A closer look at this important questionnaire section

The Overall questions can add real value to the screening process and can bring attention to potential areas of concern. So, what are they? Where are they? And why should you use them? Let’s get some answers.

Overall questions can help you build a more robust picture of children’s development and progress.

What are the Overall questions?

The Overall questions are a series of questions that give parents and caregivers the opportunity to share concerns that may have not been captured on the scored portion of the questionnaire.

There’s an Overall section on every ASQ®-3 and ASQ®:SE-2 questionnaire, though questions differ somewhat among intervals.

Overall questions are phrased as yes or no, but depending on the response, parents may be asked to provide an additional written explanation in the space provided. While Overall questions do not have numerical scoring, responses should be included in a child’s total ASQ-3 and/or ASQ:SE-2 results.


Where are the Overall questions located?

You’ll find a section of Overall items at the end of each questionnaire, right before the Information Summary sheet. See sample questionnaires for ASQ-3 and ASQ:SE-2.


What areas do these questions cover?

On ASQ-3, the Overall section focuses on health and developmental issues such as hearing, vision, behavior and general parent concerns that may require follow-up. Several Overall section questions also focus on the quality of a child’s skills, such as the quality of a child’s motor movements, or the quality of their communication.

For example, beginning at 16 months, the Overall questions, “Do you understand most of what your child says?” and “Do you think your child talks like other children their age?” are looking at the quality of a child’s expressive communication. These questions are intended to detect speech/language disorders or articulation delays that are not detected in the scored ASQ-3 Communication domain.

On ASQ:SE-2, the Overall questions cover general concerns related to eating and sleeping behaviors, such as, “Do you have concerns about your child’s eating or sleeping behaviors?” A question about concerns related to toilet training or toileting behaviors is included on the 30, 36, 48, and 60 month questionnaires.

On both tools, there is a question that asks parents whether there is anything that worries them about their child.


Why are the Overall questions important?

Research indicates that parent’s concerns are predictive of child outcomes. The Overall questions allow parents to express concerns about their child in a range of developmental, behavioral, and social-emotional areas. Discussing parent concerns as part of the screening process is a vital step to helping identify potential problems as early as possible.

Each Overall question was intentionally developed to flag indicators of potential developmental or behavioral concerns. It is not uncommon to see responses to Overall questions that indicate a need for follow-up that was not identified in the scored sections of ASQ-3 or ASQ:SE-2.

Programs can maximize the benefits of their screening programs by creating systems that use information gathered from both scored sections of these tools as well as Overall item responses to make decisions about next steps. You can increase the sensitivity of your screening program by including Overall responses in your interpretation of a child’s results.

Learn more! Using the ASQ-3 Overall questions. Use this chart to see the intent behind each of the questions asked in the Overall section and examples of referrals that could be made as a next step.


How do I interpret results of the Overall questions?

While they are not included in the score, you still need to review Overall responses and transfer them to the Information Summary sheet Answers that are “red flags” on either the ASQ-3 or ASQ:SE-2 questionnaires are shown as uppercase and boldface and should prompt a follow-up discussion.

Please keep in mind that these questions are not diagnostic—but should serve as a guide for discussion and for determining whether further assessment is needed.

Related article: Factors to consider when interpreting ASQ® results


Can I make referrals based on a parent’s answers to the Overall questions?

Yes! You should first have a discussion with parents about concerns they noted in this section, and then make any referrals you deem appropriate. You can actually make a referral solely on a parent’s response to an Overall question, even when scores are above the cutoff (ASQ-3) or below the cutoff (ASQ:SE-2).

Share your knowledge!

Send this Q&A to your program staff and encourage them to review Overall question responses and follow-up when indicated. To learn more about the Overall section, refer to your ASQ User’s Guides.


Originally published: September 2019

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    What ASQ Users are Saying

    ASQ-3 has helped make our staff and our families more aware of developmentally appropriate growth and development. The resources that come with the ASQ-3 have been instrumental for parents to provide school readiness activities at home and to understand the objectives that we cover in our plans.”

    Jessica Trail, Head of Faculty & Administration, The Young School