Transcript Ages & Stages Questionnaires: Social

Ages & Stages Questionnaires:
Social-Emotional
A New Tool for Identifying SocialEmotional Difficulties in Young
Children
Jane Squires
University of Oregon
Eugene, OR 97403-5253
[email protected]
website: eip.uoregon.edu
December, 2003
Objectives of Presentation
Define screening
 Present issues/considerations related to
assessing children’s social-emotional
behaviors
 Describe Ages and Stages
Questionnaires: Social-Emotional
(ASQ:SE)
 Discuss scoring/interpretation of scores
and referral issues

What is the ASQ system ?
 Parent/Caregiver completed screening tools


Series of questionnaires for children 3 months to
5 years
Identifies children in need of further assessment



Developmental concerns(ASQ)
social-emotional concerns (ASQ:SE)
Encourages parent involvement
ASQ System: 2 Components
ASQ

Communication

Gross Motor

Fine Motor

Problem solving

Personal-social
ASQ:SE

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Social-Emotional development
ASQ:SE initiated in 1995, published in 2002
Ages & Stages Questionnaires:
Social-Emotional
Created as a result of a “call from the field”
 Developed by a multidisciplinary team at the
University of Oregon’s Center on Human
Development
 Originally titled the Behavior-Ages and Stages
Questionnaires (B-ASQ)
 Research continues to be conducted on the
ASQ:SE

Uses of ASQ:SE
(Screening) To help guide decisions
about referrals for further assessment
 Monitor child’s social-emotional
development
 Determine information/support services
families may need
 Bridge communication between parents
and professionals about child’s behavior

Screening
 A brief
assessment procedure
designed to identify children
who should receive more
intensive diagnosis or
evaluation
.
• Early intervention (EI)
• Early childhood special education
(ECSE)
• Mental health/social service
• Health systems
Diagnostic 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 if the child
is eligible for early intervention or
mental health services.
Curriculum-Based Assessment
(Programmatic, On-going Assessment)

An in-depth assessment that helps to
determines 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 child progress over
time

Monitoring
 Developmental
surveillance
(screening at frequent intervals) of
at-risk infants and toddlers not
known to be eligible for special
health,educational or mental health
services

Similar in theory to a person with diabetes
monitoring blood sugar
Screening
Beyond (Above or
Below) Cutoff
Diagnostic
Assessment
Near Cutoff
Not Near Cutoff
Continue to Monitor
•Provide information, support
•Refer to other agencies
Eligible for
services
Not Eligible
for services
• Use Curriculum-Based Assessment to
develop learning plans
Barriers to Assessing SocialEmotional Development
Lack of screening tools
 Lack of knowledge
Variety of terminology
 Complexity of issues
 Lack of services

Types of Behavioral/Social Emotional
Assessment

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Parent (e.g, ASQ:SE) or professional
report of child’s behavior (e.g., PKBS)
Parent stress assessments (e.g, PSI)
Parent/child interaction scales (e.g., NCAST)
Combination tools (e.g., FEAS)
Structured environmental scales (e.g.,
HOME)
Examples of Child-focused
Screening Tools (Infant/Toddler)
 Infant
Toddler Symptom Checklist
 Temperament and Atypical
Behavior Scale (TABS)
 Ages and Stages Questionnaire:
Social Emotional (ASQ:SE)
Examples of child-focused
screening tools (Preschool)
 Conner’s
Rating Scale
 Carey Temperament Scale
 Social Skills Rating System
(SSRS)
 Early Screening Project (ESP)
 Preschool Kindergarten
Behavior Scales (PKBS)
The Ages and Stages Questionnaires:
Social Emotional
Features of ASQ:SE
 6,
12, 18, 24, 30, 36, 48 & 60
month intervals
 Competence and problem
behaviors targeted
 3-6 month administration window
on either side
 4th to 5th grade reading level
 From 19 items (6-month interval)
to 33 items (60-month interval)
Developmental-Organizational Framework
(Cicchetti, 1993)
Age
Stage of
Development
Behaviors
-regulation
-recognizable states
-attachment
-communication
0-12
months
Attachment
12-30
months
Autonomy & Self -differentiates between
self and others; real and
Development
make believe
-use of pronouns
exploration
-self control; rules
30
Establishing
months- Peer Relations
7 years
-empathy
-gender differences
-identification of friends
-interest in other children
Behavioral
Areas
Definition
Ability/willingness to calm, settle, or adjust to
physiological or environmental conditions
Ability/willingness to conform to the direction
Compliance
of others and follow rules
Communication Verbal/nonverbal signals that indicate
feelings, affect, internal states
Ability/success in coping with physiological
Adaptive
needs
Ability/willingness to establish independence
Autonomy
Self-Regulation
Affect
Ability/willingness to demonstrate feelings
and empathy for others
Interaction with Ability/willingness to respond or initiate
social responses with caregivers, adults,peers.
People
Features of ASQ:SE
Parent/Caregiver completed.
 Available in English and
Spanish
 Companion tool to the ASQ
questionnaires
 Each interval has a separate
summary sheet, with cutoff on
the page.

Features of ASQ:SE
 Scoring
Options
Points
Most of the time
Sometimes
Never or Hardly Ever
Is this a concern?
0 or 10
5
0 or 10
Yes= 5
Scores are totaled and compared with
empirically-derived cutoff points.
 High scores indicative of problems

Features of ASQ:SE
Open-ended questions
Questions related to eating, sleeping,
toileting.
 All intervals include question “Is there
anything that worries you about your baby
(child)? If so, please explain.”
 Tell me what you enjoy most about your
baby (child)?

