Even seasoned ASQ users sometimes make these common mistakes.
Even seasoned ASQ users sometimes make these common mistakes.

Professionals like you depend on ASQ because it’s a simple and proven screening tool with reliable results that can help identify delays sooner. But sometimes even the most seasoned ASQ users could use a refresher.

Resolve to get the most out of your screening program. By avoiding these four common mistakes, you can be sure your ASQ scores are accurate every time.

Mistake #1: Choosing the wrong questionnaire.

If a parent is given the incorrect questionnaire for his or her child’s age, the score won’t reflect the child’s true developmental or social-emotional abilities.

How to avoid it?

Know the child’s exact age (and adjust for prematurity). The ASQ-3 has narrow age intervals, so you must calculate age to the month and day from the date the ASQ will be completed (i.e., 25 months, 12 days). If a baby was born three or more weeks prematurely and is younger than 24 months old, subtract the number of weeks premature from the child’s actual age.

Then select the correct questionnaire by knowing where to locate the age ranges and making sure the child’s age falls within the range.

ASQ-3 lists the age range in the upper left corner of the cover sheet and at the top of the Information Summary Sheet. You can also check the Age Administration Chart in the ASQ-3 Quick Start Guide.

ASQ:SE lists the age range in the center of the cover sheet. Each ASQ:SE questionnaire can be used within a 3-month window (for the 6–30 month intervals) or a 6-month window (for the 36–60 month intervals) of the child’s actual age.

Mistake #2: Incorrectly scoring questionnaires with omitted items.

Occasionally parents skip items on the questionnaire. This could be because the item is inappropriate to their culture or family values, or they are concerned about their child’s behavior, or perhaps they just don’t know how to answer. It’s important to make sure that children aren’t penalized for omitted items.

How to avoid it?

First, try contacting the parents to get answers to the missing questions. If that’s not possible, or if doing so would compromise the family’s culture or values, you’ll need to provide adjusted scores.

On the ASQ-3:

 

Mary’s fine motor area score is 20, but her parent only completed four of six items. 20 (area score) ÷ 4 (# completed items in area) = 5 (average score per item). Her average item score is 5, so you would assign each of the two missing items a score of 5, giving her an adjusted area total of 30. Helpful hint: Skip the math and refer to the ASQ-3 Quick Start Guide for a chart of adjusted area scores.

If more than two items in an area were skipped, do not score that particular area.

If one or two items in an area were skipped, provide an adjusted score. Do this by calculating the average score for the completed items in that area, then assigning the skipped item(s) that average score.

 

On the ASQ:SE:

 

John’s total score is 30, but his parent only completed 28 of 31 items. 30 (total score) ÷ 28 (# answered items) = 1.07 (average points). His average item score is 1.07, so you would assign each of the three missing items a score of 1.07, giving him an adjusted total score of 33.21. Using ASQ Online? The system automates these calculations.

If more than two items were skipped on the 6–18 month questionnaires, do not score the questionnaire.

If more than three items were skipped on the 24–60 month questionnaires, do not score the questionnaire.

In all other cases, you’ll need to provide an adjusted score. Do this by calculating the average score for the items that were answered, then assigning the skipped item(s) that average score.

Mistake #3: Not knowing the differences between ASQ-3 and ASQ:SE cut-offs.

Because the ASQ-3 and ASQ:SE assign scores and identify concerns differently, professionals who use both screening programs could potentially confuse the two when evaluating cut-offs or explaining the process and scores to parents.

How to avoid it?

The best way to avoid it is to be aware of the differences between the two, and to refer to your User’s Guides and Information Summary sheets before discussing any concerns with families.

On the ASQ-3, points are scored when a child has a skill, and a score is of concern if it is below the cut-off.

On the ASQ:SE, points are scored when a child has a concerning behavior or issue, and a score is of concern if it is above the cut-off.

Mistake #4: Not adding points for items of concern on ASQ:SE.

On the ASQ:SE, questionnaires have a column that parents can check if they are concerned about a particular item or behavior. It’s important that scores reflect these concerns, so if necessary they can be evaluated and discussed.

How to avoid it?

For every item checked as a concern, add 5 points (on top of the regular scoring) to the total score. For additional information, and an example, see chapter 4 in the ASQ:SE User’s Guide.

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Want to take your ASQ screening skills to the next level? Learn how the ASQ-3 & ASQ:SE Training of Trainers Institute can help you and your colleagues make the most of your screeners and improve your program.

(originally published: February 2014)

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    What ASQ Users are Saying

    “I like the ASQ:SE, which is an easy non-threatening tool to use to assess important social-emotional developmental milestones of the baby…. This tool lends itself well to developing educational activities to foster a healthy parenting relationship.”

    Cynthia Suire, MSN, RN, Nurse–Family Partnership Program Louisiana Office of Public Health