom of the page, for programs with digital scanning capabilities, ovals may be darkened so that scores can be automatically scanned into computer records.

The questionnaires are scored by converting each answer to a numerical equivalent and comparing the totals for each area (e.g., communication, fine motor) with the empirically derived cutoff points for that area. The responses—yes, sometimes, and not yet—are converted to points—10, 5, and 0, respectively. If a child’s score for any area is at or below the cutoff point, the child is recommended for a referral for further developmental evaluation. Again, more explanation of how to score the questionnaires and how to determine when to refer a child for further evaluation can be found in The ASQ User’s Guide.

A Message from the Authors

The Ages & Stages Questionnaires were designed to encourage screening of large numbers of children in an economical and efficient way. Our goal is to assist you in establishing a system that can identify children in need of intervention services in a timely and cost-effective manner. The first edition of the Ages & Stages Questionnaires was published in 1995. We have valued the input and enthusiastic feedback we have received from the hundreds of personnel who are using the questionnaires in screening, monitoring, and home visiting programs. This second edition of the Ages & Stages Questionnaires contains 8 additional questionnaire intervals at 10, 14, 22, 27, 33, 42, 54, and 60 months. The final questionnaire at 5 years (60 months) rounds out the program. These additional intervals should assist programs in continuous screening of young children in the infancy and preschool years from 4 months through 5 years of age. We hope that you will find these materials of use and that, ultimately, the developmental outcomes of young children and families will be improved.


36 month questionnaire

Communication
Be sure to try each activity with your child.

Yes

Sometimes

Not Yet

 

1. When you ask her to point to her nose, eyes, hair, feet, ears, and so forth, does your child correctly point to at least seven body parts? (She can point to parts of herself, you, or a doll.)

____

2. Does your child make sentences that are three or four words long?
Please give an example:

____

3. Without giving him help by pointing or using gestures, ask your child to "Put the shoe on the table" and "Put the book under the chair." Does your child carry out both of these directions correctly?

____

4. When looking at a picture book, does your child tell you what is happening or what action is taking place in the picture? (For example,"Barking," "Running," "Eating," and "Crying") You may ask, "What is the dog (or boy) doing?"

____

5. Show your child how a zipper on a coat moves up and down, and say, "See, this goes up and down." Put the zipper to the middle and ask your child to move the zipper down. Return the zipper to the middle and ask your child to move the zipper up. Do this several times, placing the zipper in the middle before asking your child to move it up or down. Does your child consistently move the zipper up when you say "up" and down when you say "down"?

____

6. When you ask, "What is your name?" does your child say both her first and last names?

____

COMMUNICATION TOTAL

____

 

GROSS MOTOR    
Be sure to try each activity with your child.

Yes

Sometimes

Not Yet

 

1.  While on his back, does your baby move his head from side to side?

____

2.  After holding her head up while on her tummy, does your baby lay her head back down on the floor, rather than let it drop or fall forward?

____

3.  When he is on his tummy, does your baby hold his head up so that his chin is about 3 inches from the floor for at least 15 seconds?

____

4.  When she is on her tummy, does your baby hold her head straight up, looking around? (She can rest on her arms while doing this.)

____

5.  When you hold him in a sitting position, does your baby hold his head steady?

____

6.  While on her back, does your baby bring her hands together over her chest, touching her fingers?

____

GROSS MOTOR TOTAL

____

 
FINE MOTOR
Be sure to try each activity with your child.

Yes

Sometimes

Not Yet

 

1. Does your child put together a six-piece interlocking puzzle? (If one is not available, take a full-page picture from a magazine or catalog and cut it into six pieces. Does your child put it back together correctly?)

____

2. Using child-safe scissors, does your child cut a paper in half on a more or less straight line, making the blades go up and down? (Carefully watch your child’s use of scissors for safety reasons.)

____

3. Using the shapes below to look at, does your child copy at least three shapes onto a large piece of paper using a pencil or crayon, without tracing? Your child’s drawings should look similar to the design of the shapes below, but they may be different in size.

____

4. Does your child unbutton one or more buttons? Your child may use his own clothing or a doll’s clothing.

____

5. Does your child draw pictures of people that have at least three of the following features: head, eyes, nose, mouth, neck, hair, trunk, arms, hands, legs, or feet?

____

6. Does your child color mostly within the lines in a coloring book? Your child should not go more than 1/4 inch outside the lines on most of the picture.

____

FINE MOTOR TOTAL

____

 

PROBLEM SOLVING    
Be sure to try each activity with your child.

