An Introduction to Ages & Stages Questionnaires®: Social Emotional (ASQ:SE): A Parent-Completed,...

An Introduction to Ages & Stages Questionnaires®: Social Emotional

(ASQ:SE): A Parent-Completed, Child-Monitoring System

for Social-Emotional Behaviors

Presenter: Teri Pinto, Dept. Mental Presenter: Teri Pinto, Dept. Mental Health,Health,

Office of Children’s ServicesOffice of Children’s Services

Alabama Assuring Better Child Health and Alabama Assuring Better Child Health and

Development Screening InitiativeDevelopment Screening Initiative

[email protected]@mh.alabama.gov

205-941-9904205-941-9904

Objectives

Define and discuss the benefits of developmental screening.

Describe features of the ASQ:SE.

Score the ASQ:SE.

Describe ASQ:SE cutoff scores.

Interpret ASQ:SE 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 © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.

http://www.agesandstages.com/




What is the ASQ:SE?

Parent- or caregiver-completed screening tool that encourages parental/caregiver involvement

Series of questionnaires for children ages 3 months to 5 ½ years

Tool to accurately identify children at risk for social-emotional delay






Kristine Dorman

I think it might help to elaborate on the last point of the "Ask participants..." part of the notes. What about new moms, cultural differences, "goodness of fit" issues, etc.? Perhaps you could make each of these a separate point.

Efficacy

Test Sensitivity: 71-85%

(Need further evaluation for delay)

Specificity: 90-98%

(Probably do not have a delay)

ASQ:SE Addresses Seven Areas






Behavioral areas

Definition

Self-regulation Ability/willingness to calm, settle, or adjust to physiological or environmental conditions

Compliance Ability/willingness to conform to the direction of others and follow rules

Communication Verbal/nonverbal signals that indicate feelings, affect, internal states

Adaptive Ability/success in coping with physiological needs

Autonomy Ability/willingness to establish independence

Affect Ability/willingness to demonstrate feelings and empathy for other

Interactions with people

Ability/willingness to respond to or initiate social responses with caregivers, adults, and peers


Kristine Dorman

Ed: Again, I'm missing the source file for this table and am unable to edit electronically. Please check with author to see whether she has file. Thanks.

ASQ:SE MaterialsPublished by Paul H. Brookes Publishing Co. http://www.brookespublishing.com http://www.agesandstages.com 1-800-638-3775

Materials include The ASQ:SE User’s Guide and ASQ:SE Questionnaires (box

set or CD) ASQ:SE in Practice videotape

Available in English and SpanishCase studies, questionnaires, and a technical report about the ASQ:SE are available on the publisher’s web site.






Types of Assessment

Screening assessment

Diagnostic assessment

Curriculum-based (programmatic, ongoing) assessment






Screening Assessment

A brief assessment—similar in theory to health screenings such as a quick hearing or vision screen—designed to identify children who should receive more intensive diagnosis or evaluation from local Early Intervention (EI), Early Childhood Special Education (ECSE), health, and/or mental health agencies.






Kristine Dorman

Because this presentation is only about the ASQ:SE, do you want to include the list of examples of developmental screening assessments? Thanks.

Kristine Dorman

Please provide references for all of the tests and assessments listed. Thanks.

Diagnostic (Professional) Assessment

An in-depth assessment of one or more developmental areas to determine the nature and extent of a physical or developmental problem and determine whether the child is eligible for services (e.g., EI).






Kristine Dorman

Please provide references for the tests and assessments you've listed. Also, do you want to include the examples of developmental diagnostic assessments since this presentation is only about the ASQ:SE? Thanks.

Curriculum-Based (Programmatic, Ongoing) Assessment

An in-depth assessment that helps to determine a child’s current level of functioning. This type of assessment can Provide a useful child profile Help with program planning Identify targeted goals and objectives Be used to evaluate a child’s progress over time






Kristine Dorman

Please provide references for the various tests and assessments listed in the instructor notes. Also, since this presentation is about the ASQ:SE, do you want to include the examples of developmental curriculum-based assessments? Thanks.

Monitoring

Developmental surveillance (screening at frequent intervals) of at-risk infants and toddlers not known to be eligible for special health or educational services; similar in theory to a person with diabetes monitoring his or her blood sugar






Kristine Dorman

I wonder whether you should provide a different example of monitoring (second paragraph of instructor notes). The example provided seems like it might be more applicable to the ASQ than the ASQ:SE. Thanks.

Screening

Not near cutoffsBeyond cutoffs

Eligible for services

Near cutoffs

Professional

assessment

Not eligible for services

Continue to monitor (rescreen) and use curriculum-based

assessment to develop learning plans






Kristine Dorman

Again, much of this slide is really geared to the ASQ, not the ASQ:SE. Should we change instances of "ASQ" to "ASQ:SE"? Thanks.