Research Studies
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Validity
Reliability
Utility
Conducted
between 19952001
ASQ:SE Sample
3014 questionnaires
 National sample
 Ethnicity

59% White
 9% Black
 9% Hispanic
 6% Asia Pacific Islander
 2% Native American
 16% Mixed

ASQ:SE Means, Medians, and
Cutoffs
Age
6
12
18
24
30
36
48
60
N
Median
Means
Cutoff
331
339
307
441
289
408
447
299
16.7
25.0
26.0
28.4
35.2
35.0
36.0
35.0
22.5
27.7
34.6
35.4
48.6
49.9
55.7
49.1
45
48
50
50
57
59
70
70
Range, means, standard deviations and cutoffs

6
12
18
24
30
36
48
60
Range
0-115
0-145
0-255
0-220
0-300
0-220
0-280
0-275
Means
22.5
27.7
34.6
35.4
48.6
49.9
55.7
47.5
SD’s
22.5
21.7
33.5
30.0
45
45.9
55.2
49.1
Cutoff
45
48
50
50
57
59
70
70
30
ASQ:SE Total scores by number of children
showing a positively skewed distribution.
25
20
15
10
5
Total Scores on 48-Month ASQ:SE
20
0+
19
0
18
0
17
0
16
0
15
0
14
0
13
0
12
0
11
0
10
0
90
80
70
60
50
40
30
20
10
0
0
Number of Children
35
Concurrent Validity

Comparison of ASQ:SE
classification with standardized
tools
Achenbach Child Behavior Checklist
 Vineland Social Emotional Early
Childhood (SEEC)


Comparison of ASQ:SE
classification with social-emotional
diagnosis
DSM-IV
 DC:0-3

ASQ:SE Cutoffs Based on ROC (N = 1043)
N
6
71
12
85
18
99
24
152
30
115
36
179
48
174
60
171
Overall
Cutoff Sens
Spec
% Agree
45
48
50
50
57
59
70
70
78.0
98.2
97.2
96.6
93.0
89.5
93.0
94.6
95.8
91.8
94.0
93.0
93.9
89.5
87.8
89.9
92.0
94.0
78.6
71.4
75.0
70.8
80.0
77.8
76.9
84.6
94.5
ASQ:SE Reliability
 Test-retest
 Parent
at time 1
and 2
 N = 367
 94% agreement
Utility
Parent satisfaction survey (N=731)

How long did it take to complete
the questionnaire?
70% Less than 10 minutes
28% 10-20 minutes
2% More than 20 minutes

It was easy to understand the
questions?
97% Easy
 3% Sometimes
0% Not easy
Utility


The questions were appropriate for child’s
age
96% Yes
 3% Sometimes
1% No
The questionnaire was...... (check all that
apply)
 57% helped me think about my child’s
behavior
 56% was interesting
 27% was fun to do
 19% didn’t tell me much
 1%
was a waste of my time
 1%
took too long
Administering ASQ:SE
Format Selection
 Method(s)
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Setting(s)
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mail-out, home visit, interview
child care setting
pediatric waiting room
Intervals


all
selected
Administering ASQ:SE

Have parents complete as
independently as possible. Some
questions may require some
clarification:
(All intervals) Eating problems
 (18 months and older) Perseverative
behaviors

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Review answers to questions
Scoring the ASQ:SE
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 =
____
Review questionnaires with parent
Discuss items that individually score 10
or 15 points.
 Discuss answers to open-ended
questions
 Discuss referral considerations
 Review score and compare to cutoffs


Remember that cutoffs on ASQ:SE are
very different from ASQ!
Referral Considerations
 Time/Setting
Factors
 Developmental Factors
 Health Factors
 Culture/Family Factors
Interpreting Scores
The “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

Possible Follow-up
Below Cutoff
 Provide ASQ:SE activities &
monitor.
Close to Cutoff
 Follow up on concerns
 Provide information, education and
support. Re-administer ASQ:SE.
 Make referrals as appropriate.
Possible Follow-up
Above Cutoffs
 Refer to EI/ECSE
 Refer to local community agencies
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Feeding clinic
Church groups
Community groups (e.g., YMCA, Birth to Three)
Parenting groups
Early Head Start
 Refer
to primary health care provider
 Refer for mental health evaluation
Culture-Specific Awareness &
Understanding
Consider diversity within cultural groups
as well as between cultural groups
 Gather culture-specific Information
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Study, read, use cultural guides,
participate in daily life, learn the language,
learn parenting & caregiving practices
Culture specific issues and intervention

Make no assumptions about concerns,
priorities & resources!
Cross-Cultural Communication
Adapt to style that is comfortable for the
family
 Consider nonverbal behavior

eye contact
 facial expressions
 proximity and touching
 body language, gestures

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Sensitive use of translators, interpreters
ASQ:SE User’s Guide

Excellent resource

Covers all topics in depth
To order ASQ:SE
ASQ User’s Guide and
Questionnaires: $125 for set
 Paul Brookes Publishing
Company
www.brookespublishing .com

Great website
 Case studies, examples of
questionnaires available
 Technical Report on-line
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1-800-638-3775
In Summary
Early Identification is critical for improving
developmental outcomes.
 ASQ:SE can assist in making referrals to
community agencies.
 Social emotional issues are very
complicated.
 Interdisciplinary, community-based teams
can assist in decision-making.
 No one should feel as though they should
have all the answers.

For more information please contact:
University of Oregon
Early Intervention Program/ASQ:SE Project
5253 University of Oregon
Eugene, OR 97403-5253
541-346-0807
Project Staff: Jane Squires,Liz Twombly, Sue Yockelson, Jantina
Clifford