International researchers find common ground and new solutions for developmental screening

Fifty researchers, practitioners, and affiliated ASQ® publishers from 19 countries recently gathered in Stockholm, Sweden, for ASQ Around the World: The 2nd Invitational Symposium of International ASQ Researchers. See the photo gallery.

ASQ co-developers Diane Bricker and Jane Squires, with Brookes Executive Vice President Melissa Behm
ASQ co-developers Diane Bricker and Jane Squires, with Brookes Executive Vice President Melissa Behm

The invitation-only event offered attendees the opportunity to exchange early childhood development research and share their experience in translating and adapting ASQ®-3 and ASQ®:SE for use in different country contexts. This was the second time Brookes Publishing brought together professionals to contribute to the ongoing evolution of the ASQ tools to improve the lives of children and families everywhere.

“These meetings are amazing for me to experience—to meet a roomful of smart, caring, dedicated researchers who all want to improve outcomes for young children and families and are using the ASQ tools in this endeavor,” says Jane Squires, Ph.D., an ASQ and ASQ:SE co-developer who served as one of the meeting moderators. “It is truly satisfying as a researcher and also as an ASQ developer to experience the impact of both the tools and of the talented researchers who are using them around the world.”

ASQ researchers from around the world met in Stockholm to share and learn. (Click on image to view the full photo gallery.)
ASQ researchers from around the world met in Stockholm to share and learn

Participants represented programs at different stages of ASQ implementation. Many are already using the tools, collecting normative data, and serving as advocates for screening programs in their countries, while others are just starting to translate or make culturally appropriate adaptations.

The forum allowed presenters to share their research and discuss issues specific to ASQ—successes, language and cultural barriers, translation, adaptation, and data gathering. Attendees also learned about the latest developments in screening and the features and research behind ASQ®:SE-2.

“Since the ASQ is used currently in a worldwide context, it is important for researchers worldwide to discuss issues that they deal with every day,” says Squires. “There are so many unique and creative solutions that researchers have tested, that we feel it is important for us to learn from each other, and have a support network for asking questions and sharing concerns as they arise.”

Gaining a global perspective

The group’s diverse blend of backgrounds and experiences generated productive discussions, particularly around identifying solutions for adaptation and translation of ASQ and addressing barriers to screening in different cultures.

Research on numerous translations of ASQ-3 and ASQ:SE-2, including Bulgarian, Chinese, Croatian, and Georgian, was featured in lectures and poster sessions. Individual presentations from the U.S., China, and Portugal highlighted system-wide implementation of developmental screening, including working with national-level government agencies. Some presenters shared data from studies that examined the need to adjust certain cutoff scores for some age groups in their countries.

“For many populations, patterns of developmental growth are the same no matter where you grow up, but there are also interesting differences that this international group is coming to understand better as they learn more about each other’s work,” says Melissa Behm, Executive Vice President of Brookes Publishing, who helped moderate the event.

The Chinese presentation, by Xiaoyan Bian, Ruoshui Wang, and Huichao Xie, was a good example of how screening needs can vary across cultures. Cutoffs have been changed in certain assessment areas to accommodate different rates of development. Research showed that in the first 24 months, Chinese children don’t develop motor skills as rapidly as their American counterparts, though they do better earlier with communication skills.

Researchers aren’t yet sure why such cross-cultural variances exist, but the presenters and attendees brainstormed some ideas. Perhaps the country’s one-child policy, plus the greater likelihood that grandparents live in the home, could mean that young children are communicating more with adults and therefore making faster gains in language skills. And maybe those same circumstances also result in a child being carried more and fed by an adult for longer, thus contributing to slower motor development.

Whether or not these theories turn out to have merit, they prompted thought-provoking discussion about adjusting norms for group differences. These conversations could encourage researchers to consider similar examinations in their own countries.

The Chinese presentation also addressed the challenges of monitoring development in large populations. China has 100 million children under age six, and .23 pediatricians for every 1,000 children (as compared to 1.68 pediatricians per 1,000 in the U.S.). With these resources, it’s efficient to use a screening tool that can be completed at home by parents, without a doctor’s assistance. ASQ-3 and ASQ:SE are working very well in this context.

Using ASQ with special populations

Attendees came to the meeting for inspiration and new ideas, and they weren’t disappointed. For example, two of the presentations featured studies that sought to validate the use of ASQ with special populations.