Incidence of Children Identified as Having a Disability by Age

Infants: 2.4%

Preschool-age: 5.8%

School-age: 11.6%

Source: http://www.ideadata.org, 2005.


Why Screen Social-Emotional Behaviors?

Social-Emotional Research

Links exist between earliest emotional development and later social behavior (Cicchetti & Cohen, 1995a, 1995b; Reynolds et al., 2001).

Behaviors, even in infancy, signal the need for intervention (Shonkoff & Phillips, 2000).

Links exist between early risk factors, poor outcomes, and violence (Conroy & Brown, 2004).

By third grade, programs for children with antisocial behavior are mostly ineffective (Greenberg et al., 2003; Walker, 2004).






Kristine Dorman

Please provide a reference for Shonkoff & Phillips, 2000. Thanks.

Kristine Dorman

Ed: I'm missing the source file for this slide, too. Please change "0 to 12 months" to "0–12 months." Thanks.

Developmental-Organizational Framework

Source: Cicchetti, 1993ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.

Age Stage of development Behaviors 0Š12 months Attachment Regulation

Recognizable states Attachment Communication

12Š30 months Autonomy and self-development

Differentiates between self and others, real and make-believe Use of pronouns - Exploration Self-control; rules

30 monthsŠ7 years Establishing peer relations Empathy Gender differences Identification of friends Interest in other children

Kristine Dorman

Ed: Please obtain source file from author, then change "12 to 30 Months" to 12–30 Months." Thanks.

Kristine Dorman

Ed: Please obtain source file from author. Thanks.

Activity

What is the intent of the questions on the ASQ:SE?






Behavioral areas

Definition

Self-regulation Ability/willingness to calm, settle, or adjust to physiological or environmental conditions

Compliance Ability/willingness to conform to the direction of others and follow rules

Communication Verbal/nonverbal signals that indicate feelings, affect, internal states

Adaptive Ability/success in coping with physiological needs

Autonomy Ability/willingness to establish independence

Affect Ability/willingness to demonstrate feelings and empathy for other

Interactions with people

Ability/willingness to respond to or initiate social responses with caregivers, adults, and peers






Kristine Dorman

Ed: Again, I'm missing the source file for this table and am unable to edit electronically. Please check with author to see whether she has file. Thanks.

ASQ:SE Features

Features of the ASQ:SE

6-, 12-, 18-, 24-, 30,- 36-, 48-, and 60-month intervals

Between 19 (6-month) and 33 (60-month) scored

questions on each questionnaire

3- to 6-month administration window on either side of

interval age

No need to use CDOB or adjusted age for children born

prematurely






Features of ASQ:SEQuestionnaires are written at a fourth- to fifth-grade reading level.

Each questionnaire includes open-ended questions related to eating, sleeping, and toileting.

All intervals include the question, “Is there anything that worries you about your baby (child)? If so, please explain.”

Each interval also includes the question, “What things do you enjoy most about your baby (child)?”






Kristine Dorman

This bulleted point originally was just "What things do you enjoy most about your baby (child)?" Please confirm that each interval asks this question as I've rephrased. Thanks.

Features of the ASQ:SE

Competence and problem behaviors are targeted.Externalizing and internalizing behaviors are targeted.

Scoring Options Points Most of the time 0 or 10 Sometimes 5 Never or hardly ever 0 or 10 Is this a concern? Yes = 5

High scores falling above empirically derived cutoff points are indicative of problems.






ASQ:SE Score Information (N=2861)

Interval Range Median Cutoff

6-month 0–115 16.7 45

12-month 0–145 25.0 48

18-month 0–255 26.0 50

24-month 0–220 28.4 50

30-month 0–300 35.2 57

36-month 0–220 35.0 59

48-month 0–280 36.0 70

60-month 0–275 35.0 70






ASQ:SE

Case Study

Introducing the ASQ:SE to Parents

“This questionnaire asks questions about your child’s social-emotional growth. Your answers will help me determine what type of information I may be able to gather for you.”

“Some of the questions are not very specific; just answer based on your feelings or opinions about your child’s behavior.”






Introducing the ASQ:SE to Parents

• Review response options: Most of the time: Child is performing behavior

most of the time or too often. Sometimes: Child is performing behavior

occasionally but not consistently. Rarely or never: Child is not performing or

rarely performs the behavior.

• Discuss the “concerns” option.






Kristine Dorman

Please fix the level 1 bullets. For some reason, I'm unable to find the bullet that's used in the rest of the presentation. Thanks.

Administering the ASQ:SE

Have parents complete the questionnaires as independently as possible.

Some questions on the ASQ:SE, such as those regarding eating problems (for all intervals) and perseverative behaviors (for children 18 months and older) may require clarification.


