An Introduction to the Ages and Stages Questionnaire (ASQ … · An Introduction to the Ages and...

An Introduction to the Ages and Stages Questionnaire (ASQ-SE)

A parent-completed child monitoring system

PRESENTERS

Sonia Valenzuela

Family Involvement Manager, SF Inclusion Networks

Zulema Rubalcava Barron

ASQ Trainer and Coach, SF Inclusion Networks

• Define and discuss the benefits of screening social emotional development

• Describe features of ASQ:SE

• Score ASQ:SE

• Describe ASQ:SE cutoff scores

• Interpret ASQ:SE information in relation to other referral considerations

ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2010 Paul H. Brookes Publishing Co. All rights reserved. www.agesand stages.com

Training Objectives

• 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


What is ASQ:SE?

ASQ:SE• Social-emotional development

ASQ-3 (screens 5 domains)• Communication

• Gross motor

• Fine motor

• Problem solving

• Personal-social


Domains on ASQ:SE and Ages & Stages Questionnaires®(ASQ-3™)

• Screening assessment

• Diagnostic assessment

• Curriculum-based (programmatic, ongoing) assessment


Types of Assessment

Without

Screening Tools

With Screening

Tools

Developmental

Disabilities

30% identifiedPalfrey et al, 1994

70-80%

identifiedSquires et al, 1996

Mental Health

Problems

20% identifiedLavigne et al, 1993

80-90%

identifiedSturner, 1991

Courtesy of STARTASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2010 Paul H. Brookes Publishing Co. All rights reserved. www.agesand stages.com

Detection Rates of Children with Existing Delays

• Part C of IDEA calls for the social-emotional area to be assessed and services provided if necessary

• Programs such as Head Start mandate that this area be addressed in their performance standards

• Links to early social emotional behaviors and subsequent outcomes


Why Screen Social-Emotional Development?

• Links exist between earliest emotional development and later social behavior (Cicchetti & Cohen, 1995a, 1995b; Reynolds, Temple, Robertson, & Mann, 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 3rd grade, programs for children with antisocial behavior are mostly ineffective (Greenberg et al., 2003; Walker, 2004)


Why Screen Social-Emotional Development?

• Video from the Center on the Developing Child at Harvard University (developingchild.harvard.edu)

• Features center director Jack P. Shonkoff, M.D., Professor, Harvard Graduate School of Education, Harvard School of Public Health, and Harvard Medical School

http://www.youtube.com/watch?v=tLiP4b-TPCA


Video: The Science of Early ChildhoodDevelopment

Video: The Science of Early Childhood Development

• Lack of screening tools

• Lack of knowledge

•Complexity of issues

•Challenges accessing services


Barriers to Assessing Social-Emotional Development

Age Stage of

Development

Behaviors

0-12

months

Attachment -regulation

-recognizable states

-attachment

-communication

12-30

months

Autonomy & Self

Development

-differentiates between

self and others; real and

make believe

-use of pronouns

exploration

-self control; rules

30

months-

7 years

Establishing

Peer Relations

-empathy

-gender differences

-identification of friends

-interest in other children


Developmental-Organizational Framework (Cicchetti, 1993)

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 others

Interaction with

People

Ability/willingness to respond or initiate

social responses with caregivers, adults,peers.ASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2010 Paul H. Brookes Publishing Co. All rights reserved. www.agesand stages.com


The Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) Features

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

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

questions on each questionnaire

• 3–6 month administration window on either side of

interval age

• No need to adjust age for children born prematurely


Features of ASQ:SE

• Questionnaires are written at a 4th to 5th-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)?”


Features of ASQ:SE

• Competence and problem behaviors targeted

• Externalizing and internalizing behaviors 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


Features of ASQ:SE

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

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


Introducing ASQ:SE to Parents

Introducing 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 or is rarely performing behavior

• Discuss the “concerns” option


Video: Introducing the ASQ:SE to Parents

• Have parents complete the questionnaires as independently as possible

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


Administering ASQ:SE

TIME FOR A BREAK

ASQ:SE

Scoring Exercise

“Louis”


• Determine child’s Total score# of questions with X ___ x 10 = ____

# of questions with V ___ x 5 = ____

# Concerns ___ x 5 = ____

Total Points on each page = ____

• Transfer points on each page to ASQ:SE Information Summary


Scoring ASQ:SE

• Discuss 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 score and compare to cutoffs

Remember that cutoffs on ASQ:SE are very different from those on the ASQ!

• Discuss (consider) Referral Considerations—Family Study GuideASQ-3™ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth TwomblyCopyright © 2010 Paul H. Brookes Publishing Co. All rights reserved. www.agesand stages.com

Review Questionnaires with Parent

Time/Setting Factors

Developmental Factors

Health Factors

Culture/Family Factors


Referral Considerations

• The “sometimes” Issue

• The subjectivity Issue

• Validity of Report• Teen parents

• Parents involved with child protective services

• First time parents/isolated parents

• Parents actively involved with drugs and alcohol

• Parents with mental illness


Interpreting Scores

•Have another caregiver complete ASQ:SE

•Gather additional Information• Observe child

• Use a professionally administered screening tool

• Assess parent-child interactions

• Assess the caregiving environment


Questionable Scores?

Possible Follow-up

• Below Cutoff• Provide ASQ:SE Activities and Monitor

• Close to Cutoff• Follow up on Concerns

• Provide information, education, and support

• Re-administer ASQ:SE

• Make Referrals as appropriate


• 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


Possible Follow-up

Communicating with Families

ASQ:SE—Group Activity“comfort levels”

Cross-Cultural Considerations in Assessment and Intervention

•141 providers surveyed

•Home Visitors, Public Health, Mental Health, Social Workers, Early Interventionists

•Providers served very diverse populations

•Measured Utility (usefulness, ease and helpfulness)

•Majority indicated satisfaction with ASQ:SE

•Some challenges with translation and interpretation


ASQ:SE ResearchCan ASQ:SE be used with families from diverse cultural backgrounds?

(D. Lyman, W. Njoroge, D. Willis, 2007)

Cultural variations found most often in areas of

•Self Regulation

•Attachment

•Feeding/Toileting Training


ASQ:SE ResearchASQ:SE ResearchCan ASQ:SE be used with families from diverse cultural backgrounds?

(D. Lyman, W. Njoroge, D. Willis, 2007)

Practice Administering and Scoring the ASQ:SE

Form Pairs: • Try to partner with someone who is new to you!

• Find a place to sit with your partner.

Role Play: • Screener: Explain the screening process, administer the screening, score and

discuss the results with parent.

• Parent: Use the handout to answer the questions on the ASQ:SE. Check the scoring after your partner is done.

Directions

• Parents:• Things that worked well

• Things that you would change

• Screeners:

-Things that worked well

-Things that you would change

Group Debrief

• Screening 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


In Summary

• If you have any questions that we didn’t answer about the ASQ or ASQ:SE and how to use it, feel free to contact:

Zulema Rubalcava Barron

415-282-7494 ext. 131

[email protected]

Contact Info

mailto:[email protected]

THANK YOU (and please fill out your evaluations)

An Introduction to the Ages and Stages Questionnaire (ASQ … · An Introduction to the Ages and...

Documents

Transcript of An Introduction to the Ages and Stages Questionnaire (ASQ … · An Introduction to the Ages and...