Putting your trust in parents

The case for having parents complete questionnaires—and what to do when they can’t

When it comes to screeners that identify young children who may be at risk for developmental and social-emotional delays, ASQ^® is consistently rated as a top tool by early education and intervention professionals. Many users appreciate its focus on parent report. We hear often that inviting parents to complete ASQ helps them engage families and start the conversation about their child’s development.

What many professionals find beneficial, others see as a source of concern. Of the concerns we do hear, many have to do with the fact that ASQ is designed to be completed by parents or other primary caregivers.

• The parent did not have opportunity to try some of the items with their child.
• The parent scored it lower (or higher) than I did when I assessed the child.
• The parent skipped over an item.

If any of these concerns feels familiar, let us put your mind at ease about why parent report is the ideal screening method.

Why parent report is effective

While involving families can be challenging at times, parents are almost always the best source of information about their children—and having a parent or primary caregiver fill out questionnaires has a host of other benefits.

Parent-report tools like ASQ^®-3 and ASQ^®:SE-2 are easy for parents to complete. They are flexible—can be completed independently at home, taken on home visits, completed in school settings, or filled out in waiting rooms. And they are cost-effective, demanding little training and fewer resources than tools that require professionals to complete questionnaires.

But mostly, parent report is ideal because of how effective it is at collecting accurate and comprehensive information.

Parents typically give highly accurate information about their children

Research has shown that parents are highly accurate when reporting about their child’s development and that parent concerns are highly predictive of actual problems. There are exceptions of course, particularly parents with substance abuse issues or severe mental health problems but, in general, parents are good reporters regardless of characteristics such as socioeconomic status.

The “whole child” can be addressed—not just the child observed in one setting

“Parents report accurately about their children because they have a contextual understanding of the home and culture that gives them deeper knowledge of their child,” explains Elizabeth Twombly, M.S., ASQ co-developer. “They may also have the opportunity to observe new or emerging skills that the child tries at home, but not in the school environment.”

Providers may find it difficult or impossible to answer certain items on the ASQ, including questions related to eating, sleeping and toileting behaviors, as well as overall questions related to family history, child’s health history, and parent concerns.

“Parents know their child better than anyone else, including what they have observed their child doing across settings and how best to facilitate target behaviors. Their child is most comfortable around them and will use more language,” says Jane Squires, Ph.D., co-developer of ASQ-3 and ASQ:SE-2.

Screening teaches parents about child development

Parents who are more involved in their children’s development are better equipped to understand what to expect at different age ranges, and how they can encourage progress and identify concerns. Children with involved parents are more likely to get the support they need and be prepared for school and future success.

“When parents are involved in the screening process, they have more opportunities to learn about their child’s development and—if the child needs to go on for further evaluation or services—feel empowered to share their knowledge and concerns with Early Intervention/Early Childhood Special Education services,” says Kimberly Murphy, ASQ co-developer.

ASQ questionnaires were designed with parents in mind

From the types of questions to how norms were established to determine cutoff scores, ASQ-3 and ASQ:SE-2 were intended to be completed by parents, either on their own, or with some support from teachers, health providers, or other providers.

According to the ASQ authors, research does show a high agreement between teachers and parents when assessing skills that are easily observed—over 90%. So in many cases the professional will arrive at the same result as the parent would have, if she completes the questionnaire independently. However, that 10% difference is important. When assessing skills that aren’t so easily observed, such as those related to a child’s home routine, there’s a greater chance for inaccuracy.

Getting parents and providers on the same page can help overcome any discrepancies between provider and parent observations and ensure that ASQ remains an effective screening tool.

“If a system is established in which providers are going to begin screening a child in the classroom, the system needs to include how parents will be included in the process,” stresses Squires. “If a parent is unable or unwilling to screen their child for some reason, at a minimum, providers should meet with parents to review answers.”

What to do when parent report just won’t work

There are some scenarios—such as a cognitive disability, limited reading skills, or active drug abuse—that can make it difficult or impossible for parents to complete the questionnaire on their own. In these cases, parents will need support in the process. Some parents may only need minimal assistance, such as clarification on a particular item or assistance reading some items. Others may need a great deal of support, for example a parent with a cognitive disability may need support reading items, trying them out with their child and interpreting their child’s responses. In addition, parents who speak a different language or dialect may require an interpreter or community health worker throughout the process.

The ASQ authors offer guidance for using the questionnaire during home visits that can be helpful across a variety of settings. You can find details for ASQ-3 on pages 112–114 of the ASQ-3 User’s Guide. Instructions for ASQ:SE-2 are on pages 140–142 of the ASQ:SE-2 User’s Guide.

According to the authors, “even if parents require assistance initially, over time (and given the opportunity) they may become more independent and confident about their ability to report on their child’s developmental status.”

In cases where parent report isn’t a viable option, providers who spend a lot of time with the child and know him or her well, such as a teacher, may decide to begin completing the questionnaire on behalf of the parent.

“The provider must still review results with the parents, completing the Overall Section together and checking in on items the provider did not see demonstrated in the classroom—since the parent may have observed their child doing this skill in the home. In addition, the provider needs to discuss next steps with the family since the parents take the lead in decision-making with the ASQ,” says Twombly. “It’s important not to take the process away from parents completely, even with parents that are difficult to engage.”

Giving parent report a chance to succeed

Many times, providers take questionnaire completion into their own hands because they are used to doing professionally completed assessments and having control over processes. This is especially true in early education settings. Other times, providers opt to do it themselves because it seems easier, or because previous parent-report experiences left them feeling frustrated.

When you don’t entrust parents with questionnaire completion, your program is missing out on all of the great benefits this screening method can bring. The best way to limit the frustrations that can arise from parent report is to engage with parents sooner.

“Providers play an important role in engaging parents in the screening process by explaining the purpose of screening, providing an introduction to the parents and highlighting the important points to remember, such as that parents should ‘try each item with their child,’” says Twombly.

Communicate with families well in advance of the screening. Tell them what it is, what happens next, and how your staff can support their needs. Ensure that parents have the materials they need to complete the questionnaire and try to anticipate whether a particular parent might have difficulty so you can accommodate any special needs. Follow up to discuss answers, scores, and next steps.

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The more parents know—and know what to expect—the more likely you’ll find them to be interested, engaged, and effective throughout the process.

Originally published: October 2016

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