Yes

Sometimes

Not Yet

 

1. After she watches you draw a line from the top of the paper to the bottom with a crayon (or pencil or pen), does your child copy you by drawing a single line on the paper in any direction? (Scribbling back and forth does not count as "yes.")

____

2. Without showing him how, does your child purposefully turn a small, clear bottle upside down to dump out a crumb or Cheerio? (You can use a soda-pop bottle or baby bottle.)

____

3. Does your child pretend objects are something else? For example, does your child hold a cup to her ear, pretending it is a telephone? Does she put a box on her head, pretending it is a hat? Does she use a block or small toy to stir food?

____

4. Does your child put things away where they belong? For example, does he know his toys belong on the toy shelf, his blanket goes on his bed, and dishes go in the kitchen?

____

5. If your child wants something she cannot reach, does she find a chair or box to stand on to reach it?

____

6. While your child watches, line up four objects like blocks or cars in a row. Does your child copy or imitate you and line up four objects in a row? (You can also use spools of thread, small boxes, or other toys.)

____

PROBLEM SOLVING TOTAL

____

 

PERSONAL-SOCIAL   
 Be sure to try each activity with your child.

Yes

Sometimes

Not Yet

 

1. When you hold out your hand and ask for his toy, does your baby offer it to you even if he doesn’t let go of it? (If he already lets go of the toy into your hand, check "yes" for this item.)

____

2. When you dress her, does your baby push her arm through a sleeve once her arm is started in the hole of the sleeve?

____

3. When you hold out your hand and ask for his toy, does your baby let go of it into your hand?

____

4. When you dress her, does your baby lift her foot for her shoe, sock, or pant leg?

____

5. Does your baby roll or throw a ball back to you so that you can return it to him?

____

6. Does your baby play with a doll or stuffed animal by hugging it?

____

PERSONAL-SOCIAL TOTAL

____

 
OVERALL    
Parents and providers may use the space below or the back of this sheet for additional comments.
1.  Do you think your child hears well?
If no, explain:

Yes    

No  

2.  Do you think your child talks like other children her age?
If no, explain:

Yes    

No  

3.  Can you understand most of what your child says?
If no, explain:

Yes    

No  

4.  Do you think your child walks, runs, and climbs like other children his age?
If no, explain:

Yes    

No  

5.  Does either parent have a family history of childhood deafness or hearing impairment?
If yes, explain:

Yes    

No  

6.  Do you have any concerns about your child’s vision?
If yes, explain:

Yes    

No  

7.  Has your child had any medical problems in the last several months?
If yes, explain:

Yes    

No  

8.  Does anything about your child worry you?
If yes, explain:

Yes    

No  

 
 

 

48 Month/4 Year ASQ Information Summary

Child’s name:  
Person filling out the ASQ: 
Mailing address:  
Telephone: 
Today’s date:  
Date of birth: 
Relationship to child:  
City:  
State: 
Zip:  
Assisting in ASQ completion:  

 

OVERALL: Please transfer the answers in the Overall section of the questionnaire by circling "yes" or "no" and reporting any comments.

1.  Hears well?
Comments:

Yes    

No  

2.  Talks like other children?
Comments:

Yes    

No  

3.  Understand child?
Comments:

Yes    

No  

4.  Walks, runs, and climbs like others?
Comments:

Yes    

No  

5. Family history of hearing impairment?
Comments:

Yes    

No  

6.  Vision okay?
Comments:

Yes    

No  

7.  Recent medical problems?
Comments:

Yes    

No  

8.  Other concerns?
Comments:

Yes    

No  

 
 

SCORING THE QUESTIONNAIRE

  1. Be sure each item has been answered. If an item cannot be answered, refer to the ratio scoring procedure in The ASQ User’s Guide.
  2. Score each item on the questionnaire by writing the appropriate number on the line by each item answer.
    YES = 10
    SOMETIMES = 5
    NOT YET = 0
  3. Add up the item scores for each area, and record these totals in the space provided for area totals.
  4. Indicate the child’s total score for each area by filling in the appropriate circle on the chart below. For example, if the total score for the Communication area was 50, fill in the circle below 50 in the first row.

Examine the blackened circles for each area in the chart above.

5.  If the child’s total score falls within the     area, the child appears to be doing well in this area at this time.
6.  If the child’s total score falls within the     area, talk with a professional. The child may need further evaluation.

OPTIONAL: The specific answers to each item on the questionnaire can be recorded below on the summary chart.

Administering program or provider: ___________________________


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