Scoring the ASQ:SE

Determine a child’s total score:# of questions with X ___ x 10 = ____# of questions with V ___ x 5 = ____# of concerns ___ x 5 = ____

Total points on each page = ____

Transfer points on each page to the ASQ:SE Information Summary.


ASQ:SE Omitted Item(s)Try to obtain answers from the family.It is okay to omit up to 2 items for the 6- to 18-month questionnaires and up to 3 items for the 24-month and over questionnaires.See The ASQ:SE User’s Guide for additional guidance.

Calculation:

Step 1: Divide the total score by the number of questions answered on the ASQ:SE. For example, 105 total points/30 questions = 3.5 points.

Step 2: Add this number, which is the average score for items on this questionnaire, to the total score to get a new total score. For example, 105 + 3.5 = new total score of 108.5 points.


Kristine Dorman

Are the instructor notes correct given that this slide is about the ASQ:SE and not the ASQ? The example of "mirror items" seems like it might be more of a developmental skill than a social-emotional one. Please check. Thanks.

Kristine Dorman

Please confirm that this formula works when more than one question is omitted. Actually, I think Step 1 is fine, but should Step 2 be "Add the average score for items on this questionnaire multiplied by the number of omitted questions to the total score to get a new total score."

Review Questionnaires with Parent(s)

Discuss the child’s strengths, and reinforce positive parent–child interactions.

Discuss items that individually score 10 or 15 points.

Discuss answers to open-ended questions.

Review the child’s score, and compare it to the cutoffs. Remember that cutoffs on the ASQ:SE are very different

from those on the ASQ!

Discuss referral considerations.


Referral Considerations

Time/setting factorsDevelopmental factorsHealth factorsCulture/family factors


Interpreting ScoresThe “sometimes” issue

The subjectivity issue

Validity of report Teen parents Parents involved in protective services First-time parents/isolated parents Parents actively involved with drugs and alcohol Parents with mental illness


Questionable Scores

Have another caregiver complete the ASQ:SE.

Gather additional information:Observe the child.Use a professionally administered screening tool.Assess parent–child interactions.Assess the caregiving environment.


Possible Follow-up

Below cutoff: Provide ASQ:SE activities and monitor the

child.

Close to cutoff: Follow up on concerns. Provide information, education, and support. Re-administer the ASQ:SE. Make referrals as appropriate.


Possible Follow-up

Above cutoff: Refer to EI/ECSE. Refer to local community agencies:

Feeding clinic Church groups Community groups, YMCA, Birth to Three Parenting groups Early Head Start

Refer to primary health care provider. Refer for mental health evaluation.


Communicating Screening Results

Assure the family that the discussion is confidential.

Review the purpose of screening.

Avoid terms such as test, pass, or fail. (instead, use below cutoff or near cutoff)

Review the ASQ:SE and explain area scores.

Emphasize child and family strengths.

Provide specific examples of concerns.

Invite parents to share their observations and/or concerns.


Communicating Screening Results*Prepare for the meeting carefully: Make notes about behaviors. Note information you need to gather (e.g., health

history) from the family. Role-play the conversation with a peer. Select a private, comfortable place to meet. Consider cultural or language issues. Know your community resources. Be calm!

* Source: Hilton/Early Head Start Training Program, Sonoma State University


Kristine Dorman

Ed: Where should this attribution line be? Here? Up top? Please check. Thanks.

Infant Mental Health InterventionsDeborah Weatherston

Wayne State University, Merrill-Palmer Institute

1. Concrete service assessment or assistance2. Emotional support3. Developmental guidance4. Early developing relationship support5. Infant–parent psychotherapy**6. Advocacy

**Requires a trained mental health professional


Kristine Dorman

Ed: Is this where an attribution line should go on a PowerPoint slide, or should it be in the instructor notes or at the bottom of the slide?

The ASQ:SE User’s Guide

Excellent resource

Includes information on scoring and interpreting scores

Provides activities and case studies

Covers all topics in depth


SummaryScreening tools can help bridge communication with families.

Screening tools can assist in making referrals to community agencies.

Referrals should be based on a variety of considerations in addition to scores.

Social-emotional issues are very complicated.

Use available resources to make decisions about what steps to take after screening.ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.

Jane Squires, Ph.D.,Jantina Clifford, Ph.D., orLiz Twombly, M.S.University of Oregon541-346-0807http://eip.uoregon.edu

For more information, please contact:

Kristine Dorman

This final slide varies a bit from presentation to presentation. Should they all be consistent? If yes, please decide which format you'd like to keep. Thanks.

An Introduction to Ages & Stages Questionnaires®: Social Emotional (ASQ:SE): A Parent-Completed,...

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