Marjolein Verhoeven from The Netherlands reported that ASQ proved to be an effective tool to monitor foster children and identify whether foster parents are willing and able to screen for developmental issues. With the country’s huge increase in the number of young children in the foster care system, her program wanted to ensure that children were being followed and delays identified in a timely manner.

Anita D’Aprano and Samantha Simpson shared their innovative adaptation of ASQ-3 for remote-dwelling Australian Aboriginal children. ASQ®-TRAK uses flip boards with pictures instead of written items so that the screener works well across different Aboriginal languages. Professionals work directly with parents to complete items. The researchers are now comparing its validity to another tool and expanding the current data set so it can be used with confidence across Australia.

Improving questionnaire items for everyone

“The U.S. is a country of immigrants with a diverse population, so knowing how other countries are trying to develop ASQ to be culturally relevant for their families is incredibly useful—and most importantly, it can help us establish standard items that work better for everyone,” explains Heather Shrestha, Director of Assessment & Content Solutions for Brookes Publishing and one of the moderators.

Some of the most valuable feedback from international users concerned questionnaire items that are not as effective in particular cultures. For example, in some cultural groups, asking a child to look in a mirror is contrary to custom. In some countries, homes with stairs and railings are uncommon, or playgrounds may not have slides. Some climates do not need jackets with zippers.

“With subsequent editions of the tool, the phrasing of items improves as we all learn from this international experience and seek ways to express the skill in a manner that can be demonstrated everywhere,” says Behm.

Discovering we have a lot in common

After two days filled with presentations, poster sessions, and networking, it was clear that regardless of job titles or where in the world they were from, attendees shared many of the same goals and challenges.  “Participants from the 19 countries represented at the symposium all want to successfully build a comprehensive system that promotes optimal healthy development, addresses disparities, and achieves equity,” says Behm.

She points to three shared goals that emerged from the discussion:

  • First, to educate professionals and parents on the importance of the role of parents in fostering their children’s development.
  • Second, to ensure that after children are screened and identified as at-risk that they are successfully referred into services in their communities.
  • And third, to build cross-disciplinary bridges so that all professionals working with young children are communicating clearly and sharing resources to monitor children’s progress.

“It was obvious that we were all viewing early child development and screening through a shared lens,” adds Shrestha. “Everyone was really dedicated to their work, and to understanding how children in their countries are developing, and to working on systems in their countries that will promote positive childhood outcomes.”

Participants also found comfort and connection in knowing that they are not alone in experiencing challenges.

“The kinds of challenges that people face have different contexts but are really similar, whether it’s determining how best to engage with families, deal with financial and geographic barriers, or navigate the needs of the population and government regulations,” explains Shrestha.

Sharing a very positive experience

Before the group departed for their respective countries, Brookes staff shared a number of resources available online now—including the Developmental Screening Toolkit and the ASQ Resource Library. Jane Squires and her ASQ co-developer Diane Bricker asked participants to offer feedback on what additional resources would be helpful.

Everyone agreed that joining the symposium made them feel like part of the ASQ family. Meeting the developers and Brookes staff face to face and hearing straight from the source about ASQ features and new tools really accelerates what they can learn. The small event size was key in allowing for plenty of valuable networking. Personal exchanges over posters, meals, and break time gave attendees a chance to learn just as much from each other as they did from the formal presentations.

“For this international group, knowing they have a network of people who are doing similar work helps them pragmatically, but it also energizes them to keep going,” says Shrestha. “It gives them ideas to help support their case to stakeholders, to get people back home on board.”

Continuing the journey …

The ASQ–Brookes Publishing International Research Committee plans to hold the next symposium in a year or two and to incorporate ideas for enhancement shared by this year’s group, including topic-specific workshops, more time for discussing practical issues, and opportunities to debate issues.

Meanwhile, organizers are establishing a network to enable the group to stay in touch. Initially, this involves the exchange of email addresses and a place to post online articles and information, but future plans include setting up a portal where the group can directly communicate.

Learn more! See details about this year’s ASQ Around the World and check out the photo gallery.

Originally published: August 2016

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  • Teacher and Student

    What ASQ Users are Saying

    We chose ASQ because it is easy to do, low cost, culturally sensitive, and it meets our purpose of basic screening for our children’s development. Our infant teachers base their curriculum on each individual child based on the ASQ.”

    Kathy Bostic, Program Supervisor, Pinehurst Child Care Center